Doctors in a Bind When Parents Want to Delay, Skip
MONDAY, Nov. 28 (HealthDay News) -- Mistrust of childhood
vaccines is causing some parents to request "alternative" schedules
from doctors, either delaying or skipping some shots.
And a new study suggests that most pediatricians are willing to
go along with these requests -- up to a point.
"Parents seem to be regularly requesting alternative childhood immunization schedules," noted co-author Dr. Douglas John Opel, an acting assistant professor in the University of Washington's department of pediatrics. However, he added, "there needs to be more research into the effectiveness and safety of these schedules."
The report is published in the Nov. 28 online edition of
The issue of parents ignoring standard guidelines on childhood
vaccination schedules is worrying to many experts. One study,
published in the November issue of
Pediatrics, found that more than one in 10 parents in the United States do not follow recommended vaccination guidelines for their children, opting instead for an "alternative" schedule that could involve skipping doses or delaying shots.
In that study, 13 percent of parents surveyed reporting using an
alternative schedule. Of these, more than half (53 percent) refused
certain vaccines and/or delayed some vaccines until a child was
older (55 percent). And 2 percent of parents refused all
Some of the distrust of childhood vaccines stems from rumors
that immunization might give rise to certain medical conditions.
For example, one study published in
The Lancet in 1998 suggested that the measles-mumps-rubella
(MMR) shot might help trigger autism. That work was later
discovered to be fraudulent, however, and the journal has since
retracted the study.
The new research sought to determine physicians' attitudes to
parents' requests for alternative vaccination schedules. To do so,
Opel's team examined online survey data for 209 Washington state
pediatricians. They found that 77 percent of the doctors had
encountered parents who had asked them to alter a child's vaccine
schedule in some way.
Close to two-thirds of the pediatricians (61 percent) said they
were usually comfortable with providing an alternate schedule, if
asked. But only 4 percent said they would offer any change to the
schedule without prompting from a parent first.
However, there were three shots that doctors were most loathe to
skip or delay. These included the
haemophilus influenzae type b vaccine (Hib), which protects
against a bacteria that can cause pneumonia; the pneumococcal
conjugate vaccine (PCV), which also shields against pneumonia and
meningitis; and the diphtheria, tetanus and acellular pertussis
(DTaP) combo vaccine, which protects against three potentially
"These vaccines protect the child from diseases that are still common, like pertussis [whooping cough], and have severe consequences if a child catches it, like meningitis," Opel said.
The findings suggest that pediatricians are trying to strike a
delicate balance in caring for children while listening to parents'
concerns, he added.
"They are trying to respect a parent's decision-making authority and maintain a therapeutic alliance with them by not being rigid when parents request an alternative schedule," Opel explained. "Yet at the same time, they are also trying to honor their obligation to protect the child's health by standing more firmly on those vaccines that prevent diseases that a child is most likely to catch or suffer severe consequences from if they do catch it."
Dr. Michael Brady, chairman of the American Academy of
Pediatrics' committee on infectious disease, said the study
provides insight into how pediatricians are responding to
Agreeing with these requests may not always be wise, he added.
"The pediatricians who agree to utilize alternative schedules are
missing a tremendous opportunity to inform parents about the value
and safety of vaccines and the current vaccine schedule," he
He also believes that parents' fears about the so-called
"over-vaccination" of kids are misplaced.
"Children who are receiving multiple vaccines at one visit in 2011 are actually being exposed to fewer vaccine antigens than they were in the 1980s," he
noted. "Our immune systems can handle multiple vaccines at the same
visit very well."
There have also been very rigorous safety studies done before
and after approval of childhood vaccines, to verify their safety
when given alone or in combination, said Brady, who also chairs the
pediatrics department at Nationwide Children's Hospital in
"However, there is no such data for the alternative schedules [that parents might request]," he said. "Parents who ask for the alternative schedules because they believe that they are safer are asking for schedules that haven't been evaluated. They may place their child at risk for a serious disease if they postpone these vaccines beyond the period of greatest risk."
Also,such schedules increase the likelihood that some doses will
be skipped, because the more visits needed to receive all of the
necessary vaccines, the greater the risk that some visits and some
vaccines will be missed, Brady added.
For more information on kids' vaccinations, visit the
U.S. Centers for Disease Control and
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