Most doctors agree to alter kids' vaccine schedules

Pediatricians are facing increasing pressure from parents to delay vaccinating their children — and most of them are complying despite concerns that they are putting the children at risk for contracting preventable illnesses such as measles and whooping cough, according to a study published Monday in the journal Pediatrics.

In a national survey of 534 pediatricians and family doctors sent out via email and mail in 2012, 93 percent of the doctors reported that the parents of children under age 2 asked them to spread out or delay the child’s vaccination schedule. And 21 percent of the doctors reported that at least 10 percent of the parents asked to delay the vaccine schedule, according to the survey conducted by Children’s Hospital Colorado, the University of Colorado and the Centers for Disease Control and Prevention (CDC).

Most doctors said they agreed to do so, even though 87 percent of them thought that delaying the vaccine schedule was putting the children in danger of catching a vaccine-preventable illness. They complied either "often" or "always" 37 percent of the time and "sometimes" 37 percent of the time, while 26 percent of the doctors said they did so "rarely."

Pediatricians most often complied in order to build trust with the families, and with the hope that they would eventually fully inoculate their children, the study found. The doctors also worried that the family would leave the practice if they didn’t comply with the requests.

“The general sense from the physician standpoint is, they [the parents] will get the vaccine eventually if I agree to do this,” said Dr. Sean O’Leary, a professor of pediatrics at the University of Colorado School of Medicine and co-author of the study. “If I don’t agree to do this, they may leave my practice. To be clear, for all the physicians who answered the survey, this was against their wishes, but this was something the parents were insisting on.”

Parents who refuse to vaccinate their children altogether have received heightened attention in recent months due to the measles outbreak in California that has infected more than 150 people and spread to eight states as well as Canada and Mexico. But parents who want to delay the CDC-recommended vaccination schedule are common, O’Leary said. Some parents may want to cut down on the pain their children experience with getting multiple injections, or they worry about short-terms side effects such as fever or pain, according to the study.

One national survey taken in 2011 found that 13 percent of parents of young children used some kind of alternative vaccinating schedule, whether that meant delaying or skipping some vaccines.

That has meant much more time in the exam room discussing vaccines at the expense of other aspects of a child’s health. About half the family doctors and 60 percent of the pediatricians in the survey reported spending at least 10 minutes discussing the vaccination schedule with parents who had concerns.

With an average well-child visit lasting about 18 minutes, that meant that physicians spent more than half of their exams talking about inoculation, crowding out time that could have been spent talking about other important issues like sleeping or feeding, the authors wrote.

“The problem is, the science is behind getting the child vaccinated according to the recommended schedule,” O’Leary said. “And yet they are having to spend so much time convincing parents of that that it can, I think for some physicians, really lead to some real frustration.”

Dr. Saad Omer, a professor of global health at Emory University who has conducted research on vaccine refusals, said that he does not condone physicians complying with parents’ wishes to delay vaccines. But he doesn’t blame them.

“That may end up doing a little more harm to the child, because what happens is these types of parents tend to cluster with more sympathetic providers," he said. "In that sense, you have lost the chance of continuing that conversation. So it’s not an easy decision."

The problem, Omer said, is that there isn’t solid research about how to best communicate with parents about vaccinating their children. “We need to develop a solid, scientific-evidence based strategy on this,” he said.

Most of the methods the surveyed doctors use to convince parents not to delay vaccinations — such as discussing the importance of staying on schedule or offering to comfort a frightened child — were unsuccessful.

This led the authors to suggest that physicians discuss the importance of vaccinations while a mother is pregnant, and that more research is done on how best to talk with parents about inoculation.

“Right now, we don’t really have any clear answers, and there definitely needs to be more,” O’Leary said.