Immunizations Updates: Motivational Interviewing in Vaccine Hesitancy: Case Studies with Dr. Maddie Manfredi (S13 Ep. 87)

In the last episode of our mini-series on Immunizations Updates, we are joined again by pediatric nurse practitioner, Dr. Maddie Manfredi, for a live role-play extended episode focused on motivational interviewing (MI) in the setting of vaccine hesitancy. During 5 cases built around common worries surrounding pediatric vaccines, Dr. Manfredi uses evidence-based approaches to explore hesitancy and reach a common goal– a child’s health and well-being. The cases cover: - Immune system overload - Misinformation and distrust - The autism myth - Preference for a natural lifestyle - Low risk disease perception This episode demonstrates what a therapeutic relationship looks like and how to navigate real-world conversations with caregivers across a spectrum of hesitancy. Through five case-based scenarios, listeners will hear MI techniques applied in real time and walk away with practical scripts and strategies to use in clinical encounters. Website: www.thepedsnp.com Contact: [email protected] Instagram: @thepedsnppodcast    AACN Essentials Mapping (Domain. sub-competency):  1.1f, 1.2g 2.2c, 2.2f, 2.3b, 2.4e  3.1a, 3.2b, 3.3d  4.1a, 4.1d, 4.2c  5.1b, 5.2a, 5.3c  6.2b, 6.3a  7.1c, 7.2d  8.2c, 8.3d  9.1a, 9.2f, 9.3c  10.2a, 10.2d, 10.3b   References: Bernstein, T. A., Broome, M., Millman, J., Epstein, J., & Derouin, A. (2022). Promoting strategies to increase HPV vaccination in the pediatric primary care setting. Journal of Pediatric Health Care, 36(2), e36–e41. https://doi.org/10.1016/j.pedhc.2021.10.009 Bullen, M., Heriot, G.S., & Jamrozik, E. (2023). Herd immunity, vaccination and moral obligation. Journal of Medical Ethics, 49(9), 636–641. https://doi.org/10.1136/jme-2022-108485 Braun, C., & O'Leary, S. T. (2020). Recent advances in addressing vaccine hesitancy. Current Opinion in Pediatrics, 32(4), 601–609. https://doi.org/10.1097/MOP.0000000000000929 Brewer, N. T., Chapman, G. B., Rothman, A. J., Leask, J., & Kempe, A. (2017). Increasing vaccination: Putting psychological science into action. Psychological Science in the Public Interest: A Journal of the American Psychological Society, 18(3), 149–207. https://doi.org/10.1177/1529100618760521  Brewer, N. T. (2021). What works to increase vaccine uptake. Academic Pediatrics, 21(4S), S9-S16. https://doi.org/10.1016.j.acap.2021.01.017 Centers for Disease Control and Prevention. (2024a, August 9). Reasons to vaccinate. https://www.cdc.gov/vaccines-children/reasons/index.html Centers for Disease Control and Prevention. (2024c). Talking with parents about vaccines. https://www.cdc.gov/vaccines-children/hcp/conversation-tips/index.html Eagan, R.L., Larson, H.J., & de Figueiredo, A. (2023). Recent trends in vaccine coverage and confidence: A cause for concern. Human Vaccines & Immunotherapeutics, 19(2), 2237374. https://doi.org/10.1080/21645515.2023.2237374 Frew, P.M., & Lutz, C.S. (2017). Interventions to increase pediatric vaccine uptake: An overview of recent findings. Human Vaccines & Immunotherapeutics, 13(11), 2503-2511. https://doi.org/10.1080/21645515.2017.1367069 Gagneur, A., Gutnick, D., Berthiaume, P., Diana, A., Rollnick, S., & Saha, P. (2024). From vaccine hesitancy to vaccine motivation: A motivational interviewing based approach to vaccine counselling. Human Vaccines & Immunotherapeutics, 20(1), 2391625. https://doi.org/10.1080/21645515.2024.2391625 Jarrett, C., Wilson, R., O'Leary, M., Eckersberger, E., Larson, H. J., & SAGE Working Group on Vaccine Hesitancy. (2015). Strategies for addressing vaccine hesitancy - A systematic review. Vaccine, 33(34), 4180–4190. https://doi.org/10.1016/j.vaccine.2015.04.040 Kestenbaum, L. A., & Feemster, K. A. (2015). Identifying