NEW YORK (Reuters Health) - Parents who are hesitant about having their children vaccinated might want to listen to their health care provider. Doctors can play a critical role by explaining the benefits and addressing concerns about risks, researchers report in this week's New England Journal of Medicine.

Vaccine refusal is a growing phenomenon, as indicated by the proportion of children exempted from school immunization requirements for non-medical reasons, explain Dr. Saad B. Omer, at Emory University in Atlanta and his associates. Between 1991 and 2004, exemption rates rose from less than 1 percent to more than 2.5 percent in states that allow exemptions for philosophical or personal beliefs.

Officials have also noted that some parents insist on delaying vaccinations or spreading them out over extended periods or skipping some shots, which may leave children vulnerable to diseases that can be prevented by vaccination.

However, Omer's team reports, "Parents who reported that decisions were influenced by their child's health care provider were almost twice as likely to consider vaccines safe as parents who said their decisions were not influenced by the provider."

In a national survey, almost 40 percent of pediatricians said they would not provide care to families that refused all vaccines.

The American Academy of Pediatrics is against this approach, and instead recommends that pediatricians "share honestly what is and is not known about the risks and benefits of the vaccine in question."

Specifically, physicians should respectfully listen to parental concerns, explain the risks of not immunizing children, and discuss vaccines of most concern.

If all else fails, doctors are advised to respect continued refusal unless there is risk of serious harm, such as during an epidemic. "Only then should state agencies be involved to override parental discretion on the basis of medical neglect."

SOURCE: New England Journal of Medicine, May 7, 2009.

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