EC Paediatrics

Importance: Health care professionals are increasingly encountering parents of newborns who decline well-established prophylactic and therapeutic interventions and shifts in public policy have led to a crisis. Concurrently, there is an increasing number of doctors who do not want to engage in persuasive dialogue with parents, and most concerning is the emergence of pediatricians who actively support or encourage refusal.

Observations: This state-of-the-art review examines clinician responses to tackle parental refusal, highlighting variation based on communication style and comfort level and consequences of clinician behavior. Ethical frameworks guiding clinician decision-making are examined, relevant literature is synthesized, and a nine-point practical toolkit is proposed to support providers managing refusals of intramuscular vitamin K, erythromycin ophthalmic prophylaxis, hepatitis B vaccination, and empiric antibiotic therapy.

Conclusion and Relevance: Clinician responses can be categorized into three groups, inspired by the Serenity Prayer: the non-confrontational Serenity group, the assertive and ethically grounded Courage group, and the pragmatic Selective group. This review identifies areas of accommodation that can be reached with parents without compromising newborn safety. It underscores the need for hospitals to prioritize parent education, support clinician advocacy, and protection against frivolous complaints, which can help mitigate rising physician cynicism. More proactive hospital engagement is essential to mitigate clinician discouragement and safeguard standards of newborn care.

 Keywords: Infant; Newborn; Vitamin K; Hepatitis B; Antibiotics; Erythromycin; Ethics

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