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Provider's Guide: Helping Parents Who Question Vaccines
Respect - Educate - Communicate

Concerns About Unimmunized Children in My Practice

Many 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"
Liability 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 a refusal to vaccinate form [PDF-95KB] .

"If a parent doesn’t trust my judgment about vaccines, they won’t heed my advice regarding other issues"
A 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"
Doctors' 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?

Effective Communication

Effective, 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.

Ask questions

• Evaluate whether the child has a valid contraindication to a vaccine by asking about medical history, allergies, and previous experiences.
• Assess 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 reservations?)
• If parents have safety concerns or misconceptions about vaccination ask them to identify the source(s) of those concerns or beliefs.
• Listen carefully, paraphrase to the parent what they have told you, and ask them if you have correctly interpreted what they have said.

Respect & address concerns

• Provide factual information in understandable language that addresses the specific concerns or misconceptions the parent has about vaccination.
• Use 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/vaccines/pubs/VIS/
  VISs in a variety of languages can be obtained at www.immunize.org/vis/.
• Educate parents about the dangers of vaccine-preventable diseases and the risks of not vaccinating as they relate to the child, family, and community.
• Express your personal support for vaccinations and share experiences you have had with children with vaccine-preventable diseases.
• Provide 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.

Educate about responsibilities

• Inform 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.

Explore acceptable options

• Explore 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 communication open

• 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.
• Periodically 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.

Child Care and School Requirements

Be prepared to address parents' questions about state school or child care entry laws

• The 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.
• Currently all 50 states offer medical exemptions, most offer religious exemptions, and some allow philosophical exemptions.
• Become 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 .

For more information

We invite both health care professionals and consumers to call our CDC Information Contact Center for further immunization information.

• English and Español: 1-800-CDC-INFO (1-800-232-4636)
• TTY: 1-888-232-6348

and to visit our immunization website - www.cdc.gov/vaccines

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