help with refusal to vax form- UPDATED

[ollineeba]

I know there have been a few other threads on this, but I didn't want to de-rail those posts, because I didn't think it would be fair to the OP.. so..

My dd is almost 2. She hasn't had any vaccinations. We're still doing our research but we do not want to vaccinate at this point.
At every appointment we've just said "We're not vaccinating today." and we were always met with the response, "okay."

When we took dd to her 18 month visit in May, the pediatrician and I discussed this. She was not supportive of the delay vaxxing (I let her think that we were just delaying as opposed to skipping them altogether), but didn't push the issue.
She gave me a form that she wanted me to sign on the spot. I know most of you have seen it before- basically that I understand the great risk I am putting my child in, blah, blah, blah. I told her I'd like to show DH the form. She said "That's fine. Sign it now and I will go make a copy that you can take home." I said, "No, I will take it home and show DH and sign it after he's had a chance to read it." She wasn't pleased, but left it at that.
Needless to say, we never signed it or returned it.
DD is supposed to go to her 2 yr appointment on the 28th of this month. I know that they will tell us to sign it.. or leave.
I mostly like this pediatrician.. she is really into breastfeeding (she used to talk to dd when she was an infant about how beautifully fast she was growing, thanks to mama's super milk ) and she supports our co-sleeping and everything.
We're in sync in every other aspect. She has been so helpful with my ds who is speech delayed and didn't potty learn until 4.5 years. She always reassured me that we needed to follow his lead and not put him on a timetable.. and what he was doing was normal for him. He was fully-vaxxed, so she is probably wondering what the heck I'm doing now with dd.
I don't really want to leave the practice.. but it looks like it might come to that.

Could I really cross off some of the lines on the form? Would they even accept that??
It really makes me second-guess myself when I talk to her.. because like I said, we're so in agreement on every other aspect..
I don't know
I know all that matters is that I look out for my daughter's best interests, but I don't think there is even a better option around here, from my conversations with other parents
Help.

[LongIsland]

Even the AAP states on their website that the form can be altered to suit your needs - they don't see it as an all or nothing form. I'll get you the link.

[Gitti]

I would say the delayed speech in your son is vaccine damage. JMO.

As for everything else, why bother going to wbv? And why worry about what the ped wants, you should only be concerned about keeping your child safe.

[LongIsland]

This form may be duplicated or changed to suit your needs and your patients' needs.
http://www.cispimmunize.org/pro/pdf/...%204-11-06.pdf

There's nothing wrong with the ped having some sort of documentation of refusal, but that particular "neglect" portion needs to be removed or crossed out - if the ped refuses to allow you to do that, then you should leave without hesitation.

And I agree with Gitti on well baby visits. You were just at the ped's 6 months ago. If he's healthy, there's no reason to go. He's old enough to stand on a scale.

[Ruthla]

I simply crossed off the lines that said "I know I'm putting my kids at risk by not vaccinating yada yada yada" and initialed where I changed the form.

I fully agree that the ped has told me about the vaccine(s), recomends that I let them be administered to my child, I know that the AAP also recomends the vaccine(s) at this time, and that am making the decision not to let my child receive the vaccine(s) at this time.

The main point of the form is to document that the dr didn't "forget" to offer the vaccine(s).

[ollineeba]

Originally Posted by Gitti

I would say the delayed speech in your son is vaccine damage. JMO.

As for everything else, why bother going to wbv? And why worry about what the ped wants, you should only be concerned about keeping your child safe.

This first comment is what keeps me awake at night I've suspected that for a while now. That's actually what brought me here. It's more than just the speech.. it's attention span, hyperactivity.. :

Anyway, thank you for your response. I am, obviously, most concerned about keeping my daughter safe.. I guess I was curious as to what reaction I might be able to expect from the pediatrician if I take a pen and cross off a significant portion of the refusal form.

[ollineeba]

Originally Posted by LongIsland

This form may be duplicated or changed to suit your needs and your patients' needs.
http://www.cispimmunize.org/pro/pdf/...%204-11-06.pdf

There's nothing wrong with the ped having some sort of documentation of refusal, but that particular "neglect" portion needs to be removed or crossed out - if the ped refuses to allow you to do that, then you should leave without hesitation.

And I agree with Gitti on well baby visits. You were just at the ped's 6 months ago. If he's healthy, there's no reason to go. He's old enough to stand on a scale.

Thank you for the link. I will print it off and make the necessary changes.
I appreciate your help.

[ollineeba]

Originally Posted by Ruthla

I simply crossed off the lines that said "I know I'm putting my kids at risk by not vaccinating yada yada yada" and initialed where I changed the form.

I fully agree that the ped has told me about the vaccine(s), recomends that I let them be administered to my child, I know that the AAP also recomends the vaccine(s) at this time, and that am making the decision not to let my child receive the vaccine(s) at this time.