and addressing vaccine hesitancy. Pediatric Annals, 44(4), e71–e75. https://doi.org/10.3928/00904481-20150410-07 Lafnitzegger, A., & Gaviria-Agudelo, C. (2022). Vaccine hesitancy in pediatrics. Advances in pediatrics, 69(1), 163–176. https://doi.org/10.1016/j.yapd.2022.03.011 Limaye, R. J., Opel, D. J., Dempsey, A., Ellingson, M., Spina, C., Omer, S. B., Dudley, M. Z., Salmon, D. A., & Leary, S. O. (2021). Communicating with vaccine-hesitant parents: A narrative review. Academic pediatrics, 21(4S), S24–S29. https://doi.org/10.1016/j.acap.2021.01.018 McClure, C. C., Cataldi, J. R., & O'Leary, S. T. (2017). Vaccine hesitancy: Where we are and where we are going. Clinical Therapeutics, 39(8), 1550–1562. https://doi.org/10.1016/j.clinthera.2017.07.003 Mical, R., Martin-Velez, J., Blackstone, T., & Derouin, A. (2021). Vaccine hesitancy in rural pediatric primary care. Journal of Pediatric Health Care, 35(1), 16–22. https://doi.org/10.1016/j.pedhc.2020.07.003 Minta, A. A., Ferrari, M., Antoni, S., Lambert, B., Sayi, T. S., Hsu, C. H., Steulet, C., Gacic-Dobo, M., Rota, P. A., Mulders, M. N., Wimmer, A., Bose, A. S., O'Connor, P., & Crowcroft, N. S. (2024). Progress toward measles elimination - Worldwide, 2000-2023. MMWR. Morbidity and Mortality Weekly Report, 73(45), 1036–1042. https://doi.org/10.15585/mmwr.mm7345a4 Nandi, A., & Shet, A. (2020). Why vaccines matter: understanding the broader health, economic, and child development benefits of routine vaccination. Human Vaccines & Immunotherapeutics, 16(8), 1900-1904. https://doi.org/10.1080/21645515.2019.1708669  Nyhan, B., Reifler, J., Richey, S., & Freed, G. L. (2014). Effective messages in vaccine promotion: A randomized trial. Pediatrics, 133(4), e835–e842. https://doi.org/10.1542/peds.2013-2365 Obohwemu, K., Christie-de Jong, F., & Ling, J. (2022). Parental childhood vaccine hesitancy and predicting uptake of vaccinations: a systematic review. Primary Health Care Research & Development, 23, e68. https://doi.org/10.1017/S1463423622000512  Offit, P. A., & Moser, C. A. (2009). The problem with Dr Bob's alternative vaccine schedule. Pediatrics, 123(1), e164–e169. https://doi.org/10.1542/peds.2008-2189  O'Leary, S. T., Opel, D. J., Cataldi, J. R., Hackell, J. M.; Committee on Infection Diseases, Committee on Practice and Ambulatory Medicine, & Committee on Bioethics. (2024). Strategies for improving vaccine communication and uptake. Pediatrics, 153(3), e2023065483. https://doi.org/10.1542/peds.2023-065483 Opel, D. J., Heritage, J., Taylor, J. A., Mangione-Smith, R., Salas, H. S., DeVere, V., Zhou, C., & Robinson, J. D. (2013). The architecture of provider-parent vaccine discussions at health supervision visits. Pediatrics, 132(6), 1037–1046. https://doi.org/10.1542/peds.2013-2037 Opel, D. J., Mangione-Smith, R., Robinson, J.D., Heritage, J., DeVere, V., Salas, H.S., Zhou, C., & Taylor, J. A. (2015). The influence of provider communication behaviors on parental vaccine acceptance and visit experience. American Journal of Public Health, 105(10), 1998–2004. https://doi.org/10.2105/AJPH.2014.302425 Petca, A., Borislavschi, A., Zvanca, M. E., Petca, R. C., Sandru, F., & Dumitrascu, M. C. (2020). Non-sexual HPV transmission and role of vaccination for a better future (Review). Experimental and therapeutic medicine, 20(6), 186. https://doi.org/10.3892/etm.2020.9316  Shattock, A. J., Johnson, H. C., Sim, S. Y., Carter, A., Lambach, P., Hutubessy, R. C. W., Thompson, K. M., Badizadegan, K., Lambert, B., Ferrari, M. J., Jit, M., Fu, H., Silal, S. P., Hounsell, R. A., White, R. G., Mosser, J. F., Gaythorpe, K. A. M., Trotter, C. L., Lindstrand, A., O'Brien, K. L., Bar-Zeev, N. (2024). Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization. Lancet (London, England), 403(10441), 2307–2316. https://doi.org/10.1016/S0140-6736(24)00850-X Smith M. J. (2015). Promoting vaccine confidence. Infectious Disease Clinics of North America, 29(4), 759–769. https://doi.org/10.1016/j.idc.2015.07.004 Songol, A., Amiri-Farahani, L., Haghani, S., Pezaro, S., & Omrani Saravi, S. (2023). Comparing the effect of parental education via both lecture and film upon vaccination uptake for children under one year of age: A cluster randomized clinical trial. Vaccine, 41(5), 1067-1073. https://doi.org/10.1016/j.vaccine.2022.12.012 Szilagyi, P. G., Albertin, C. S., Gurfinkel, D., Saville, A. W., Vangala, S., Rice, J. D., Helmkamp, L., Zimet, G. D., Valderrama, R., Breck, A., Rand, C. M., Humiston, S. G., & Kempe, A. (2020). Prevalence and characteristics of HPV vaccine hesitancy among parents of adolescents across the US. Vaccine, 38(38), 6027–6037. https://doi.org/10.1016/j.vaccine.2020.06.074 World Health Organization. (n.d.). A brief history of vaccines. https://www.who.int/news-room/spotlight/history-of-vaccination/a-brief-history-of-vaccination World Health Organization. (2015, August 18). Vaccine hesitancy: A growing challenge for immunization programmes. https://www.who.int/news/item/18-08-2015-vaccine-hesitancy-a-growing-challenge-for-immunization-programmes World Health Organization. (2019). Ten threats to global health in 2019. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019 Zhou, F., Jatlaoui, T. C., Leidner, A. J., Carter, R. J., Dong, X., Santoli, J. M., Stokley, S., Daskalakis, D. C., & Peacock, G. (2024). Health and economic benefits of routine childhood immunizations in the era of the vaccines for children program - United States, 1994-2023. MMWR. Morbidity and Mortality Weekly Report, 73(31), 682–685. https://doi.org/10.15585/mmwr.mm7331a2  

As we continue on in our mini series on Immunizations Updates, we are joined by pediatric nurse practitioner Dr. Maddie Manfredi to explore the growing challenge of vaccine hesitancy. Together we will review the profound public health impact of immunizations, define vaccine hesitancy as a spectrum of decision-making rather than simple refusal, and discuss its implications for herd immunity and pediatric outcomes. Dr. Manfredi shares findings from her DNP project, including the use of a novel Caregiver Vaccine Readiness Survey to proactively identify concerns and guide more tailored, patient-centered conversations using motivational interviewing. We’ll highlight the critical role of provider communication in building trust, addressing caregiver concerns, and improving vaccine acceptance, with promising results shared from a DNP project on MMR vaccine acceptance. The episode underscores that how we communicate matters just as much as what we say and invites listeners to rethink traditional approaches in today’s complex sociopolitical landscape. Stay tuned for the next episode, where Dr. Carson and Dr. Manfredi model motivational interviewing strategies through case-based role play. Website: www.thepedsnp.com Contact: [email protected] Instagram: @thepedsnppodcast    AACN Essentials Mapping (Domain. sub-competency):  1.1f, 1.2g 2.2c, 2.2f, 2.3b, 2.4e  3.1a, 3.2b, 3.3d  4.1a, 4.1d, 4.2c  5.1b, 5.2a, 5.3c  6.2b, 6.3a  7.1c, 7.2d  8.2c, 8.3d  9.1a, 9.2f, 9.3c  10.2a, 10.2d, 10.3b   References: Bernstein, T. A., Broome, M., Millman, J., Epstein, J., & Derouin, A. (2022). Promoting strategies to increase HPV vaccination in the pediatric primary care setting. Journal of Pediatric Health Care, 36(2), e36–e41. https://doi.org/10.1016/j.pedhc.2021.10.009 Bullen, M., Heriot, G.S., & Jamrozik, E. (2023). Herd immunity, vaccination and moral obligation. Journal of Medical Ethics, 49(9), 636–641. https://doi.org/10.1136/jme-2022-108485 