Parents Who Hesitate or Choose Not to Vaccinate Their Children

In February 2025, the Texas Department of State Health Services reported the death of an unvaccinated child who had tested positive for measles, a highly contagious, vaccine-preventable disease. Since that time, more than 1,300 measles cases and three deaths have been confirmed in the U.S. Most of those infections occurred in unvaccinated children.
 
Despite the availability of effective vaccines, a significant number of infants and children, especially those under 5 years of age, die each year from vaccine-preventable diseases, including measles, pertussis, pneumonia, and influenza. The American Academy of Pediatrics (AAP) and the U.S. Centers for Disease Control and Prevention (CDC) recommend immunizations as the safest and most cost-effective way of preventing disease, disability, and death. Regardless of these recommendations, some parents continue to hesitate or choose not to vaccinate their children.
 
Reasons for vaccine declination or hesitancy vary based on personal, environmental, social, and safety-related factors. Some parents cite religious beliefs. Others may hesitate due to lack of understanding or misinformation on vaccine safety and efficacy, or a belief that vaccines are neither necessary nor relevant to the child’s health status. Whatever the reason, healthcare practitioners are in the best position to influence parental vaccination decisions by encouraging communication, building trust, and promoting evidence-based recommendations.

Healthcare practitioners take a variety of approaches in addressing parents who hesitate or choose not to vaccinate their children. While some may opt to continue seeing these patients, others may choose to discharge these patients from their practice. According to the AAP, “[If] repeated attempts to help understand and address parental values and vaccine concerns fails to engender trust, move parents toward vaccine acceptance, or strengthen the therapeutic alliance, dismissal can be an acceptable option.” The decision to discharge a patient from practice should be made only after carefully considering the patient’s health condition, the practice setting, and the availability of other healthcare resources. Clear communication regarding your organization’s vaccination policy is essential to avoid misunderstanding and confusion.
 

Risk Recommendations

 
While a parent ultimately has the right to decline vaccinations on behalf of their child, this decision exposes the patient to risk and affects their care. It can also expose others to communicable diseases. Consider the following when interacting with parents who hesitate or choose not to vaccinate their children: 

• Address hesitancy with education. The AAP stresses how important it is to communicate with parents, focusing on using evidence-based resources and recommendations to support practitioners in shifting the narrative during vaccine conversations. Ensure that you understand the reasons for vaccine hesitancy or declination. Discuss the risks associated with not vaccinating, especially in children or adolescents with a history of high-risk health conditions, such as asthma or diabetes. Educate and encourage open communication using health literacy principles such as plain language and teach-back. Uncover and address misconceptions by offering evidence-based information and resources. Continue the dialogue by discussing vaccinations during follow-up and routine appointments. Document the education and resources provided with each visit, along with the parents’ response. Review CDC and AAP guidance on talking to parents about vaccines. 
• Continue to educate. Inform parents about clinical presentations of vaccine-preventable diseases, including symptoms and actions to take. Conduct ongoing informed refusal discussions when parents decline offered vaccines. Ensure that educational materials are written in plain language and document each discussion in the medical record. Consider using the AAP’s Refusal to Vaccinate form. Seek legal guidance as appropriate when implementing this form.
• Know the law. Understand your state’s laws and regulations regarding the ability of a minor to consent to immunizations. Educate minors who can consent on the importance of vaccinations, including risks and benefits, and document those conversations in the medical record. Seek guidance from an attorney who is familiar with your state’s laws and regulations on vaccine exemptions.
• Develop a vaccination policy. Consider whether you wish to accept or continue seeing families who decline vaccinations on behalf of their children and develop a policy based on your preference. If you choose not to accept these families into your practice, make your policy clear by posting a statement on your website and including it in your new patient materials. Prepare for social media backlash. Recognize that parents may be upset with a policy to discharge or screen patients for vaccination status or attitudes. Know how to respond to negative posts.
• Consider discharge. If you choose to discharge patients whose families choose not to vaccinate, review best practices for discharge from practice. Assess each patient’s health status on a case-by-case basis to decide if discharge is appropriate. Verify that less drastic alternatives are not feasible, and work to minimize potential negative impacts on the child. Communicate the policy to parents and educate staff to ensure consistency and compliance with the policy. Document your discussions with the parents in the medical record.
• Safeguard unvaccinated patients. If you choose to accept unvaccinated patients into your practice, consult an infection prevention professional to determine how your organization can best implement appropriate precautions to prevent the spread of disease. Flag the medical records of unvaccinated patients so that practitioners and staff can take precautions and continue discussions about vaccination with parents.

While caring for patients who hesitate or choose not to vaccinate can be a challenge, healthcare practitioners may have the opportunity to influence those decisions. Providing parents with an opportunity to ask questions, addressing their concerns regarding vaccinations, attempting to understand reasoning for refusal or hesitancy, and maintaining a supportive relationship with the family are all part of a good risk management strategy.
 
Additional Resource: 

• American Academy of Pediatrics Communicating with Families and Promoting Vaccine Confidence