It happens every once in a while in my practice: Parents ask if we can delay or skip certain vaccines, or spread them out.
According to a study just published in the journal Pediatrics, I'm not alone -- in fact, 93 percent of pediatricians get asked the same thing.
Now, it's important to point out that most families don't ask for this. Most families are fine with the current vaccine schedule -- as they should be, since it has been carefully studied and is felt to be safe. We give so many vaccines to babies because they are the ones who are most likely to get very sick from vaccine-preventable diseases. Not only do we think they can handle it, we think it's the best thing for their health and safety.
But some families worry. They have heard things. They don't like all the shots at once. There are certain shots that particularly frighten them -- or that they don't want at all. It's uncommon for parents to refuse all vaccines, but refusing some or wanting to do them differently is more common -- a recent survey showed that 13 percent of parents of young children used some kind of alternative schedule.
Now, most of us pediatricians don't like this alternative schedule idea. The reasons doctors gave in the study are the same ones I have. Mostly, we think it puts children at risk of disease. I have seen babies die of meningitis caused by haemophilus influenza or pneumococcus, or get very sick from whooping cough or rotavirus (there have been deaths from whooping cough in newborns). I am worried about the resurgence of polio. I am very worried about the resurgence of measles.
Like almost half of the doctors in the study, I also worry that it sends a mixed message if I agree to spacing out the vaccines. The schedule is fine, but it's fine to tweak it? Does that say to parents that tweaking it might be better? I certainly don't want to send that message.
But here's the thing: For me, some vaccines are better than none. If it takes tweaking the schedule for a child to get vaccinated, I'll tweak. And I'm not alone there, either; in the study, most doctors were willing to do an alternative schedule.
When I tweak, I'm saying to parents: You are in charge. I know that you love your child and want to do the best thing. I may not agree with your choice, but what's most important now is that we do something -- and keep talking.
See, when we hold a firm line, when we say that it's our way or the highway, it's a bit of a conversation-stopper. That's why I would never turn away a family that is hesitant about vaccines. I'd rather keep talking. I'd rather keep them in a practice where there is some herd immunity to protect them, rather than sending them to a waiting room full of unvaccinated children (it's these clusters of underimmunized children that can worsen epidemics). I'd rather be sure that I am keeping the child healthy, and helping the parents, in every way I can.
I've had families who initially didn't want to give vaccines change their minds and give them, or at least give more than they initially planned. If I hadn't been willing to listen to and work with them, if I'd sent them away, that wouldn't have happened.
So much of this is about trust: Helping families trust not just me, but all the research and science behind vaccines, helping them trust the people who truly are experts as opposed to the people who say they are, but aren't.
We don't build trust by drawing lines in the sand, no matter how strongly we might believe in those lines. We build trust by listening, understanding -- and, when needed, compromise.