Recent measles outbreaks have many parents concerned about the safety of their children — especially when they have to visit the pediatrician. What happens when you take your child to a medical office that treats patients who are and are not vaccinated?
“I think parents are more aware than ever before, because of outbreaks like the one from measles we’re currently experiencing, that they are dependent on a vaccinated community,” Dr. Wendy Sue Swanson, a spokesperson for the American Academy of Pediatrics (AAP) and practicing physician in Seattle, told Healthline.
Her area has been hard hit by a recent measles outbreak, but she said it’s motivating the community to discuss the need for vaccinations in stopping outbreaks.
A doctor’s office can choose not to treat unvaccinated patients. A proposed law in Pennsylvania, however, would force physicians to treat patients who are not vaccinated.
The measure would stop healthcare providers from requiring a patient, parent, or guardian to sign a liability waiver to receive care if they delay or opt out of a vaccination. Some states have regulations that allow people to decline vaccinations based on religious or philosophical beliefs.
In recent years, the AAP changed its stance on supporting pediatricians who will not treat unvaccinated children.
“They now suggest it’s okay for pediatricians to dismiss families who don’t agree with their vaccine recommendations when they fail to follow the recommendations for vaccinations per the schedule,” Swanson said.
Dr. Jaime Friedman, a pediatrician from San Diego, notices a lot of chatter online about parents who support doctors that refuse to see unvaccinated children, or at least prefer a pediatrician who won’t see them.
“In practice I have not had any parents ask if I have unvaccinated children. I do have parents who are worried about the ongoing measles outbreak and ask what they can do to protect their children,” she said.
Some pediatricians take extra precautions with unvaccinated patients by creating separate waiting rooms, especially in the event of an outbreak. During times when flu activity has been elevated, this can also occur.
Washington, where Swanson practices, requires parents to sign paperwork saying that they have discussed the matter with the doctor and understand the risks of choosing not to vaccinate their children despite the doctor’s recommendation.
“I always bring it up. I always remind parents that these illnesses are life-threatening, and I am documenting that the parents are aware of this and are still choosing not to vaccinate,” Friedman added.
Doctors sometimes change how they immunize to get big groups of children caught up during an outbreak. They also may change how they triage patients coming into the clinic during an outbreak, Swanson said.
“Because measles is so contagious, if a patient calls for an appointment with symptoms that are concerning for measles, they can even be asked to enter the clinic through a separate door,” Swanson said.
From a standpoint of infection control, typically clinics and hospitals have policies for masking patients when they come in with symptoms that are concerning for infections such as rash and runny nose, Swanson said.
Friedman said many practices have separate waiting rooms for sick and well children as a standard practice — not only during outbreaks. They may also have a policy that stipulates children with a rash and fever must call when they arrive so they can quickly be triaged or moved to a room.
“If a parent suspects measles, we ask them to stay in the car and we can see them there,” she said. “If we suspect measles in the office, we have to close for two hours.”
In her practice, they keep children suspected of measles in the car, though the rash policy exists all of the time.
Unvaccinated children are only a risk to a healthy, immunized child if they have an infection, Swanson explained. Children should practice regular handwashing and steer clear of any other ill children.
If a child has an underlying immune deficiency, they can ask to have the child bypass the waiting room and go right into an exam room if that is an option, Friedman noted.
Parents should feel open to talk with their pediatrician about their worries during a visit, as their apprehension may be elevated during an outbreak. The pediatrician can also provide perspective on what’s happening in that community at the time.
Parents who don’t vaccinate their children should discuss vaccinations with their pediatrician, even after opting out. Though it can be exhausting to bring up the issue repeatedly, Swanson believes most pediatricians offer to educate families on the benefits outweighing the risks.
“I suspect as they learn more they may want to get their child protected. Otherwise, the best thing they can do is keep their child home when ill,” Swanson said, noting that many children don’t show symptoms right away when they have an ailment such as the flu, so they may be spreading it unknowingly.
“This is why vaccinations afford us such a huge individual benefit and community benefit from protecting from ever getting some infections in the first place,” Swanson said.
Friedman said she understands that parents who do not want to vaccinate their children have the best interest of their child at heart.
“They think they are protecting them,” she said. “However, no matter how healthy their lifestyle, they are susceptible to life-threatening infections and can spread them to others.”
Friedman recommends that unvaccinated children stay home when they are sick or if they have been exposed to an illness.
Many pediatricians feel it is their job to care for children no matter what decisions the parents have made, Friedman noted. “Unfortunately, that may mean being in an office with someone who is unvaccinated,” she said.
“Parents need to remember that their child can get a vaccine-preventable disease anywhere in public and are more likely to do so than in the doctor’s office,” she added.
Friedman said that she finds people often have misconceptions about what vaccines do and how serious viral infections can be.
“Many believe measles is benign or that healthy children don’t die of the flu,” Friedman said. “It’s becoming harder and harder to correct this misinformation but I continue to do it regularly. I hope that parents can find a pediatrician who they trust enough to tell them accurate information and to believe it.”