Editor's Note: (Dr. Edith Bracho-Sanchez is a primary care pediatrician and assistant professor of pediatrics at Columbia University Irving Medical Center.
(CNN) "Your child is due for shots today," is frequently followed in my practice by a grimace and a visible tightening of parents' hold on their baby. Then comes my rehearsed recital of the diseases against which we are protecting the baby through vaccination and lastly, I lay out the total number of shots due. That is when the bargaining starts -- "Does she really need that many Dr. Bracho? Couldn't we do two today and the rest next time?"
It is perhaps because I have become used to this bargaining dance, that the results of a study published Friday in the journal Pediatrics do not surprise me. Using data from the 2014 National Immunization Surveillance Survey, the latest available data from a nationally representative sample at the time of the study, researchers found that over a third of parents of children ages 19 to 35 months followed delayed immunization schedules.
Of the parents surveyed, 23% followed an alternate schedule that either limited the number of shots per visit or skipped at least one vaccine series altogether. Another 14% followed an unknown or unclassifiable schedule that did not follow a pattern and was not in line with national recommendations. Children who followed an alternate pattern were four times as likely not to be up to date on their vaccines and those who followed an unclassifiable pattern were over twice as likely not to be up to date.
The latest findings follow a 2015 survey, also published in Pediatrics, in which 93% of the 534 pediatricians surveyed said they had been asked by parents of children under 2 to spread out vaccines. Eighty-two percent of the pediatricians in the study thought agreeing to parents' requests would build trust with families and 80% thought if they declined the request, families might leave their practice.
Although not surprising, the results of these studies are alarming.
They seem to imply that trust in pediatricians is built during the vaccine conversation, not before, and that this trust will be broken by disagreement, which, in my experience, is not the case. My patients trust me because I have proven I care -- I listen, I call with results when I say I will, I call to make sure things are improving when kids have been sick. When we have options, I lay them all out, listing pros and cons and asking for their preferences.
It is out of this trust that I can point out inconsistencies. "Shots are traumatizing to you, your baby is fine." This statement, which I have now said countless times, is followed by an awkward, nervous laugh; moms often turning to dads: "You have to hold the baby, I can't do it!"
I can confidently say, "Your baby is fine" because I know kids are usually back to smiling and waving goodbye by the time parents get to the checkout window, and because I know the science: Vaccines have never been safer.
Vaccines today contain less antigens, the components that tell the immune system to create protective antibodies, than ever before. Receiving several vaccines at once cannot "overwhelm" the immune system. The components used to make vaccines are safe; some have even been removed out of an abundance of caution. Every vaccine goes through extensive safety testing by itself, and in combination with other vaccines, before it is ever approved for use. And, perhaps most importantly, I realize that every day we delay vaccination we are delaying protection, unnecessarily putting my patients and our community at increased risk for dangerous infections.
Yet the system is not built to give me extra time or money to have these types of discussions in the office. If I am behind, the wheels keep turning, the next patient and the one after that are waiting. On busy days, I often want to cave, to let parents dictate the vaccine schedule. I sometimes say this aloud, "It is much easier for me to only order what you're telling me to order and send you home."
But to do this -- without pointing out these made-up alternate schedules are not based in science and are instead rooted in misplaced fear -- would violate the trust parents have placed in my knowledge and would represent a failure to their children.