The health benefits of immunizations are immense. Smallpox has been eliminated and polio is no longer seen in the United States. Common diseases including tetanus, measles and diphtheria have become rare. The most common cause of meningitis in children is also now rare. Millions of children no longer die each year due to illnesses prevented by immunizations. The most written about downside, autism, has been disproven as a side effect of the MMR vaccine.
One of the problems with immunization success, however, is the lack of visible illness due to these diseases. Parents no longer see the severe health sequellae including life changing illness, mortality or even acute hospitalization due to these diseases. The remarkable success of our immunization program has made it difficult for many parents to see the actual benefits of immunizations. This has led to an increasing number of parents not immunizing or delaying immunizing their children. Measles-mumps-rubella vaccine is the most frequently refused and is followed closely by varicella vaccine, pneumococcal conjugate vaccine, hepatitis B vaccine, diphtheria and tetanus toxoid and pertussis vaccine.
The American Academy of Pediatrics strongly endorses universal immunization. We support immunizing all children and endorse the American Academy of Pediatrics Schedule.
There are many reasons given by parents to not follow the recommended immunization schedule. Some parents disagree due to philosophical or religious concerns and others are concerned about the risks of immunization. When the risks raised by parents are analyzed the claims are found to be unsupported or lower than the risk of sequellae due to contracting the disease the vaccine protects the child from.
As a parent what should you do? Most parents decide to immunize their child. Yet, an increasing number of parents are choosing not to immunize their child. If you decide not to immunize then you are relying on a highly immunized population providing your child with a relatively low risk of contracting the disease. If the frequency of the disease is high, however, then the safety margin for your child is lessened and your child by contracting the illness will place other unimmunized children at risk. In this situation you are making decisions that no longer only effect your child. This community or herd immunity is important for every parent who chooses not to immunize to understand. Your decision can and does place others in your community at risk. Those at highest risk will be young children, the elderly and anyone who is immunocompromised including those being treated for cancer.
We believe our job is to answer all of your questions regarding immunization benefits and risks. We will listen to your concerns and not minimize them. We realize many parents do not use the same decision making criteria that we use and everyone weights risks differently. We explain that vaccines are not 100% risk free or effective, and we will ask you what your concerns are. We will work with you to answer your individual concerns. Our goal is to use our relationship with you as your child’s pediatrician to foster and allow a dialog to discuss the vaccines. We will ask you if you are interested in discussing your decision. If your answer is no then we will document your decision. We will continue, however, to ask you at follow-up health maintenance visits if you have changed your mind about immunizing your child. Our hope is that communication and our relationship will build over time, and you will reconsider a prior decision not to immunize your child.
Some parents ask about delayed or alternative schedules. Many of these schedules have been written about in various publications and on the web. If you ask for an alternative immunization schedule we will work with you to provide the immunizations you choose at the time you choose. We cannot, however, decide for you which immunization to give and when to administer it since all the immunizations are important, and we will not endorse alternative schedules. We will, however, help you decide which illnesses place your child at greatest risk and make sure the immunizations that are given are administered in a way that allows your child to receive the benefits of the vaccine. All vaccines have specific interval schedules between vaccine administration and this can cause altered schedules to be very
The final decision whether and when to immunize is always yours. We will explain to you, however, that your decision not to immunize is against our advice and we are not responsible for any harm that comes to your child due to an illness contracted due to a lack of immunity. We will not discharge your child from our practice but will discuss any trust or communication issues that arise due to our difference in opinion over immunization administration. Our intent is to work through any of these issues and continue to provide you and your child the pediatric care every child deserves.