Braun, C., & O'Leary, S. T. (2020). Recent advances in addressing vaccine hesitancy. Current Opinion in Pediatrics, 32(4), 601–609. https://doi.org/10.1097/MOP.0000000000000929 Brewer, N. T., Chapman, G. B., Rothman, A. J., Leask, J., & Kempe, A. (2017). Increasing vaccination: Putting psychological science into action. Psychological Science in the Public Interest: A Journal of the American Psychological Society, 18(3), 149–207. https://doi.org/10.1177/1529100618760521  Brewer, N. T. (2021). What works to increase vaccine uptake. Academic Pediatrics, 21(4S), S9-S16. https://doi.org/10.1016.j.acap.2021.01.017 Centers for Disease Control and Prevention. (2024a, August 9). Reasons to vaccinate. https://www.cdc.gov/vaccines-children/reasons/index.html Centers for Disease Control and Prevention. (2024c). Talking with parents about vaccines. https://www.cdc.gov/vaccines-children/hcp/conversation-tips/index.html Eagan, R.L., Larson, H.J., & de Figueiredo, A. (2023). Recent trends in vaccine coverage and confidence: A cause for concern. Human Vaccines & Immunotherapeutics, 19(2), 2237374. https://doi.org/10.1080/21645515.2023.2237374 Frew, P.M., & Lutz, C.S. (2017). Interventions to increase pediatric vaccine uptake: An overview of recent findings. Human Vaccines & Immunotherapeutics, 13(11), 2503-2511. https://doi.org/10.1080/21645515.2017.1367069 Gagneur, A., Gutnick, D., Berthiaume, P., Diana, A., Rollnick, S., & Saha, P. (2024). From vaccine hesitancy to vaccine motivation: A motivational interviewing based approach to vaccine counselling. Human Vaccines & Immunotherapeutics, 20(1), 2391625. https://doi.org/10.1080/21645515.2024.2391625 Jarrett, C., Wilson, R., O'Leary, M., Eckersberger, E., Larson, H. J., & SAGE Working Group on Vaccine Hesitancy. (2015). Strategies for addressing vaccine hesitancy - A systematic review. Vaccine, 33(34), 4180–4190. https://doi.org/10.1016/j.vaccine.2015.04.040 Kestenbaum, L. A., & Feemster, K. A. (2015). Identifying and addressing vaccine hesitancy. Pediatric Annals, 44(4), e71–e75. https://doi.org/10.3928/00904481-20150410-07 Lafnitzegger, A., & Gaviria-Agudelo, C. (2022). Vaccine hesitancy in pediatrics. Advances in pediatrics, 69(1), 163–176. https://doi.org/10.1016/j.yapd.2022.03.011 Limaye, R. J., Opel, D. J., Dempsey, A., Ellingson, M., Spina, C., Omer, S. B., Dudley, M. Z., Salmon, D. A., & Leary, S. O. (2021). Communicating with vaccine-hesitant parents: A narrative review. Academic pediatrics, 21(4S), S24–S29. https://doi.org/10.1016/j.acap.2021.01.018 McClure, C. C., Cataldi, J. R., & O'Leary, S. T. (2017). Vaccine hesitancy: Where we are and where we are going. Clinical Therapeutics, 39(8), 1550–1562. https://doi.org/10.1016/j.clinthera.2017.07.003 Mical, R., Martin-Velez, J., Blackstone, T., & Derouin, A. (2021). Vaccine hesitancy in rural pediatric primary care. Journal of Pediatric Health Care, 35(1), 16–22. https://doi.org/10.1016/j.pedhc.2020.07.003 Minta, A. A., Ferrari, M., Antoni, S., Lambert, B., Sayi, T. S., Hsu, C. H., Steulet, C., Gacic-Dobo, M., Rota, P. A., Mulders, M. N., Wimmer, A., Bose, A. S., O'Connor, P., & Crowcroft, N. S. (2024). Progress toward measles elimination - Worldwide, 2000-2023. MMWR. Morbidity and Mortality Weekly Report, 73(45), 1036–1042. https://doi.org/10.15585/mmwr.mm7345a4 Nandi, A., & Shet, A. (2020). Why vaccines matter: understanding the broader health, economic, and child development benefits of routine vaccination. Human Vaccines & Immunotherapeutics, 16(8), 1900-1904. https://doi.org/10.1080/21645515.2019.1708669  Nyhan, B., Reifler, J., Richey, S., & Freed, G. L. (2014). Effective messages in vaccine promotion: A randomized trial. Pediatrics, 133(4), e835–e842. https://doi.org/10.1542/peds.2013-2365 Obohwemu, K., Christie-de