A parent has doubts before a vaccination: how to talk without an argument

A parent’s hesitation does not mean opposition to all vaccinations

A father brings his child in for a check-up. The doctor says: “Today we have a vaccination planned, in line with the immunisation schedule.” The parent replies: “I’d like to know about complications. I read something worrying.” It is easy to hear these words as an attack on medicine. Yet the father may be asking about a specific reaction or about a previous experience with an older child, or he may simply not understand information he found online. A reply such as “Please don’t read that rubbish” usually does not help establish what the concern is.

Doubts about vaccination have various causes and can be more or less pronounced. Some parents want to compare the risk of the disease with the risk of a vaccine reaction, others are worried about the number of vaccinations, and still others don’t know whether their child can be vaccinated after a recent infection. Listening to a question does not mean agreeing with false claims. It is enough to ask: “What worried you most?” That way, the doctor learns what information will actually be useful.

The first sentence: a firm recommendation that leaves room for questions

The doctor does not need to shift onto the parent the job of working out what is medically recommended for the child. It is better to say: “We’ve planned a vaccination for today’s appointment. I recommend it because it protects against a specific disease. What questions do you have?” A clear recommendation defines the professional’s role, but it does not take away the parent’s right to information and to a decision. If the parent hesitates, there is no point in repeating the recommendation more and more loudly. You need to find out the reason for the hesitation.

In 2013, Opel and colleagues analysed recordings of 111 conversations about childhood vaccinations in US practices. Starting by presenting vaccination as a planned part of the visit was associated with less resistance than an open question about whether the parent wanted to vaccinate at all. This was an observational study conducted within the US healthcare system, not proof that a single sentence will work in every consulting room. A later analysis also pointed out that accepting vaccination does not always go hand in hand with satisfaction with the visit. The practical conclusion is more modest, and more important: the doctor should speak clearly while also showing the parent respect.

What really lies behind the words “it’s dangerous”

“A friend told me her child had a fever after a vaccination.” The doctor might reply: “Fever can indeed occur after some vaccinations. Is it the fever itself that worries you, or its possible consequences?” A question like this does not diminish the concern. It opens up a conversation about expected reactions, symptoms that call for contacting a doctor and the child’s particular circumstances, in line with the information for the vaccine in question.

Another parent asks: “Can you guarantee that nothing will happen?” Answering “A hundred per cent, nothing will happen” would be dishonest. You could say: “No medical intervention comes with a guarantee of zero risk. I can explain the benefits and known side effects of this vaccine, and how that applies to your child’s situation.” If the parent refers to something they found online, it is worth asking what it actually said rather than guessing what they read. Sometimes a specific inaccuracy can be cleared up in a minute; sometimes a longer consultation is needed.

Three steps instead of a lecture: listen, explain, check

The principles of motivational interviewing point to a simple sequence: first recognise the other person’s perspective, then ask whether you may share some information, and finally check what it means for them. For example: “I hear that what worries you most is a reaction after the vaccination. May I explain what we know about reactions like that?” After a brief explanation: “Which part still raises questions for you?” This is not about avoiding a clear recommendation, but about reducing the risk that your answer misses the actual concern.

However, this sequence should not be treated as a foolproof method of obtaining consent. Studies of vaccination conversations differ in their methods, participants and outcome measures. A doctor’s communication behaviours can be practised, but no particular formula should be credited with promised success rates. The parent may need time to think, a conversation with the other parent or carer, or information relating to the child’s particular health condition. In that case, professionalism also means being able to say: “Let’s look into this carefully before we make a decision.”

How to correct misinformation without humiliating the parent

When a parent repeats a sensational claim, a long lecture about mistakes on the internet may fail to address their concern. A better response has three parts: accurate information, a brief explanation of where the misunderstanding may come from, and a pointer to a reliable source. Instead of “Only ignorant people write things like that”, you could say: “That claim isn’t supported by good-quality research. Let me explain what has been studied and what data the recommendation is based on.” If the question concerns a specific vaccine product, the answer should address that product, not vaccinations in general.

Doctors are entitled not to know everything off the top of their head. Rather than improvising risk figures, it is better to consult the current summary of product characteristics, the recommendations of the immunisation programme and recognised patient information materials. A sound correction does not require ridiculing the source or making assumptions about the other person’s intelligence. It is also worth separating the statement “we have no evidence of such a link” from the indefensible promise that no adverse reaction will ever occur.

If there is no consent today, the conversation doesn’t have to end in conflict

Not every consultation ends with the vaccine being given. The parent may need another conversation, and the doctor must meet the information and procedural requirements in line with current regulations and the child’s situation. A response such as “Come back when you’ve come to your senses” is unacceptable. You could sum up: “It matters to me that your child is protected. Today, the most important issue for you is safety. I’ll give you verified information, and we’ll agree when to come back to the decision.” A response like this does not play down the importance of vaccination; it leaves the way open for the next contact.

Before the appointment ends, it is worth asking what the parent remembers, what they would still like clarified and how they can get in touch if they have further questions. If there are contraindications, special indications or doubts about the child’s health, the course of action should be determined according to current clinical guidelines. The role of communication is to help the parent understand the recommendation and the reasons behind it, not to replace clinical judgement. The parent may leave not fully persuaded, but persuaded that their questions were taken seriously.

A good conversation about vaccination combines a clear recommendation with a willingness to listen to questions. You don’t have to choose between a professional recommendation and respect for the parent. It is worth identifying the single most important concern, answering it with verified information and ending the appointment with a concrete plan. Trust is built not by promising zero risk, but by being reliable.

How Em helps you prepare a response to a parent’s doubts

After a difficult on-call shift, a paediatrician keeps going back over the sentence “I don’t trust these vaccinations”. He reacted too sharply in the consulting room and wants to handle the next conversation differently. He describes the situation to Em without any details that would allow the family to be identified: what he said, what he heard, how much time he has for the appointment and what he wants to achieve. He asks for two versions of an opening: a short recommendation and a question that will help him identify the concern. He then practises responding to “It says something different online” and looks for an answer that doesn’t sound like a reprimand. Em helps him tell a factual correction apart from irony, structure what he says and end the appointment by inviting further questions. If the doctor knows his own communication tendencies, he can also look at whether, under stress, he starts speaking too quickly or too categorically. Checking clinical information, making the individual recommendation and taking medical decisions remain the doctor’s responsibility. With this kind of preparation, the doctor can communicate the recommendation clearly and give the parent time to ask questions.