Discussing vaccine hesitancy with parents

Discussing vaccine hesitancy with parents
Discussing vaccine hesitancy with parents

Parents who bring their child into primary care offices for vaccines today are more likely than ever to have questions or concerns about the safety of immunizations, according to the American Academy of Pediatrics.

Having a child vaccinated can be unpleasant for many parents, especially if they are the ones holding their crying child down for the injection. At the same time, fears about vaccine safety are proliferating due to unfounded but prominent claims in the mainstream media and on anti-vaccine websites.

Unlike the past, many of today's parents have never seen the diseases that vaccines prevent, according to Kristine Sheedy, PhD, associate director of communication science at the CDC's National Center for Immunization and Respiratory Diseases in Atlanta.

"Most parents have never met a child that has had Haemophilus influenza type B, pertussis or measles," Sheedy said, adding that many worry more about potential risks than the disease the vaccine protects against.

Although the vast majority of parents — even those with concerns about vaccines — continue to get their children immunized, clinicians should be prepared to have effective conversations with parents looking for reassurance.

Reasons for reluctance

Understanding the reasons behind parents' reluctance is the first step in overcoming vaccine hesitancy. To answer this question, the CDC has conducted various parent surveys and focus groups, and found the following factors are the top causes for concern:

  • Multiple shots administered in one visit
  • Numerous shots administered during the first few years of life
  • Belief that vaccines will cause fever
  • Belief that vaccines might cause autism
  • Pain from the injection
  • Child is ill at the time of the visit

It is important that clinicians take the time to listen to these concerns. Parents stated that reassurance from their health care provider was the biggest reason that they followed-through with immunizations, despite fears.

But not all parents will be satisfied with the same clinician explanations — some might just need quick reassurance, whereas others may ask for more detailed scientific information. Be sure to tailor your response to the individual, Sheedy said.

Michele Roberts, MPH, of the Immunization Registry Program at Washington State Department of Health Promotion, emphasized that speaking with parents in terms that are too scientific can initially be overwhelming. 

“What many parents are really looking for is emotional reassurance,” Roberts said. “They need you to acknowledge their concerns and to be empathetic, not recite a litany of facts.”

This does not mean that clinicians should avoid factual information, but rather, that the information presented is easy to understand. Personal stories can also be helpful, Sheedy advised. "If clinicians can share that they have vaccinated their own children or grandchildren, that can really be helpful.”

Alternately, clinicians can also share cases of children who had negative health outcomes or even died from illnesses that vaccines prevent, Roberts said.

Fever & illness

Parents often worry that fevers are a sign that something is wrong, but fevers are not necessarily cause for concern when it comes to vaccination.  “Post-vaccination fevers can actually be a signal that the child has had a good immune response to the vaccine,” Sheedy explained.

Also remember that there is no reason to delay immunizations if a child is sick with a cold or an ear infection. Clinicians should review the CDC's recommendations related to illnesses and vaccination to make sure opportunities to properly vaccinate children are not missed.

It's important that clinicians end any conversation with a strong recommendation in favor of vaccination. “Physicians sometimes will have the discussion, but never make that strong statement saying that they want the child to get the vaccine, which is often critical to compliance,” Roberts said.

Offering parents tips for how to comfort children after vaccination is also a great way to empower them and make them feel like they are a part of the process, Sheedy added.

Delaying vaccines

Some parents may ultimately decide to vaccinate their children, but only if the vaccines are spaced out. If a practitioner believes that there is no other way to preserve the relationship without making this concession, the flexibility may be warranted.

"Obviously we feel that the recommended vaccine schedule is incredibly important, the reason being that we want to get children protected from these diseases as early as possible," Sheedy emphasized. But agreeing to a modified schedule leaves the door open for the child to be completely vaccinated, even if the process is delayed, she said.

Parents who won't vaccinate

Despite a practitioner's best efforts, there may be parents that continue to refuse vaccination. In these cases, the AAP recommends that the physician have parents sign a declination form, document the decision in the medical record and educate the parent about associated risks.

"What's concerning for us is that parents who decline vaccines for their children tend to cluster geographically," Sheedy said. “This makes it more likely that an outbreak will occur in that area. There have been a number of measles outbreaks this year in Europe due to under vaccination.”

Parents who decline should know that they are not only making that decision for their child; they are making a decision for the whole community. Unvaccinated children put other more vulnerable populations, such as infants who are too young to be vaccinated and individuals whose immune systems are compromised, at risk for infection. The AAP recommends that health care providers contact parents that opt out of vaccinating their child periodically to see if they have changed their minds.

Although it is essential to talk about the importance of vaccinations, practitioners should not gloss over the risks. "Vaccinations are not 100% safe or effective, and clinicians still need to be very frank with parents about potential vaccine adverse events," Sheedy said.

Health care providers should make detailed vaccine information available in the office. They can also refer concerned patients to outside resources. The CDC has created a number of tools to help practitioners have meaningful conversations with parents about vaccines, which are available online. But remember that pamphlets and brochures are no substitute for discussion.

Clinicians play a big role in parents' vaccination decisions. Taking the time to understand this issue and to properly address parental concerns is key to encouraging compliance.

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