Unvaccinated children in the pediatricians office.
November 27, 2012 10:56 AM   Subscribe

I'm expecting my first child next week and have chosen his pediatrician, but the doctor takes unvaccinated patients. How dangerous would it be to bring an unvaccinated newborn into this office?
posted by Circumstands to Health & Fitness (23 answers total) 4 users marked this as a favorite
Sorry, I didn't know doctors refusing patients on the basis of vaccination status was a thing. Or you know, walking the streets. I'd say you have equal risk of taking your newborn to the grocery store.
posted by DoubleLune at 11:01 AM on November 27, 2012 [5 favorites]

While it is possible that someone who isn't vaccinated against a particular illness could somehow be a carrier for said illness, it's not likely. People who are not (or in my case, people who absolutely cannot be) vaccinated are not automatically cesspools of illness and disease who can infect everyone around them.

Talk to this pediatrician about your concerns and call a few other pediatricians for their input. Ask them to explain vaccinations to you so you have a better idea of what fears are reasonable and what aren't. Putting your child in daycare or even among other children in general has plenty of risk but I've yet to hear a strong argument for isolating little kids from one another for that reason.

Congrats on the soon to be babe! :)
posted by These Birds of a Feather at 11:10 AM on November 27, 2012

I would be shocked to learn that any doctor turned away patients based on their vaccination status.

Your risk is the same in that doctor's office as it is in any other doctor's office.
posted by DWRoelands at 11:12 AM on November 27, 2012

My pediatrician would allow parents with newborns to sit in a separate little room away from the older kids. You might ask if they have a space that would work for this, or if you can wait in the car and have them call your phone when it's time to come in.

Honestly, overall I would worry less about the immunized kids in the waiting room and more about the germs you can't really immunize for anyway. if you keep baby in the carrier and drape a blanket over it while you're in the waiting room you're probably pretty well covered for germs. It's when they're older and squirming around touching all the things you really need to worry about the germs.

FWIW - there are Docs who don't take patients who refuse vaccination. But even those Docs would likely have patients who couldn't be immunized for various legitimate medical concerns.
posted by dadici at 11:12 AM on November 27, 2012 [1 favorite]

Sorry, I didn't know doctors refusing patients on the basis of vaccination status was a thing.

It actually is a thing. A very big contentious thing.

Your child is going to run into many unvaccinated people in many places --- some people who choose not to vaccinate and some people from places where vaccination isn't as easily done.

A newborn baby will also be at risk for anything someone in that office has. So, if someone is there to be seen for suspected pneumonia, or pink eye, or anything else contagious, your baby will be exposed to that as well.

There's no way around being exposed to sick people completely, and it's unfortunate that an increasing number of people are choosing not to vaccinate (pertussis scares the crap out of me, for example). But you'll find with babies that to the extent you can, you choose which risks to accept -- much like in other places of life.

If the risk of unvaccinated children in your pediatrician's office is too great for you, then you can find another pediatrician.
posted by zizzle at 11:13 AM on November 27, 2012 [1 favorite]

I am not a parent (yet! Expecting baby next week also!) but the family I used to work for would try to get the very first appointment of the day, for well baby visits, to minimize exposure to other patients.
posted by Swisstine at 11:18 AM on November 27, 2012 [9 favorites]

To me this would be a deal killer.

You don't have to take a newborn to the grocery store or the mall, but you do have to take them to the doctors' office, usually several times before they have their first set of shots. The risk of them interacting with unvaccinated kids who may have been exposed and incubating something is not something I would want to even touch.
posted by Leezie at 11:21 AM on November 27, 2012 [8 favorites]

I hear you. I was stressed about this too. I know of at least one case where a newborn got whooping cough from a kid in the doctor's waiting room.

However. Statistically -- not a big risk. You can, and perhaps should, ask to be scheduled as their very first appointment of the day.

I would also probably not work with a pediatrician who didn't require vaccines, because I like a low bullshit threshold. But even the strictest doctors sometimes share practices and waiting areas with other types.
posted by fingersandtoes at 11:24 AM on November 27, 2012 [3 favorites]

I wish my ped had the scheduling setup young rope-rider suggests. Maybe if you ask around (heck even ask your ped - she should know) you can find out whether any peds in your area segregate their newborn well visits like that.
posted by fingersandtoes at 11:33 AM on November 27, 2012

Yes, many pediatricians are refusing to see patients whose parents refuse vaccination for nonmedical reasons in part because of the increased risk to other patients. Last year, a small survey found that 30% of surveyed Connecticut pediatricians have dismissed families for this reason.

