Case Scenario: Parental Refusal of Flu Vaccination for a Child

Summary:

This scenario involves counseling a parent who is hesitant about vaccinating their child with the flu vaccine. The key aspects of this station include addressing parental concerns, ensuring vaccine safety, and providing clear, evidence-based information while maintaining a patient-centered approach.

Key Points:

Understanding the Parent’s Concern

• The parent has a misconception linking flu vaccination to epilepsy.

• Immediate response should be: "Can you tell me why you are concerned about the vaccine?"

• Identify and address the misinformation directly.

Assessing Suitability for Vaccination

• Always confirm contraindications:

  • Egg allergy

  • Neomycin allergy

  • Immunocompromised state

  • Current infections (fever, flu-like symptoms, diarrhea, vomiting)

• Ensure a focused approach to history taking.

• Confirm the child's age, even if stated in the case notes.

Explaining the Flu Vaccine

• Mechanism: A weakened form of the virus that helps build immunity.

• Safety Profile:

  • No established link with epilepsy.

  • Mild side effects such as temporary flu-like symptoms.

• Benefits Over Risks:

  • Protection against severe flu complications (pneumonia, bronchitis, ear infections).

  • Helps prevent outbreaks.

Handling Treatment Refusal

• Ethical Consideration:

  • Parents have the right to refuse, but informed refusal is key.

  • Emphasize consequences of non-vaccination: increased risk of severe illness.

  • Vaccination is not legally compulsory, but highly recommended.

• Communication Strategy:

  • Do not be forceful—instead, highlight benefits over risks.

  • Use leaflets and additional resources for further guidance.

Diagnostic Approach:

1. Confirm child’s history:

   • Any allergies, chronic illnesses, or immunocompromised conditions.

   • Recent infections.

2. Explore parental concerns:

   • Ask directly about reasons for refusal.

   • Identify misinformation.

3. Assess knowledge gaps:

   • Ensure parents understand the actual risks and benefits of the vaccine.

Management:

• Counsel on vaccine benefits and safety.

• Address misconceptions clearly.

• Explain side effects vs. severe complications of flu.

• Assess child's eligibility for vaccination.

• Offer reassurance and safety-netting.

• Provide written materials for further reading.

• If the parent remains unwilling, respect their decision but document discussion.

Communication Skills:

• Listen actively—let the parent speak without interruption.

• Acknowledge concerns before providing information.

• Use simple language, avoiding medical jargon.

• Check understanding by asking, “Does that make sense to you?”

• Maintain a non-judgmental, supportive tone.

Ethical Considerations:

• Parental autonomy vs. child's best interest.

• Avoid coercion while ensuring informed decision-making.

• Explain public health implications—herd immunity is crucial for some vaccines (e.g., MMR), but flu vaccine is more individual protection.

Additional Resources:

• NHS Flu Vaccination Guidelines

• GMC Guidance on Shared Decision Making

• WHO Vaccine Safety Information

Examiner’s Key Tips (Based on PLAB 2 Guidelines):

• Stay focused—avoid irrelevant history (e.g., fixating on epilepsy).

• Ensure structured communication—address concerns before history taking.

• Check vaccine eligibility—allergy and immunocompromised status are crucial.

• Be aware of time management—don’t get stuck on unnecessary details​​.