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  1. Nicastro, Beth M. CPNP, MS

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In the 20th century, over 16,000 Americans died of polio. In 2005, one case was reported. Rates of pertussis, measles, and other once-common childhood diseases have also plummeted due to widespread administration of effective vaccines to children.1

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Because vaccination has been so successful, most Americans have never seen a child who can't walk because of polio or can't breathe because of whooping cough. As a result, people have lost their fear of these dangerous diseases.


That's undoubtedly one reason some parents refuse vaccines for their child. Other reasons include religious or cultural beliefs or the fear that vaccination will trigger autism. Antivaccine messages appear in print media and on the Internet, influencing parental decisions.2 Many parents turn to nonmainstream practitioners for advice. What most of these parents have in common is a commitment to their child's health and welfare. For whatever reason, they view vaccinations as a threat, not a safeguard.


The American Academy of Pediatrics (AAP) makes four strong arguments in favor of vaccination: Vaccines work, vaccines are safe, vaccines are necessary, and vaccines are studied.3


Review the facts so you're prepared to answer parents' questions and correct misunderstandings. Then use these strategies to encourage reluctant parents to follow the recommended childhood vaccination schedule.


Maintain a nonjudgmental attitude. Be approachable!! Speak to parents in an empathetic manner. Ask why they object to vaccination and address each concern.


Educate. Teach parents how vaccines keep their child safe by preventing illness. Provide a sheet of reputable Web sites they can explore for more information and give them a Vaccine Information Statement before administering any vaccine (see http://www.cdc.gov/vaccines/pubs/vis/vis-facts.htm). Discuss the risks and benefits and document this in the medical record.


Follow up with every family at each sick or well visit.


Document refusals. The AAP has an online form for documenting informed refusal of consent to vaccinate that informs parents about the serious consequences of deferring immunizations.


Encourage communication. Prepare an informative handout for parents that the entire healthcare team agrees to. Send a clear and consistent message to your patients.


Pediatric caregivers in all settings can use these strategies to keep children and their families safe and healthy.


Beth M. Nicastro, CPNP, MS

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Clinical Assistant Professor, State University of New York at Buffalo




1. Centers for Disease Control and Prevention. Manual for the Surveillance of Vaccine Preventable Diseases. 4th ed. 2008. http://www.cdc.gov/vaccines/pubs/surv-manual/chpt21-surv-adverse-events-htm. [Context Link]


2. Burns IT, Zimmerman RK. Immunization barriers and solutions. J Fam Pract. 2005;54(1 Suppl):S58-62. [Context Link]


3. American Academy of Pediatrics. Vaccine Safety: The Facts. http://www.cispimmunize.org. [Context Link]