There is a slightly increased risk from being in a waiting room with ill, unvaccinated children. A pediatrician's office is not the same as any other environment, because it is full of children (a known and significant communicable disease vector) and sick children at that. Many areas in the U.S. are in the midst of pertussis epidemics, primarily due to vaccine refusers. Pertussis, or whooping cough, is a disease with a high mortality rate in infants, especially those under three months. Thus far in 2012, we have had 36,078 confirmed cases of pertussis, already more than twice the number in all of 2011, more than 3.5 times the number from ten years ago, and almost six times the number from 1993. Because of the growing pertussis epidemic, some physicians recommend keeping your newborns cocooned from all unvaccinated people for the first few months.

The increased risk may be balanced by other benefits of this pediatrician. Given the current pertussis epidemic, I would probably be looking for a new pediatrician unless there was a really good reason that you must see this one that counteracts the increased risk.
posted by grouse at 11:37 AM on November 27, 2012 [14 favorites]

Are you planning to breast-feed your baby? Breast milk supposedly strengthens newborns' immune systems. Whether you stick with this pediatrician or not when you do take your newborn in just make sure nobody in the waiting room gets too close and be sure to wash your hands.
posted by mareli at 11:41 AM on November 27, 2012

Best answer: Okay, so, one result of American peds practices moving toward blanket vaccination policies is that most cities wind up with only one or two practices that still take non-vaxxing families, so ALL the families in those communities that don't vaccinate will go to the same two doctors. And so the totally-unvaccinated rates of those practices are terrible. 50%, 60%, more. The odds of Disease X showing up in those waiting rooms is so much higher than the odds of that disease being present on any random street corner. This is the main thing I think people are not taking into account when they claim that the risk is not any higher than it is anywhere else.

Of course, luckily, non-vaccinating families are generally going to be disease-free, because so many other families around them do vaccinate, and they benefit from that herd immunity, but herd immunity is not magic, and its benefit declines when the population in question doesn't have great vaccination rates. Diseases can and do get passed around in low-vax waiting rooms. Famously, Dr. Bob Sears' waiting room was Ground Zero for a measles outbreak.

I consider myself skeptical and semi-well-read on the thorny topic of people who refuse (for non-health reasons) to vaccinate. My kid attends a hippie school where half the families do not vaccinate. I vaccinate the shit out of my kid, so I'm willing to take those odds, but if I had a newborn, I would feel differently. There are two main issues here:

First, what are the illnesses present in your community? Where I live, my main concern for an unvaccinated newborn would be pertussis. Pertussis can and does kill very new babies. And it is now endemic where I live, and people are bad at diagnosing it, and it is extremely contagious. So that would be something I would specifically ask the doctor about. I would not worry very much about measles or mumps or something, since the incidence of those diseases is much, much lower. But pertussis, that I would ask about.

Second, a sensible practice should have systems in place that minimize the risk to newborns (or any vulnerable patient) in the waiting room. You should ask about this. My script would be "I understand that there are a number of non-vaccinating families in your practice, and that pertussis is now endemic in our community. What are your methods for minimizing the risk of this kind of disease being present in your waiting room and transmitted to newborns?" The answers you want are "We have agreements with all our families to call ahead if they even suspect the child has something infectious" and "Newborns don't wait in the waiting room, they go directly to an exam room."

To put this another way, there are practices where I would be nearly 100% comfortable bringing an unvaccinated newborn, even if the practice had lots of unvaccinated families. And there are practices where I will not take my kid even now that he has had all his shots, because I think that the practice is unscientific and full of shit and doesn't understand disease transmission to even the minimal extent that this layperson does.
posted by thehmsbeagle at 11:41 AM on November 27, 2012 [23 favorites]

When little cestmoi was a newborn we would check into the peds office and be put in our own room right away. They also scheduled nbs first thing in the morning. We thought we were special the first few visits 'til we figureded it out;) ask what your peds policy is, they are very used to newborns.

Good Luck and get some sleep!
posted by cestmoi15 at 11:47 AM on November 27, 2012

I am not a parent, but HMSbeagle makes an excellent logical point - if this pediatrician is one of a few in your area that takes unvaccinated patients, there will be a higher concentration of unvaccinated children passing through. If no pediatricians screen for unvaccinated children in your area, this would be less of an issue. Pertussis is no joke, and if there are other options for a pediatrician in your area (one that does NOT take unvaccinated children) then I would switch.
posted by permiechickie at 11:49 AM on November 27, 2012 [1 favorite]

Yes, really the key point for me is how MANY unvaccinated families are at this practice. If all the anti-vax parents are concentrated at one or two practices (either because other doctors won't take them or because they all like the pro-woo attitude of those practices), that's when it's going to be a problem. We attend a medical school teaching pediatric practice that takes a strong pro-vaccination stance but I know they don't "fire" unvaccinated families for that alone (I know a couple of "slow-vax" families who go to this practice). But there are other practices that are a lot more popular with the anti-vax people (partly because this practice takes a strong pro-vaccination stance and they get patient-educated about it every visit), so I'm not too worried about it. Separate sick/well waiting rooms is a nice thing that a lot of baby books recommend, but I couldn't find a single practice locally with separate sick/well waiting rooms, even very large practices; it's just not a thing around here. (The practice I went to 30 years ago when *I* was a child had separate sick/well waiting rooms, however!)

