Guide: Helping Parents Who Question Vaccines
Respect • Communicate • Educate
a glance: Most parents believe in the benefits of
immunization for their children. However, health care providers
may encounter parents who question the need for or safety
of childhood vaccines. Such parents may choose to delay or
forgo immunizing their children with some or all of the recommended
vaccines. To assist parents in making fully informed immunization
decisions, providers should try to understand differing views
of vaccine risks and benefits, and be prepared to respond
effectively to concerns and questions.
About Unimmunized Children in My Practice
of the concerns that providers have about caring for unimmunized
children can be addressed.
“I don’t want to be held responsible if the
child contracts a vaccine-preventable disease”
to a provider in case of an occurrence of
a vaccine-preventable disease in an unimmunized
patient can be addressed by documenting in
writing all immunization discussions and
parent refusals in the patient’s record.
The American Academy of Pediatrics offers
to vaccinate form (exit
“If a parent doesn’t trust my judgment about
vaccines, they won’t heed my advice regarding other issues”
parent’s reluctance to heed immunization advice does not
necessarily mean that the parent will dismiss other medical advice.
“I don’t want to put my other patients at risk”
offices and clinics can manage the risks of transmission of vaccine-preventable
diseases in their facilities by adopting the same methods used
to control other communicable diseases.
Excluding patients from your practice whose parents decline
immunizations is not deemed the best public health strategy. Remember,
unimmunized young children did not decide for themselves to forgo
vaccination. If you don’t care for them, who will?
empathetic communication is critical in responding to parents who
are considering not vaccinating their children. Parents should be
helped to feel comfortable voicing any concerns or questions they
have about vaccination, and providers should be prepared to listen
and respond effectively.
Evaluate whether the child has a valid contraindication to a vaccine
by asking about medical history, allergies, and previous experiences.
the parent’s reasons for wanting to delay or forgo vaccination
in a non-confrontational manner. (Have they had a bad experience?
Obtained troubling information? Do they have religious or philosophical
parents have safety concerns or misconceptions about vaccination
ask them to identify the source(s) of those concerns or beliefs.
carefully, paraphrase to the parent what they have told you, and
ask them if you have correctly interpreted what they have said.
& address concerns
Educate about responsibilities
factual information in understandable language that addresses
the specific concerns or misconceptions the parent has about vaccination.
Vaccine Information Statements (VIS) for discussing vaccine benefits
and risks. Before administering each dose of certain vaccines,
providers are required by law to give a copy of the current VIS
to the child’s parent/legal guardian. Providers must also
record in the child’s chart the date that the VIS was given
and the publication date of the VIS. The updated versions of VISs
can be found at www.cdc.gov/nip/publications/VIS/.
VISs in a variety of languages can be obtained at www.immunize.org/vis/
parents about the dangers of vaccine-preventable diseases and
the risks of not vaccinating as they relate to the child, family,
your personal support for vaccinations and share experiences you
have had with children with vaccine-preventable diseases.
educational materials to be taken home and refer the parent to
other credible sources of information such as CDC’s National
Immunization Information Hotline or website.
Explore acceptable options
parents who defer vaccination of their responsibilities to protect
other family and community members, including people who may be
immunocompromised (i.e., keeping sick children at home and
other ways to limit the spread of infection).
Parents also should be advised of state school or child-care entry
laws, which might require that unimmunized children stay home
from school during outbreaks of vaccine-preventable diseases.
Keep communication open
whether the parent is willing to allow his/her child to receive
certain vaccines, to be immunized on an alternative schedule,
or delay vaccination and “catch-up” if the parent
changes his/her mind.
Keep the lines of communication open with parents who choose to
defer or who refuse vaccination by expressing your desire to talk
more about vaccines during future visits.
assess the parent’s willingness to vaccinate their child,
including at every well child visit. And document any refusal
to vaccinate in the medical record.
Care and School Requirements
Be prepared to address parents' questions about state school or
child care entry laws
American Academy of Pediatrics (AAP), the American Academy of
Family Physicians (AAFP), and the Advisory Committee on Immunization
Practices (ACIP) establish and annually update the schedule of
recommended childhood immunizations. However, states and territories
are responsible for determining which vaccines are required by
law and for enforcing their immunization requirements.
all 50 states offer medical exemptions, most offer religious exemptions,
and some allow philosophical exemptions.
familiar with state laws regarding documentation of immunization
exemption/refusal. For clarification of the
laws in your state, contact your state
health department or immunization program. You can review
your state’s immunization information through the National
Network for Immunization Information (NNii) website (exit
We invite both health care professionals and
consumers to call our CDC Information Contact
Center for further immunization information.
and to visit our immunization website - www.cdc.gov/nip