When parents say "No" to immunizing their child

As a healthcare practitioner, you know that immunization is the most important measure you can take to safeguard the health of the children in your care. You know that children should receive all the immunizations in the Recommended Childhood Immunization Schedule, and you do your best to make sure that all the children in your practice do so.

Surveys have shown that most parents agree that immunization is important for their child's health. And so most of the families in your practice are willing to put up with the frequent visits and the tears and fussiness that are part of the process.

But you have probably encountered a few families that are hostile to immunization; in a climate of opinion their numbers are likely to increase. Motivations are varied. Some parents object to the so-called pincushion syndrome-the ever-growing number of shots to which their child is subjected. They find it hard to accept the necessity for four or five injections at a single visit and would rather believe that at least some of those shots could be dispensed with.

Some families that reject immunization are simply afraid. They have heard heartbreaking stories of children with autism who were healthy, happy babies until they got their first MMR immunization, and then unexplainedly began to deteriorate. They've read articles or seen TV exposés that blame one or another vaccine for sudden infant death syndrome, asthma, diabetes, attention deficit hyperactivity disorder, and a host of other childhood tragedies-even though reputable research has ruled out links between immunizations and these conditions. Like all parents, they want to protect their child from harm, and the stories they've heard make them think children will be safer if they refuse to have them immunized.

You may also have families in your practice that shun immunization because, in their ethnic group, there is no concept of preventive medicine for healthy children. Their cultural background may prompt them to turn to healers when children are ill and relies on the folk wisdom of grandmothers to keep children safe. Or they may have a Christian Science or Amish or Mennonite religious background that regards immunization as a sign of unbelief.

What can you do? One scenario for dealing with families like these, of course, is to refuse to treat their child at all. You can tell them that if they are unable to accept your recommendations on immunization, they are unlikely to accept other recommendations-and so they should find themselves another physician. That's not a response most pediatricians prefer, however. They would rather find effective means for turning the situation around, so that parents feel comfortable and children receive the immunizations they need.

In almost every case, it can be done. Here's how: