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 A wide majority of pediatricians and family physicians acquiesce to parents who wish to delay vaccinating their children, even though the doctors feel these decisions put children at risk for measles, whooping cough and other ailments, a new survey has found. 
 
 
 
 
 
 
 
 
 
 Physicians who reluctantly agreed said they did so to build trust with families and to avoid losing them as patients. 
 
 The survey, published Monday in the journal Pediatrics, asked a nationally representative sample of 534 primary care physicians in 2012 how often parents in their practices postponed one or more vaccinations for children younger than age 2. 
 
 The Centers for Disease Control and Prevention advises that children be vaccinated for 14 diseases before age 6 on a schedule, which entails roughly 29 shots, sometimes several at once. 
 
 Ninety-three percent of doctors reported that in any given month, they had been asked at least once to delay vaccines. A fifth said more than 10 percent of parents in their practices had asked them to delay vaccines. 
 
 One-third of doctors said they acquiesced “often” or “always”; another third gave in only “sometimes.” 
 
 Such deference is in keeping with today’s doctoring style, which values patients as partners, said Dr. Paul A. Offit, a pediatrician specializing in infectious diseases at the Children’s Hospital of Philadelphia, who was not involved in the study. 
 
 “At some level, you’re ceding your expertise, and you want the patient to participate and make the decision,” he said. The downside is that “you have to be willing to stand back and watch them make a bad one.” 
 
 Too many doctors compromise on vaccines, instead of mounting a passionate plea, Dr. Offit said. 
 
 “It is sad that we are willing to let children walk out of our offices vulnerable to potentially fatal infections,” he said. “There’s a fatigue here, and there’s a kind of learned helplessness.” 
 
 Part of the problem is the lack of a proven strategy to guide physicians in counseling parents. 
 
 “Unfortunately, we don’t have a solid evidence base in terms of how to communicate to patients about vaccines,” said Saad Omer, an epidemiologist at Emory University. “A lot of approaches are wisdom-based, not evidence-based.” 
 
 Dr. Omer said that he did not sanction the use of alternative vaccine schedules, but that he understood why primary care physicians keep treating these patients — just as doctors do not kick smokers out of their practices when they fail to quit. 
 
 “Physicians recognize it’s not ideal, but they’re saying, ‘Let’s continue this relationship’ to the family,” he said. 
 
 The American Academy of Pediatrics advises doctors to keep skeptics in the fold, lest the doctors lose the opportunity to educate, cajole or persuade them. 
 
 Physicians in the survey reported trying various strategies, like telling skeptical parents that they had immunized their own children, or warning them that outbreaks will continue if too few people are fully vaccinated. 
 
 A disproportionate amount of time is spent discussing vaccines during doctor visits, the survey also found. For hesitant parents, counseling can take 10 to 14 minutes or longer — more than half of the average 18-minute visit. 
 
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 Guidance on safe sleep or toilet training is being crowded out, the study authors said. Forty percent of the doctors reported that dealing with changes to vaccine schedules had decreased their job satisfaction. 
 
 In late February, Dr. Nivedita More, a pediatrician in Rancho Santa Margarita, Calif., sent letters ending her relationship to parents who refused all vaccinations. 
 
 “If they aren’t getting their act together to even start the process, I’ll discharge them within 30 days,” said Dr. More, a board member of the Orange County chapter of the pediatrics academy. 
 
 By contrast, her stance on vaccine delays is much more flexible. “I do allow that most times,” she said. “The reason is, ultimately they will get vaccinated.” 
 
 Many of those parents are simply hoping to limit the number of shots their children receive at once, she added, and are willing to accept combination vaccines. 
 
 But “the people who didn’t want to vaccinate at all — I had a really hard time converting them,” she said. “They are never going to change.” 
 
 In the midst of the current measles outbreak, which began nearby at Disney parks, Dr. More said she also felt the need to safeguard vulnerable patients in her waiting room from unvaccinated patients. Infants in particular do not get their first measles-mumps-rubella shot until age 1. 
 
 Dr. Allison Kempe, the study’s lead author and a pediatrician at Children’s Hospital Colorado, thinks the time has come to acknowledge that the idea that “vaccine education can be handled in a brief wellness visit is untenable.” 
 
 Dr. Omer said doctors should be paid separately for vaccine counseling in cases where a “substantial proportion of time is being spent on vaccines.” 
 
 In addition to compensation, Dr. Kempe said, vaccine counseling should begin during a woman’s pregnancy, and pro-vaccine parents — perhaps even celebrities — should star in marketing campaigns to help “reinforce vaccination as a social norm.” ||||| Photo 
 
 Coni Butler, an accountant in Austin, Tex., and a devout Catholic, encourages her three children to remain celibate before marriage. But that did not stop her from getting them vaccinated against human papillomavirus, or HPV, a sexually transmitted disease that raises the risk of some cancers. 
 