Jong, F., & Ling, J. (2022). Parental childhood vaccine hesitancy and predicting uptake of vaccinations: a systematic review. Primary Health Care Research & Development, 23, e68. https://doi.org/10.1017/S1463423622000512  O'Leary, S. T., Opel, D. J., Cataldi, J. R., Hackell, J. M.; Committee on Infection Diseases, Committee on Practice and Ambulatory Medicine, & Committee on Bioethics. (2024). Strategies for improving vaccine communication and uptake. Pediatrics, 153(3), e2023065483. https://doi.org/10.1542/peds.2023-065483 Opel, D. J., Heritage, J., Taylor, J. A., Mangione-Smith, R., Salas, H. S., DeVere, V., Zhou, C., & Robinson, J. D. (2013). The architecture of provider-parent vaccine discussions at health supervision visits. Pediatrics, 132(6), 1037–1046. https://doi.org/10.1542/peds.2013-2037 Opel, D. J., Mangione-Smith, R., Robinson, J.D., Heritage, J., DeVere, V., Salas, H.S., Zhou, C., & Taylor, J. A. (2015). The influence of provider communication behaviors on parental vaccine acceptance and visit experience. American Journal of Public Health, 105(10), 1998–2004. https://doi.org/10.2105/AJPH.2014.302425 Shattock, A. J., Johnson, H. C., Sim, S. Y., Carter, A., Lambach, P., Hutubessy, R. C. W., Thompson, K. M., Badizadegan, K., Lambert, B., Ferrari, M. J., Jit, M., Fu, H., Silal, S. P., Hounsell, R. A., White, R. G., Mosser, J. F., Gaythorpe, K. A. M., Trotter, C. L., Lindstrand, A., O'Brien, K. L., Bar-Zeev, N. (2024). Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization. Lancet (London, England), 403(10441), 2307–2316. https://doi.org/10.1016/S0140-6736(24)00850-X Smith M. J. (2015). Promoting vaccine confidence. Infectious Disease Clinics of North America, 29(4), 759–769. https://doi.org/10.1016/j.idc.2015.07.004  Songol, A., Amiri-Farahani, L., Haghani, S., Pezaro, S., & Omrani Saravi, S. (2023). Comparing the effect of parental education via both lecture and film upon vaccination uptake for children under one year of age: A cluster randomized clinical trial. Vaccine, 41(5), 1067-1073. https://doi.org/10.1016/j.vaccine.2022.12.012 Szilagyi, P. G., Albertin, C. S., Gurfinkel, D., Saville, A. W., Vangala, S., Rice, J. D., Helmkamp, L., Zimet, G. D., Valderrama, R., Breck, A., Rand, C. M., Humiston, S. G., & Kempe, A. (2020). Prevalence and characteristics of HPV vaccine hesitancy among parents of adolescents across the US. Vaccine, 38(38), 6027–6037. https://doi.org/10.1016/j.vaccine.2020.06.074 World Health Organization. (n.d.). A brief history of vaccines. https://www.who.int/news-room/spotlight/history-of-vaccination/a-brief-history-of-vaccination World Health Organization. (2015, August 18). Vaccine hesitancy: A growing challenge for immunization programmes. https://www.who.int/news/item/18-08-2015-vaccine-hesitancy-a-growing-challenge-for-immunization-programmes World Health Organization. (2019). Ten threats to global health in 2019. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019 Zhou, F., Jatlaoui, T. C., Leidner, A. J., Carter, R. J., Dong, X., Santoli, J. M., Stokley, S., Daskalakis, D. C., & Peacock, G. (2024). Health and economic benefits of routine childhood immunizations in the era of the vaccines for children program - United States, 1994-2023. MMWR. Morbidity and Mortality Weekly Report, 73(31), 682–685. https://doi.org/10.15585/mmwr.mm7331a2 

