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What are top questions you get from caregivers about vaccines and how do you approach vaccine hesitancy?

Our HealthySteps program transforms the promise of pediatric primary care by integrating a child development and behavioral health prevention and promotion expert into the primary care team. These HealthySteps Specialists work alongside families to address the skills and resources key to healthy development, including navigating vaccine schedules.
Zero to Three, Healthy StepsFamily Care CenterMontefiore Medical Group
The HealthySteps model is transforming the promise of pediatric care.

Caregiver concerns can stem from:

  • Fear of how their child will react to the vaccine in the short-term and long-term
  • Mistrust of the government
  • Religious beliefs
  • Feeling that a vaccine is unnecessary if their baby is healthy 
  • Anxiety around the possibility of their child experiencing pain from the injection

Having your child vaccinated comes with many questions and concerns. Some of the top questions we receive are: Is this going to make my baby sick? What happens if I decline the vaccination? Will my baby get an allergic reaction from the vaccine? These are all very common parent and caregiver questions and it is normal to feel vaccine hesitancy. 

We provide as much education as possible to make the parent or caregiver feel comfortable, because at the end of the day they have a choice and we have to respect their decision.

We inform the family that unfortunately not being vaccinated can potentially put your child at a higher risk for disease or illness. Additionally, daycare can also pose a barrier as the child can become susceptible to more illnesses from other children. Regardless of the family’s decision, we provide as much support and information as possible so that the family can make a sound decision. 

As a HealthySteps Specialist, my vaccine-related experiences have centered around offering space for general feelings associated with “readiness” for a well-check visit that will include vaccines for the first time. At the 1-month visit, I provide a preparatory tip sheet that offers ways to support your child before, during, and after shots and highlight comforting and calming strategies that can be employed by the parent or caregiver.

During the 2-month visit, I gauge how the caregiver is feeling about their child receiving vaccines that day. I ask what they have found to be calming to their baby and verbally reinforce their knowing what their baby needs by speaking to baby with phrases like, “Sure sounds like your mama figures out how to make you feel better when times are tough.”

Sometimes, within that conversation, a caregiver will become tearful or share their anxiety in anticipation of shots, related to witnessing the baby in pain and crying. I work to validate their experience, normalize the expression of emotion and offer a gentle reminder of the power of their experience as reflective to their baby’s. I might also offer reassurance for them to be their baby’s favorite space and face for comfort. 

It’s an opportunity to acknowledge and reinforce the caregiver's role as being the #1 advocate for their baby’s overall health, wellness in all matters — medical, educational, and more.

It’s also important to approach the topic from a place of empathy that acknowledges the different experiences and worldviews that may impact parents’ and caregivers’ feelings about vaccination. For example, they may have a history of intravenous drug use that leads them to be more sensitive to the idea of injectables for their child, or they may have cultural norms that conflict with or make them wary of the idea of vaccination.

In cases of vaccine hesitancy, our nursing staff recommends that caregivers check out the book, Vaccines and Your Child by Dr. Offit and visit this website for additional information.

I usually talk to families at the 1-month appointment and tell them that at the 2-month appointment, we start doing the Ages & Stages Questionnaires® and immunizations. At the 2-month appointment, I share the Recommended Immunizations for Children from Birth Through 6 Years Old from the Centers for Disease Control. I also print their child’s immunization records from the Immunization Information System so they can see exactly where their child stands. I rarely have any questions from caregivers and most of them do choose to vaccinate their children.

I feel the support I provide is reflective and preventative. I treat every family like they are my own and work together with them to ensure their children have a strong start in life.

It’s understandable that parents and caregivers may have hesitation about immunizations, especially when it comes to very young children. No one likes to see a baby cry and there is a lot of information—true and false—being shared about the science behind vaccines, which may feel overwhelming.

Although most parents ultimately accept vaccines, the increasing frequency of refusal and the requests for alternative vaccine schedules indicate that there are still significant barriers to overcome—whether it stems from a lack of clear information about the importance of timely vaccination or from concerns about how their child will react to the immunization. HealthySteps Specialists can provide an additional layer of support to listen to each family’s questions or concerns and help them navigate decisions that are in the best interest of their child. We also know that with HealthySteps, children are more likely to attend on-time well-child visits, key for staying up to date on vaccinations.

As the American Academy of Pediatrics outlines, there is a delicate balance between perceived risk and benefit for each vaccine and how this balance is integrally linked to vaccine acceptance and the success of immunization efforts to stop the spread of disease.

Evolution of a vaccine program. Chen RT, Orenstein WA. Epidemiologic methods in immunization programs. Epidemiol Rev. 1996;18(2):102. Copyright © 1996 by the Oxford University Press.

In the case of the new respiratory syncytial virus (RSV) injectable drug, clinical trials showed a reduction in the risk of hospitalization in very young infants by 75%. When something is “new,” it can be met with even more hesitancy, similar to what we saw with the COVID-19 vaccine. However, we know that RSV contributes to almost 80,000 hospitalizations and 300 deaths per year in the U.S. for children under 5, according to the CDC. When the new vaccination is widely available, HealthySteps will be there work with pediatric primary care providers to address this option with families and mitigate risk for the youngest babies.

When life-saving options are available, HealthySteps will be there to partner with parents and caregivers and help them make the best choices for their infants and toddlers.

A recent study shows 17% of toddlers don’t finish all vaccine series they started.

A recent study released by the American Academy of Pediatrics urges action to address logistical barriers to completion of multidose vaccine series. The most common incomplete series after initiation were Hib, PCV and DTaP. About 47% of this group were just one dose short of completing the seven series.

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