Lori Kestenbaum, MD

is a fellow in Pediatric Infectious Diseases at The Children’s Hospital of Philadelphia. She graduated with a BS in Psychology from Duke University and received her MD from the Perelman School of Medicine at the University of Pennsylvania. She completed her residency in Pediatrics at The Children’s Hospital of Philadelphia in 2012.  She is currently a member of the American Academy of Pediatrics, the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Follow her on Twitter @lorikestenbaum.

Confronting our hesitancy to spend time with vaccine-hesitant parents

Last week, one of the medical students I was working with recounted an experience with an interesting patient she had seen. The child was 17 months old and had eaten home canned food that had not been stored properly. The parents came to medical attention concerned that the child could have contracted botulism from the ingestion. The student recounted enviously the upbringing of this child – she was raised on a farm, with access to fresh fruits, vegetables, organic meats and dairy products. Her parents made an effort not to feed her excess sugar or packaged snacks.

“There was just one thing off,” the medical student said. “They are delaying certain vaccines.” The child had received many of the infant vaccine series, except she failed to complete the rotavirus series on time. At 17 months, the child had not received MMR or varicella vaccines.

“What was their reason for delaying vaccines?” I asked.

“Oh, we didn’t really get into that. The visit was intensely focused on making sure the child did not have botulism. It seems like the pediatrician has talked to them about it, though.”

This was the moment to move the parents from vaccine hesitancy to vaccine acceptance. Here they were, presenting to medical attention concerned that their child had an extremely rare disease. According to the CDC, there are about 145 cases of botulism yearly, only 15% of which are foodborne. Meanwhile, the parents were unaware that their child was much more likely to get measles, with over 600 cases reported last year, and they had the power to prevent that disease with a vaccine. These parents have had conversation after conversation with their pediatrician in 15-minute windows, but really needed a longer conversation with an expert. Here were parents who did not flat out refuse vaccines, as they had accepted the concept of vaccination, but rather were vaccine hesitant, needing help to move toward full acceptance.

Conversations with vaccine hesitant parents take effort. Discussions eat into other appointments and slow down the day or the emergency department visit or hospital admission. The provider must work to find out the parents’ concerns and be armed with information to address these concerns. Our patients depend on us to advocate for them, so even when the visit is a concern for a toxic ingestion, or runny nose, or broken arm, take the time to try to address the parents’ hesitancies. You might even move them toward vaccine acceptance.