Gray Matters

What to Do with Unvaccinated Children in the Doctor’s Office?

BY SARAH J. CLARK, MPH

Winter 2020
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Primary care providers strive to keep children healthy through regular well-child care, which includes making sure children receive recommended vaccines. But when a family refuses all childhood vaccines, it puts providers in a challenging position. A completely unvaccinated child is unprotected against harmful and contagious diseases, such as measles, pertussis, and chicken pox. That same child also poses a risk of transmitting diseases to other patients. 

The C.S. Mott Children’s Hospital National Poll on Children’s Health asked a national sample of parents of children 0-18 years old about how their child’s primary care practice deals with children whose parents refuse all vaccines, as well as parent preferences around this situation. 

We found that many parents are unaware of policies in their child’s primary care office regarding unvaccinated children: 39% say there is a policy requiring children to get all recommended vaccines, 8% say children are required to get some vaccines, 15% say their child’s primary care provider’s office has no policy about vaccination, and 38% don’t know if any policy exists. 

The most important finding in the poll was that the majority of parents want their child’s primary care office to take action to minimize the risk from unvaccinated children: 28% said the office should ask the parent to find another health care provider for their unvaccinated child, while 44% said the unvaccinated child should have limited access to the waiting room. Only 28% of parents said the primary care office should allow the unvaccinated child to continue getting care with no restrictions. 

What if the primary care practice does not take action? More than four in 10 parents (43%) say they would be very or somewhat likely to move their child to a different provider if their child’s doctor continues to allow completely unvaccinated children in the practice. 

Implications 

Vaccines often are given in conjunction with well-child visits with the primary care provider. Some children are delayed or miss certain doses, due to barriers to scheduling well-child appointments, parents not knowing that additional doses are needed, or parents choosing to have their child skip certain vaccines or certain doses. 

A less common situation, which occurs in 1-2% of U.S. children, is parent refusal of all vaccines for their child. 

Child health providers face a difficult decision in this situation. Keeping unvaccinated children in the practice allows providers to continue discussions with parents to explain the importance of childhood vaccinations and to answer any questions the parents have about possible side effects. 

At the same time, providers must consider the risk to other patients, particularly infants too young to have received vaccines, elderly patients, and patients who have weakened immune systems. This concern prompts some providers to ask parents who refuse all vaccines for their child to leave the practice and find another provider. In other cases, providers may institute restrictions such as requiring unvaccinated children to wear a mask or not to use the common waiting area. 

The 2019 measles outbreak illustrates the need for both parents and health care providers to consider policies around unvaccinated children. Measles is highly contagious: the virus can live for several hours in an area where an infected person coughed or sneezed. However, people can spread the disease even before symptoms appear and measles is diagnosed. When parents bring a child with suspected measles to the waiting room of a doctor’s office or emergency room, they can expose many other patients to the disease. 

Primary care providers need to think carefully about whether to institute policies to prevent their patients from being exposed to vaccine-preventable diseases, and then communicate those policies to all patients in their practice. In addition, parents of infants or immunocompromised children, and all parents who are concerned about possible exposure to vaccine-preventable diseases, should ask their child’s primary care provider about policies surrounding unvaccinated children. 

 

Sarah J. Clark, MPH, is co-director of the C.S. Mott Children’s Hospital National Poll on Children’s Health