The main point of the form is to document that the dr didn't "forget" to offer the vaccine(s).

Ok.. thanks

[LongIsland]

Originally Posted by mama2babybeans

Thank you for the link. I will print it off and make the necessary changes.
I appreciate your help.

Take a copy of that AAP link with you to the peds so you can show them if they initially balk at your changes.

PLEASE let us know what happens!

[ollineeba]

Originally Posted by LongIsland

Take a copy of that AAP link with you to the peds so you can show them if they initially balk at your changes.

PLEASE let us know what happens!

I will. Thank you so much for taking the time to help me

[LongIsland]

Originally Posted by mama2babybeans

I will. Thank you so much for taking the time to help me

No problem

I wanted to ask you though - will you be offering up the form or will you wait until (or if) they mention it?

[suschi]

As others have pointed out, that form can be modified to suit your needs.

Here's the way I modified it,

************************************************** ***

Consent Declined for Vaccines

Child’s Name: _________________________Child’s ID #_______________________

Parent’s/Guardian’s Name(s):__________________________________________ ___

My child’s health care provider, _________________has advised me that my child (named above)
should receive the following vaccines:
Recommended Declined
Hepatitis B vaccine .
Diphtheria, Tetanus, acellular Pertussis (DTaP) vaccine .
Diphtheria Tetanus (DT or dT) vaccine .
Haemophilus influenzae type b (Hib) vaccine .
Pneumococcal conjugate vaccine .
Polio vaccine (IPV) .
Measles, mumps, rubella (MMR) vaccine .
Varicella (chickenpox) vaccine .
Influenza (flu) vaccine .
Meningococcal vaccine .
Hepatitis A vaccine .
Other __________________________________________

I have read the Centers for Disease Control and Prevention’s (CDC) Vaccine Information Sheet(s) explaining the vaccine(s) and the disease(s) they prevent. I have had the opportunity to discuss these with my child’s health care provider, who has answered all of my questions regarding the recommended vaccine(s). I understand the following:
The intended purpose of recommending the above listed vaccine(s)
The risks and benefits of the recommended vaccine(s)
If my child does not receive the vaccine(s), the consequences may include:
-Contracting the illness the vaccine should prevent. (the outcomes of these illnesses may include one or more of the following: pneumonia, illness requiring hospitalization, death, brain damage, meningitis, seizures and deafness. Other severe and permanent effects from these vaccine-preventable diseases are possible as well)
-transmitting the disease to others
-the need for my child to stay out of daycare of school during disease outbreaks

If my child does receive the vaccine(s), the consequences may include:
-Contracting the illness the vaccine should have prevented
-Transmitting the disease to others
-Suffering from any of the adverse events listed in the package insert(s) and possibly adverse events not yet listed and/or associated with the vaccine. (the outcomes of these adverse events may include one or more of the following: illness requiring hospitalization, death, brain damage, meningitis, seizures and deafness. Other severe and permanent effects from these vaccines are possible as well)
-Chronic illness and/or death

My health care provider, the American Academy of Pediatrics, the American Academy of Family Physicians, and the Centers for Disease Control and Prevention have all strongly recommended that the vaccine(s) be given based on the information they have been given by the drug companies producing the vaccines.
I am not giving consent for the vaccine(s) recommended for my child, as indicated above, by checking the appropriate box under the column titled “Declined.”

I know I may re-address this issue with my health care provider at any time.

I acknowledge that I have read this document in its entirety and fully understand it.

Parent/Guardian Signature ________________________________ Date ___________________


Witness ______________________________________________ Date ___________________

Modified from original form:

http://www.cispimmunize.org/pro/doc/...oVaccinate.doc

[spero]

LI once advised me to submit a short letter, instead. I'll see if I can find the link.

Here it is:
http://www.mothering.com/discussions...l+to+vaccinate

I intend to do that the next time it comes up with the ped. (Long story short - we stopped vaxing when our youngest was due for her kindergarten vaxes. They asked me to sign a refusal to vaccinate form - though NOT the AAP form - and I stupidly did. This year, for her appt, I brought the modified AAP form - which they hadn't ever seen - and the accompanying guidelines from the link so they would know I was within my rights to modify it. My other three kids have no RtV forms in their files yet - I will do the letter for them.)

[LongIsland]

Originally Posted by skellbelle

LI once advised me to submit a short letter, instead.

I just wanted to add that even though exemptions are for school and I'm not obligated to provide my ped with one, I have my older son's school religious exemption letter and the school district's approval letter in my kids' files -- there's no need for the doc to ask me to sign the AAP form with a copy of the exemption in there.

Also, in case of an emergency and I'm not around, at least it's more likely my ped's office will mention our religious objection to ER staff when the ER personnel ask for tetanus vax history, particularly since the letter is right smack in front of vax history sheet.