In the second episode of our Immunization Updates mini-series, we’ll break down the evolving—and increasingly confusing—2026 pediatric immunization landscape, helping clinicians make sense of diverging CDC and AAP vaccine schedules. Following major federal changes to the ACIP process and subsequent shifts in CDC recommendations, several vaccines were reclassified from universal use to “high-risk” or “shared decision-making,” creating uncertainty for providers and families alike. We’ll walk through what changed, why it matters, and how these updates compare to the AAP’s continued endorsement of universal protection against 18 diseases. Using real-world examples like HPV and RSV prevention, this episode unpacks how wording, categorization, and policy decisions impact clinical care, patient understanding, and public confidence. We end with practical strategies for navigating vaccine conversations, maintaining an AAP-aligned workflow, addressing insurance and liability concerns, and documenting when families choose alternate approaches. This episode is a must-listen for pediatric providers who want to stay grounded in evidence, communicate clearly with families, and confidently advocate for childhood immunizations in a shifting policy environment. Website: www.thepedsnp.come Contact: [email protected] Instagram: @thepedsnppodcast    AACN Essentials Mapping (Domain. sub-competency):  1.1, 1.3  2.5  3.3, 3.5 4.2 6.1 9.1  References:  Abers, M. S., Ulrich, A. K., & Walensky, R. P. (2026). Universal Hepatitis B Vaccination at Birth-Risks of Revising the Recommendation. JAMA, 335(7), 569–570. https://doi.org/10.1001/jama.2025.24996 American Academy of Pediatrics. (2026, January 26). AAP’s 2026 immunization schedule keeps routine recommendations intact after overhaul of federal schedule. AAP News. https://publications.aap.org/aapnews/news/34141/ American Academy of Pediatrics. (2026). What is the difference between the AAP immunization recommendations and other vaccine schedules? HealthyChildren.org. https://www.healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/what-is-the-difference-between-the-AAP-recommended-immunization-schedule-and-other-vaccine-schedules.aspx American Public Health Association. (2026, March 16). Federal Judge Blocks Immunization Schedule Changes, Stays ACIP Member Appointments. APHA News Releases. https://www.apha.org/news-and-media/news-releases/apha-news-releases/federal-judge-blocks-immunization-schedule-changes#:~:text=A%20coalition%20of%20leading%20medical,the%20December%202025%20ACIP%20meeting. Arthur, E. (2025). AAP has been leading voice on childhood vaccine recommendations since 1930s. AAP News. Retrieved from https://publications.aap.org/aapnews/news/32762/AAP-has-been-leading-voice-on-childhood-vaccine?searchresult=1 Association of Immunization Managers. (2026, February 13). What to know about one-dose HPV vaccination. Childhood Immunization. https://www.immunizationmanagers.org/what-to-know-about-one-dose-hpv-vaccination/ Cacho, F., Gebretsadik, T., Anderson, L. J., Chappell, J. D., Rosas-Salazar, C., Ortiz, J. R....Hartert, T. (2024). Respiratory Syncytial Virus Prevalence and Risk Factors among Healthy Term Infants, United States. Emerging Infectious Diseases, 30(10), 2199-2202. https://doi.org/10.3201/eid3010.240609. Centers for Disease Control and Prevention. (2025). Healthcare Professionals: Immunization Schedules. Vaccines and Immunizations. https://www.cdc.gov/vaccines/hcp/imz-schedules/index.html Department of Health and Human Services. (2026). Fact Sheet: CDC Childhood Immunization Recommendations. Press Room. https://www.hhs.gov/press-room/fact-sheet-cdc-childhood-immunization-recommendations.html Kates  J, Bell  C, Michaud  J, Williams  E, Tolbert  J. Tracking state actions on vaccine policy and access. KFF. September 24, 2025. Accessed December 28, 2025. https://www.kff.org/covid-19/tracking-state-actions-on-vaccine-policy-and-access/#:~:text=Thirteen%20states%20have%20moved%20to,recommendations%20apply%20to%20all%20vaccines Mello, M. M., Walensky, R. P., Osterholm, M. T., & Brennan, T. A. (2026, January 13). Navigating conflicting vaccination recommendations: Guidance for clinicians. JAMA. https://jamanetwork.com/journals/jama/fullarticle/2844090 