At a time when measles is making a dramatic comeback, a new study finds that more than 70% of children's doctors have agreed to parents' requests to delay vaccinations, even though most believe it puts children at risk, a new study shows.
The study highlights the enormous pressures faced by pediatricians, who have only about 18 minutes per clinic visit in which to persuade parents to vaccinate their children, perform physical exams and discuss critical things such as sleep and nutrition. Doctors say they spend about half their time with patients discussing vaccines, according to a study out today in Pediatrics. One in five doctors say more than 10% of parents asked to delay vaccinations.
More parents are skipping selected vaccines or delaying others, sometimes out of concern that immunizations cause autism, an idea that has been debunked in dozens of studies. Some parents worry that children get too many vaccines too soon, leading them to ask their doctors to space out shots rather than administer several at once.
Doctors often agree to delay vaccinations to maintain trust with parents or to avoid parents leaving the practice, according to the study, led by researchers at Children's Hospital Colorado in Aurora.
About 9% of pediatricians and 2% of family physicians say they always or sometimes dismiss families from their practice if parents want to skip or delay vaccinations, the study says. The American Academy of Pediatrics says doctors shouldn't "fire" families who refuse vaccines, because it's important to continue trying to persuade them.
Over time, families who are skeptical of vaccines may come to see that their pediatrician has their child's best interest at heart, says Saul Hymes, assistant professor and attending physician at Stony Brook University Hospital on New York's Long Island, who was not involved in the new study.
Hymes says he knows of families who get their children's medical care through urgent care centers because they can't find a pediatrician to accommodate their vaccine requests. That's bad for kids, who need a regular "medical home" and familiar pediatricians to monitor their growth and development.
Pediatrician Scott Krugman says he tries several strategies to persuade parents to have their children vaccinated. He begins the conversation assuming they will and offers to continue the discussion later if parents resist.
Krugman, chairman of pediatrics and director of medical education at MedStar Franklin Square Medical Center in Baltimore, says he asks hesitant parents to agree to vaccinations for at least two of the most dangerous infections: whooping cough and Haemophilus Influenzae Type b, or Hib, which can cause life-threatening complications.
Krugman also warns parents that an unvaccinated child who gets a fever may need blood tests or even a spinal tap to rule out meningitis, a life-threatening inflammation of the lining of the brain and spinal cord.
"If they totally refuse, I continue to ask at each visit to try to get them to change their mind," says Krugman, who was not involved in the new study. "Many times, it is a plain old fear of the unknown, which is hard to argue against. If it is a specific fear, it is easier to educate."
Studies have found no benefit to delaying vaccinations, and there are clear risks, including the danger of leaving kids vulnerable to disease for a longer time, says Paul Offit, director of infectious diseases at Children's Hospital of Philadelphia, who was not involved in the new study.
Pediatricians have tried different strategies to persuade hesitant parents to have their babies vaccinated on time, Offit says, but they rarely work.
He says he is concerned that support for vaccines wasn't higher among children's doctors.
"If 87% of physicians thought it was a bad idea to delay or withhold vaccines, that means that 13% didn't," Offit says. "That means one in seven pediatricians don't think it's a bad idea to delay vaccines."
Surveys show that support for vaccines is usually strongest among older people, who remember seeing children crippled by polio or killed by measles. Younger parents and physicians often don't share those fears, Offit says.
Surveys show that vaccination rates have risen since an outbreak of measles linked to Disneyland. According to the Centers for Disease Control and Prevention, 154 people have been diagnosed with measles this year, including 118 linked to Disneyland. Most of those patients were unvaccinated.
Measles can cause severe complications. One or two children die for every 1,000 people infected, according to the CDC.
Offit says fear of an outbreak may be the only thing that resonates with vaccine-hesitant parents.
"People are compelled by fear more than anything," Offit says.
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