If you know another parent who is an attachment parent or considers themselves crunchy/granola, they probably know where the local anti-vax parents hang out online (even if your friend herself is pro-vax). You can ask, or ask your friend to ask, "Which pediatricians do anti-vax or slow-vaxing families prefer around here?" to get an idea of where they're clustering. I mean, don't be dishonest, but just asking informationally is fine. I'm on my local AP list, and there are plenty of anti-vaxxers, and as long as you're not a jerk about it, people don't mind answering even if your goal is to avoid those practices.
posted by Eyebrows McGee at 12:02 PM on November 27, 2012 [1 favorite]

As a practical, short-term, solution, (AKA if you can't find a new pediatrician immediately) most doctor's offices will have a breastfeeding room. Check in, let the nurses know where you will be, and hole up in there.
posted by misterbrandt at 12:10 PM on November 27, 2012

Our ped office has 2 entrances, one for well babies, one for all the other children. So with your baby (and we are still doing it at 18 months), you wait in a separate waiting room (door to the outside and door to the inside), until your appt, and then you are whisked away to your exam room. In the exam room, I suppose you are as in as much risk as any exam room at any medical facility, at the mercy of the staff who have hopefully cleaned it. I don't know if this is standard practice at ped offices, but if I had to change drs, I would look for it at places I visited.
posted by snowymorninblues at 12:23 PM on November 27, 2012

Probably a small chance that your child could get a horrid disease, but I personally believe in minimizing as many risks as I can. I would change doctors. Good luck.
posted by roomthreeseventeen at 1:11 PM on November 27, 2012

Are you planning to breast-feed your baby? Breast milk supposedly strengthens newborns' immune systems.

This is true, but breastmilk is not magic. Breastfed babies still get whooping cough.

I think the things to consider are:
1. How many unvaccinated kids are there at the practice?
2. What is the whooping cough rate in your community currently? (some areas are much higher than others, remember also that [at least in Australia] babies are catching more whooping cough from adults than other children)
3. How often are you likely to take your kid to the Dr? For example, our daughter was very healthy, and only went in for vaccinations (until she split her head open two weeks ago, sigh).

For me, I would de facto uncomfortable, but maybe not to the point of switching, dependent on the questions above and how much I liked this doctor. Good luck.
posted by smoke at 2:14 PM on November 27, 2012

I'm a doctor and I just wanted to say good for you for being concerned about this. Folks above who think it's not a big deal probably never knew a newborn who got a fever in the first 60 or 90 days of their lives. It's a BIG DEAL. That newborn needs a full sepsis (bloodstream infection) workup including probably a spinal tap and an overnight stay in the hospital.

Bacteremia kills babies. Influenza kills babies. And it can be really hard to tell that babies are sick until they are really sick because they don't react like older human beings, even like toddlers or young children do when they are sick.

I'm expecting a baby soon myself and you'd better believe that no person with any symptoms of an infectious disease is coming anywhere near the baby (nor do I plan to be taking the baby out and about to any public places to the extent I can avoid it) until after that point.

Thanks for asking this btw because I learned a few interesting things about how pediatric practices are structured these days from the great answers upthread.
posted by treehorn+bunny at 8:32 PM on November 27, 2012 [4 favorites]

You can easily prevent contact between your newborn and any children in the waiting area; it's just as important to avoid getting exposed yourself. Keep that in mind. And please get an updated Dtap yourself.
posted by bq at 10:34 PM on November 27, 2012

We minimized contact for a fragile preemie with frequent clinic visits by keeping her in a sling so she was close to us and not in touching range of other people, bringing our own hand sanitiser and using it frequently before handling the baby, and by doing a two parent visit where one parent waited outside the clinic with the baby while the other parent did everything else - registering, picking up prescriptions etc - so the baby only went directly into an exam room, then immediately out of the clinic/hospital. No-one at the clinics ever commented on it, and I saw other parents doing the same small baby in-out dance.

The only thing I regret is not saying anything when a doctor didn't sanitise his hands inbetween patients, but I was too intimidated to say anything. It was once out of hundreds of medical interactions our daughter had, and nothing happened as a result, but I still wince for not speaking up.
posted by viggorlijah at 12:04 AM on November 28, 2012

I wouldn't go to a doctor that accepted anti-vax families into the practice.

Maybe this is unfair of me, but it would cause me to suspect the judgement of the doctor. Anti-vax is stupid and selfish, and a doctor that condones that just wouldn't have my trust.

Plus, as a kid, I remember that I always got sick after being dragged to the doctor's office with my younger siblings.
posted by gjc at 5:00 AM on November 28, 2012

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