Most pediatricians delay vaccines if asked by parents

Corrections and clarifications: An earlier version of this story did not say when the study was conducted.

At a time when measles is making a dramatic comeback, a new study finds that more than 70% of children's doctors have agreed to parents' requests to delay vaccinations, even though most believe that puts children at risk.

The study highlights the pressure faced by pediatricians, who have only about 18 minutes per clinic visit in which to persuade parents to vaccinate their children, perform physical exams and discuss critical things such as sleep and nutrition. Doctors say they spend about half their time with patients discussing vaccines, according to a study out Monday in Pediatrics. One in five doctors say more than 10% of parents have asked to delay vaccinations, according to the study, which was conducted from June through October 2012.

More parents have begun skipping selected vaccines or delaying others in recent years, sometimes out of concern that immunizations cause autism, an idea that has been debunked in dozens of studies. Some parents worry that children get too many vaccines too soon, so they ask their doctors to space out shots rather than administer several at once.

Doctors who agree to delay vaccinations say they hope to maintain trust with parents or avoid having parents leave the practice, according to the study, led by researchers at Children's Hospital Colorado in Aurora, Colo.

San Diego pediatrician Jaime Friedman regularly sees parents who want to delay or skip vaccines. While she doesn't turn them away, she does work to persuade them to vaccinate. "They seem to want my advice on every other part of their child's life," says Friedman, who was not involved in the new study. "I talk to them about car seats or sunscreen, and they go, 'Alright.' This is the one issue that's so polarizing."

Some doctors say non-vaccinators aren't welcome.

About 9% of pediatricians and 2% of family physicians say they always or sometimes dismiss families from their practice if parents want to skip or delay vaccinations, the study says. The American Academy of Pediatrics says doctors shouldn't "fire" families who refuse vaccines, because it's important to continue trying to persuade them.

Over time, families who are skeptical of vaccines may come to see that their pediatrician has their child's best interest at heart, says Saul Hymes, assistant professor and attending physician at Stony Brook University Hospital on New York's Long Island, who was not involved in the new study.

Hymes says he knows of families who get their children's medical care through urgent-care centers because they can't find a pediatrician to accommodate their vaccine requests. That's bad for kids, who need a regular "medical home" and familiar pediatricians to monitor their growth and development, he says.

Pediatrician Scott Krugman says he tries several strategies to persuade parents to have their children vaccinated.

"If they totally refuse, I continue to ask at each visit to try to get them to change their mind," says Krugman, who was not involved in the new study. "Many times, it is a plain old fear of the unknown, which is hard to argue against. If it is a specific fear, it is easier to educate."

Studies have found no benefit to delaying vaccinations. But delaying shots leave children vulnerable for a longer time. Research shows that missing even one whooping cough booster increases the odds that a child will contact that disease, says Saad Omer, an epidemiologist and professor at Emory University who studies immunizations.

Paul Offit, director of infectious diseases at Children's Hospital of Philadelphia, says he is concerned that support for vaccines wasn't higher among children's doctors.

"If 87% of physicians thought it was a bad idea to delay or withhold vaccines, that means that 13% didn't," Offit says. "That means one in seven pediatricians don't think it's a bad idea to delay vaccines."

Surveys show that support for vaccines is usually strongest among older adults, who remember seeing children crippled by polio or killed by measles.

Surveys also show that vaccination rates have risen since an outbreak of measles linked to Disneyland. According to the Centers for Disease Control and Prevention, 170 people have been diagnosed with measles so far this year, including 125 linked to Disneyland. Most of those patients were unvaccinated.

Measles can cause severe complications. One or two children die for every 1,000 people infected, according to the CDC.

Offit says fear of an outbreak may be the only thing that resonates with vaccine-hesitant parents.

"People are compelled by fear more than anything," Offit says. "The threat of the disease didn't scare them. The disease scares them."