[ollineeba]

Originally Posted by LongIsland

No problem

I wanted to ask you though - will you be offering up the form or will you wait until (or if) they mention it?

I'm really hoping it won't come up.. a little naive, maybe
I'm going to bring it, though, just in case.. I will keep it folded in the diaper bag.

The AAP form looks just like the form from our pediatrician's office.. I'm pretty sure it's the same one. So I'm not sure if it would be better to print it off with certain parts actually deleted or to print it off as-is and then cross off those sections with pen.
I'm leaning towards just deleting them so that it doesn't draw any attention.. thoughts?

[ollineeba]

LI- what were your thoughts on the altered form that suschi composed in that thread? Do you think it would be better to bring that one?

[ollineeba]

Originally Posted by skellbelle

LI once advised me to submit a short letter, instead. I'll see if I can find the link.

Here it is:
http://www.mothering.com/discussions...l+to+vaccinate

I intend to do that the next time it comes up with the ped. (Long story short - we stopped vaxing when our youngest was due for her kindergarten vaxes. They asked me to sign a refusal to vaccinate form - though NOT the AAP form - and I stupidly did. This year, for her appt, I brought the modified AAP form - which they hadn't ever seen - and the accompanying guidelines from the link so they would know I was within my rights to modify it. My other three kids have no RtV forms in their files yet - I will do the letter for them.)

Thanks for the info I appreciate the first-hand experience!

[ollineeba]

UPDATE...:

So today was my daughter's 2 year appointment. The nurse called me yesterday to ask me about what I had decided to do about the vaccines and bringing the form back. I told her that we would not be vaccinating, but I would be bringing the form they had requested and she said that was fine. She asked if we would ever be vaccinating and I told her honestly, "I don't know. But we won't be vaccinating at this appointment." She was pleasant about it.

Towards the end of our appointment, our ped looked at the form and noticed that I crossed off the line towards the end about acknowledging that death could occur as a result of one of the diseases.
She was NOT pleased. I pointed out that the AAP states that the form can be edited to suit the patient or doctor's needs (I brought the whole document and had that part highlighted). She said that they are now being advised not to accept anything other than the official form in its full content. She said that she has four children and can't risk putting everything she has in jeopardy. That it needs to be known that she told me my child could die from one of those awful diseases.

She asked why I would cross that out. I told her that I didn't agree with what I was signing my name to and I was also advised to do that by friends who have done the same and also do not vax. She said she had never heard of such a thing : and pushed WHY would we need to do that? To counter her previous comment about putting her job & family in jeopardy, I told her that I was protecting the same thing. I told her that I didn't want to risk anything, either, and that I didn't even agree with the form in the first place. I told her it was completely one-sided and didn't list the risks of the vaccines themselves. She said that's because there has never been a death as a result of a vaccine. There have been seizures and fevers. I told her I didn't believe that to be the case because I know someone who actually received a settlement from the vaccine compensation board (a fib, but I know there is a mama here who did.. but it helped to prove my point). She said the risks of the vaccines would have nothing to do with her and shouldn't be on the form because they would be handled through the vaccine compensation board.
I told her that by crossing off that particular line, I was also protecting myself.. She said that CPS has never messed with a family for not vaccinating and that was just a rumor. She told me that she needed to have the form in its full content with nothing crossed out to continue being our pediatrician.
I told her that I would only do that if I could add a large portion detailing the risks of the vaccines themselves. She thought about it for a minute and told me that I could do that and she would review it and then let me know whether or not she would accept it.

We also talked about the specific vaccines and it was just so frustrating! For example, we talked about the chicken pox vaccine (DH and I know for sure that we will never get dd the chicken pox or the flu shots). I asked her why get the vaccine as a child if it doesn't confer lifelong immunity? She told me about the booster shot and now with those 2 shots, they have immunity. I asked her, "Well, if A caught it naturally, what would be the best age?" and she looked at me like I was crazy. She said, "We do NOT recommend that."
At this point, I feel like I'm bending over backwards to make the Dr. happy and I'm not pleased about it. After talking to DH, we've decided that we won't do that and I will call this week to request our records. I don't know who we will see now and I'm not confident that we will be able to find what we're looking for
But I thought I would update this to let you all know what happened..:

[wonderwahine]

drop that ped right now! This is your child, not hers, who cares what she thinks. Do not try to make your Dr happy, go with your gut!

you really need to find a new ped or perhap just stop WBV's alltogether.

[ollineeba]

Originally Posted by romans_mum

drop that ped right now! This is your child, not hers, who cares what she thinks. Do not try to make your Dr happy, go with your gut!

you really need to find a new ped or perhap just stop WBV's alltogether.

Yes.. we are definitely dropping her. I'm actually looking forward to that phone call (DH thinks I'm confrontational, but I have no idea what he's talking about! )