What to do with unvaccinated children in the doctor's office?
What to do with unvaccinated children in the doctor's office?
Primary care providers strive to keep children healthy through regular well-child care, which includes making sure children receive recommended vaccines. However, some parents refuse all vaccines for their child. 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 primary care offices should handle children whose parents refuse all vaccines.
With regard to current policies at their child's primary care office, 39% of parents say there is a policy requiring children to get all recommended vaccines, while 8% say children are required to get some vaccines. Fifteen percent of parents say their child's primary care provider's office has no policy about vaccination, and 38% don't know if any policy exists.
Only 6% of parents say their child's primary care office does not allow unvaccinated children to use the same waiting are as other patients, while 2% say the office allows unvaccinated children to use the waiting area if they wear a mask. In contrast, 24% of parents say their child's primary care office allows unvaccinated children to use the same waiting area as other patients with no restrictions. Two-thirds of parents (68%) don't know about policies pertaining to the waiting area.
About 4 in 10 parents (43%) say they would want to know if there were other children at their child's primary care office whose parents had refused all vaccines; 33% of parents say they would not want to know, and 24% are unsure. If there were other children in the office whose parents had refused all vaccines, 12% of parents say they are very likely and 29% somewhat likely to move their own child to a different health care provider.
Parents have a variety of opinions on how their child's primary care office should handle situations where a parent refuses all vaccines for their child: 28% say the office should ask the parent to find another health care provider for their unvaccinated child. Others say the primary care office should allow the unvaccinated child to continue getting care but with restrictions to protect other patients: 17% say the unvaccinated child should not use the waiting room, and 27% say the unvaccinated child should wear a mask in the waiting room. The remianing 28% of parents say the primary care office should allow the unvaccinated child to continue getting care with no restrictions.
Highlights
- 7 in 10 parents say their child’s primary care office should have a policy to prevent completely unvaccinated children from infecting other patients.
- 4 in 10 parents say their child's primary care office has a policy requiring that children get all recommended vaccines; about the same number of parents are unsure of the office policy.
- 4 in 10 parents are very or somewhat likely to move their child to a different provider if there are children in the practice whose parents refuse all vaccines.
Implications
Most US children receive all recommended vaccines according to the schedule set out by the Centers for Disease Control and Prevention (CDC). Vaccines often are given in conjunction with well-child visits with the primary care provider - usually a pediatrician, family physician or nurse practitioner. 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 US children, is parent refusal of all vaccines for their child. A completely unvaccinated child is unprotected against measles, pertussis, chicken pox, and many other diseases. However, that unvaccinated child also poses a risk of transmitting diseases to others. In most cases, child health providers will have multiple discussions with parents to explain the importance of childhood vaccinations, and to answer any questions the parents have about possible side effects.
This Mott Poll asked a national sample of parents about their awareness of current policies, and preferences for future actions, in how their child's primary care office handles the subset of parents who refuse all vaccines for their children, even after multiple discussions.
Some primary care providers ask parents who refuse all vaccines for their child to leave the practice and find another provider. In other cases, unvaccinated children are allowed to continue getting care but with restrictions designed to protect other children, such as requirements to wear a mask or not to use the common waiting area. Such restrictions are particularly important for vulnerable patients, including infants too young to have received vaccines, elderly patients, and patients of all ages who have weakened immune systems, such as people with cancer.
The recent 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.
Results of this Mott Poll indicate that many parents are unaware of policies in their child's primary care office regarding unvaccinated children. Parents also are divided in their views on what those policies should be. Many parents think the primary care provider should ask parents who refuse all vaccines to find another practice for their unvaccinated children; slightly more parents feel that the primary care provider could still allow the unvaccinated child to continue receiving care in the practice, but with restrictions in place that will protect the most vulnerable patients.
There also is a question about whether to notify parents if there are children in the practice whose parents have refused all vaccines: 43% of parents indicated they would want to know about this situation. For some parents, this is essential information - such as the 12% who said they would be very likely to move to another practice to ensure their child would not be at increased risk of disease due to an unvaccinated patient.
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.
Data Source & Methods
This report presents findings from a nationally representative household survey conducted exclusively by Ipsos Public Affairs, LLC (Ipsos), for C.S. Mott Children’s Hospital. The survey was administered in February 2019 to a randomly selected, stratified group of adults who were parents of at least one child age 0-18 years living in their household (n=2,032). Adults were selected from Ipsos’s web-enabled KnowledgePanel® that closely resembles the U.S. population. The sample was subsequently weighted to reflect population figures from the Census Bureau. The survey completion rate was 60% among panel members contacted to participate. The margin of error for results presented in this report is ±1 to 3 percentage points.
Findings from the C.S. Mott Children’s Hospital National Poll on Children’s Health do not represent the opinions of the University of Michigan. The University of Michigan reserves all rights over this material.
Citation
Clark SJ, Schultz SL, Gebremariam A, Singer DC, Freed GL. What to do with unvaccinated children in the doctor's office? C.S. Mott Children's Hospital National Poll on Children's Health, University of Michigan. Vol 34, Issue 5, August 2019. Available at: https://mottpoll.org/reports/what-do-unvaccinated-children-doctors-office.