 Ms. Butler had her son and two daughters vaccinated between ages 12 and 15. She was not deterred by widespread concerns that the vaccine might encourage promiscuity. 
 
 â€śWe talk about remaining chaste until they get married, but thereâ€™s always the possibility that one bad choice could lead to devastating consequences,â€ť she said. â€śI tell my friends that you pray for the best, but you plan for the worst.â€ť 
 
 Since public health officials began recommending in 2006 that young women be routinely vaccinated against HPV, many parents have hesitated over fears that doing so might give their children license to have sex. But research published on Monday in the journal Pediatrics may help ease those fears. 
 
 Looking at a sample of nearly 1,400 girls, the researchers found no evidence that those who were vaccinated beginning around age 11 went on to engage in more sexual activity than girls who were not vaccinated. 
 
 â€śWeâ€™re hopeful that once physicians see this, it will give them evidence that they can give to parents,â€ť said Robert A. Bednarczyk, the lead author of the report and a clinical investigator with the Kaiser Permanente Center for Health Research Southeast, in Atlanta. â€śHopefully when parents see this, itâ€™ll be reassuring to them and we can start to overcome this barrier.â€ť 
 
 HPV, the most common sexually transmitted virus in the United States, can cause cancers of the cervix, anus and parts of the throat. Federal health officials began recommending in 2006 that girls be vaccinated as early as age 11 and last year made a similar recommendation for preadolescent boys. The idea is to immunize boys and girls before they become sexually active to maximize the vaccineâ€™s protective effects. 
 
 According to research, nearly a third of children 14 to 19 years old are infected with HPV. But despite the federal recommendations, vaccination rates around the country remain low, in part because of concerns about side effects as well as fears the vaccine could make adolescents less wary of casual sex. In one study of parental attitudes toward the vaccine, Yale researchers found that concern about promiscuity was the single biggest factor in the decision not to vaccinate. (A report last year from the Institute of Medicine, which advises the government, found that that the HPV vaccine was generally safe.) 
 
 While there have been studies suggesting that the vaccine does not lower inhibitions in girls who receive it, most of them were based on self-reporting, which is not very reliable. So Dr. Bednarczyk and his colleagues looked instead at medical data collected by a large managed care organization. 
 
 They selected a group of 1,398 girls who were 11 or 12 in 2006 — roughly a third of whom had received the HPV vaccine — and followed them through 2010. The researchers then looked at what they considered markers of sexual activity, including pregnancies, counseling on contraceptives, and testing for or diagnoses of sexually transmitted diseases. 
 
 Over all, in the time that the girls were followed, the researchers did not find any differences in these measures between the two groups. 
 
 In addition to the HPV vaccine, federal guidelines also call for 11-year-olds to be immunized against meningitis, tetanus, diphtheria and pertussis. Dr. Elizabeth Alderman, president of the North American Society for Pediatric and Adolescent Gynecology, said parents almost never object to those vaccines for their preadolescents. But she regularly encounters parents who balk at the HPV vaccine â€śbecause of the nature of what itâ€™s preventing.â€ť 
 
 â€śIâ€™ll now be able to use this study as a piece of evidence to show them that itâ€™s not going to give girls a license to sexual activity,â€ť said Dr. Alderman, an adolescent medicine specialist at Childrenâ€™s Hospital at Montefiore Medical Center in New York. 
 
 Dr. Jonathan Temte, a family doctor in Wisconsin who is chairman of the United States Advisory Committee on Immunization Practices, said he tells skeptical parents in his practice to think of vaccination no differently from wearing a helmet to ride a bike or play football. 
 
 â€śBy providing this protection, are we encouraging kids to take more risky behaviors?â€ť he said. â€śI donâ€™t believe so.â€ť
– Doctors are reluctantly delaying vaccine schedules for kids, despite knowing the risks of doing so, because they don't want to alienate parents altogether, reports the New York Times. A study published in Pediatrics that surveyed 534 primary care physicians found that 93% of them were asked to delay a vaccine by a parent in any given month; a fifth of respondents said more than 10% of parents in their practice had asked for delays. More than one-third of the physicians copped to giving in "often" or "always"; another 37% said they did "sometimes." "Doctors are feeling really conflicted because they overwhelmingly think this is the wrong thing to do, and is putting children at risk, but at the same time, they want to build trust with their patients and meet people halfway," the study's lead author says, per Time. It's not for lack of trying to reach these vaccine-wary parents, the researchers note: Doctors will often use a variety of strategies to convince parents to stick to the traditional schedule, including telling them their own kids have been vaccinated, bringing up possible future outbreaks if they buck vaccination, or even warning that the alternate schedules haven't been studied adequately. But in the end, the doctors still often acquiesce and are faced with a stressful decision. "To know I'm going to pick one [vaccine] and leave the other behind, despite all the time I spend explaining the risks and benefits to the parents—it's very difficult for me," a pediatrics professor at Baylor College of Medicine tells Time.