Yes, I do see unvaccinated children and here is why

Vaccines have been controversial since they were discovered. The vaccine conversation frequently comes up in the media and in my office. Especially with the continued discussion around COVID-19 vaccines. Recently, the discussion has also included whether or not a pediatrician should keep unvaccinated children in their practice. In my practice, I never turn anyone away. The American Academy of Pediatrics recommends pediatricians continue to provide excellent care to unvaccinated children while also continuing the conversation about the importance of vaccinating. I’ve had many discussion with parents about vaccines and vaccine safety and overall it seems that families who don’t vaccinate fall into one of three categories.

1. Children who can not get vaccines for legitimate medical reasons. Some children have medical conditions, like immune system problems, that make it dangerous for them to get certain vaccines. They rely on those around them to be vaccinated to protect them. Furthermore, sometimes parents are concerned about vaccinating a child after a sibling had a reaction. This requires a careful history of the reaction to determine if vaccinating the child or sibling is still appropriate.
2. Vaccine hesitant families. These are families who have lots of questions surrounding vaccines. Many develop concerns after reading social media posts that paint vaccines in a negative light. There are many myths surrounding vaccines and it’s my job to correct misinformation for my families. Those who see me right after the birth of their child are able to start asking questions early on. I answer their questions with honest, scientific answers in a caring and diplomatic way.  Many of these questions and answers can be found at my blog post here.  These conversations build trust and many of these families will vaccinate either on schedule or on a delayed schedule. While I agree that a delayed schedule leaves children vulnerable to disease, my part of the informed consent equation is providing the “information”. It is up to the parents to make the ultimate decision and as long as they understand the risks and we work in a partnership, I support them. Building trust with your pediatrician and making sure you are heard is extremely important.
3. New patients who are already unvaccinated after hopefully having the discussion with their previous doctor. Sometimes these families have already made up their mind and refuse to have the discussion. As long as they understand it’s my job to continuously bring up vaccinations, we can continue to work together. This can be uncomfortable for the first few visits with a family but I offer to answer any questions they have. They will still be given stellar pediatric care and for the most part they seem to appreciate all of my other advice.  

Some families continue to refuse vaccines despite my best efforts. Here is what I want them to know:

Thank you so much for trusting me to be your partner in the care of your child. I have been to 4 years of medical school, 3 years of pediatric residency, 20 years of experience in practice and I am a mom too. For more information on my background, please see my blog post Becoming a Doctor. I feel that this more than qualifies me to help guide you through parenthood. Together, we will get through growth, development, sleep issues, behavior, potty training, picky eating and even the occasional illness. One of the most important things I will do is advise you on ways to keep your child safe and protected. The mainstay of preventative medicine in pediatrics is vaccination. Since you have already decided not to vaccinate, I need to let you know what my concerns are. Please keep in mind that I have your child’s best interests at heart and no matter what your choice, I will be here for you.

• I worry that your child will come down with a serious life threatening disease.
• I worry that your child will infect a vulnerable child that is unable or too young to be vaccinated either in my waiting room or out in the community.
• I worry that this will affect our relationship as it becomes the elephant in the room. I have to bring it up at every well visit whether you want me to or not.
• I worry that if you don’t trust me on this important issue, are you still trusting my other advice?
• I worry that your choice was based on false or unscientific information.

My hope is that over time I can build enough trust with families that they will be able to make informed choices that keep their children healthy and safe.