Refusal To Vaccinate

Documenting Parental Refusal to Have Their Children Vaccinated

All parents and patients should be informed about the risks and benefits of preventive and therapeutic procedures, including vaccination. In the case of vaccination, the American Academy of Pediatrics (AAP) strongly recommends and federal law mandates that this discussion include the provision of the Vaccine Information Statements (VISs). Despite our best efforts to educate parents about the effectiveness of vaccines and the realistic chances of vaccine-associated adverse events, some will decline to have their children vaccinated. This often results from families misinterpreting or misunderstanding information presented by the media and on unmonitored and biased Web sites, causing substantial and often unrealistic fears.

Within a 12-month period, 74% of pediatricians report encountering a parent who refused or delayed one or more vaccines. A 2011 survey of children six months to six years of age reported that 13% of parents followed an alternative vaccination schedule. Of these, 53% refused certain vaccines and 55% delayed some vaccines until the child was older. Seventeen percent reported refusing all vaccines. In a 2009 survey, 11.5% of parents of children 17 years and younger reported refusing at least one vaccine. The use of this or a similar form in concert with direct and non-condescending discussion can demonstrate the importance you place on appropriate immunizations, focuses parents’ attention on the unnecessary risk for which they are accepting responsibility, and may in some instances induce a wavering parent to accept your recommendations.

Providing parents (or guardians) with an opportunity to ask questions about their concerns regarding recommended childhood immunizations, attempting to understand parents’ reasons for refusing one or more vaccines, and maintaining a supportive relationship with the family are all part of a good risk management strategy. The AAP encourages  documentation of the health care provider’s discussion with parents about the serious risks of what could happen to an unimmunized or underimmunized child. Provide parents with the appropriate VIS for each vaccine at each immunization visit and answer their questions. For parents who refuse one or more recommended immunizations, document your conversation and the provision of the VIS(s), have a parent sign the Refusal to Vaccinate form, and keep the form in the patient’s medical record. The AAP also recommends that you revisit the immunization discussion at each subsequent appointment and carefully document the discussion, including the benefits to each immunization and the risk of not being age-appropriately immunized. For unimmunized or partially immunized children, some physicians may want to flag the chart to be reminded to revisit the immunization discussion, as well as to alert the provider about missed immunizations when considering the evaluation of future illness, especially young children with fevers of unknown origin.

This form may be used as a template to document that the health care provider had a discussion with the parent signing the form about the risks of failing to immunize the child. It is not intended as a substitute for legal advice from a qualified attorney as differing state laws and factual circumstances will impact the outcome. While it may be modified to reflect the particular circumstances of a patient, family, or medical practice, practices may want to consider obtaining advice from a qualified attorney.

If a parent refuses to sign the refusal form such refusal along with the name of a witness to the refusal should be documented in the medical record.

The AAP Section on Infectious Diseases and other contributing sections and committees hope this form will be helpful to you as you deal with parents who refuse immunizations. It is available on the AAP Web site on the Section on Infectious Diseases Web site (http://www2.aap.org/sections/
infectdis/resources.cfm), and the Web site for the AAP Childhood Immunization Support Program (http://www2.aap.org/immunization/pediatricians/refusaltovaccinate.html).