Montori, V. M., Ruissen, M. M., Hargraves, I. G., Brito, J. P., & Kunneman, M. (2023). Shared decision-making as a method of care. BMJ evidence-based medicine, 28(4), 213–217. https://doi.org/10.1136/bmjebm-2022-112068  O'Leary, S. T., Opel, D. J., Cataldi, J. R., Hackell, J. M., COMMITTEE ON INFECTIOUS DISEASES , COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE , & COMMITTEE ON BIOETHICS (2024). Strategies for Improving Vaccine Communication and Uptake. Pediatrics, 153(3), e2023065483. https://doi.org/10.1542/peds.2023-065483 Payne AB, Battan-Wraith S, Rowley EAK, et al. Effectiveness of nirsevimab among infants in their first RSV season in the United States, October 2023-March 2024: a test-negative design analysis. Lancet Reg Health Am. 2025;49:101196. Published 2025 Aug 6. doi:10.1016/j.lana.2025.101196 Radcliffe, C. R., Akkawi, G., & Carson, R. A. (2025). Practical Application of Nirsevimab Recommendations for Infants and Toddlers. Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners, 39(4), 638–645. https://doi.org/10.1016/j.pedhc.2024.11.005 Schering, S. (2026). 12 medical groups representing 1 million health care professionals endorse AAP immunization schedule. AAP News. https://publications.aap.org/aapnews/news/34259/12-medical-groups-representing-1-million-health U.S. Department of Health and Human Services. (2026). Fact Sheet: CDC Childhood Immunization Recommendations. Press Room. https://www.hhs.gov/press-room/fact-sheet-cdc-childhood-immunization-recommendations.html

Welcome to our vaccine-focused mini-series, "Immunizations Updates"! Today we will use data from the United States' measles resurgence following the 2025 outbreak to explore what every pediatric provider needs to know as cases continue to climb. We walk through how measles slipped toward losing its elimination status, how today’s clinicians can rapidly rebuild their diagnostic instincts, and what early symptoms are most likely to be missed. We also break down high‑risk groups, key clinical clues, key references, practice tips, and highlights from Lyles & Carson’s recent 2026 reference for prevention and post-exposure prophylaxis for children with inflammatory bowel disease. Along the way, we’ll discuss practical strategies for vaccine advocacy, documentation, differential diagnosis, and post‑exposure management, giving you the tools to protect vulnerable kids and strengthen vaccine confidence in their communities. Website: www.thepedsnp.come Contact: [email protected] Instagram: @thepedsnppodcast AACN Essentials Mapping (Domain. sub-competency): 1.1f, 1.2g, 1.2h, 1.2i, 1.3d, 2.1d, 2.2j, 2.4g 3.1m, 3.2e, 3.3c, 3.3e, 3.3f, 3.5f, 3.5g, 3.6g 4.1i, 4.2f, 4.2k, 4.3e 9.1i, 9.2i, 9.3i 10.1c, 10.2g, 102i, 10.3l, 10.3o  References: American Academy of Pediatrics [AAP]. (2026). Measles Infection Prevention and Control Frequently Asked Questions. Patient Care. https://www.aap.org/en/patient-care/measles/measles-frequently-asked-questions/#:~:text=Because%20measles%20in%20HCP%20has,of%20serologic%20immunity%20is%20demonstrated. Centers for Disease Control and Prevention [CDC]. (2026, February 20). Measles cases and outbreaks. Retrieved from https://www.cdc.gov/measles/data-research/index.html Do, L. A. H., & Mulholland, K. (2025). Measles 2025. The New England Journal of Medicine, 392(25), 1–12. https://doi.org/10.1056/NEJMra2504516 Kiang, M. V., Bubar, K. M., Maldonado, Y., Hotez, P. J., & Lo, N. C. (2025). Modeling reemergence of vaccine-eliminated infectious diseases under declining vaccination in the US. JAMA. https://doi.org/10.1001/jama.2025.70336 Imdad, A., Mayo-Wilson, E., Haykal, M. R., Regan, A., Sidhu, J., Smith, A., & Bhutta, Z. A. (2022). Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age. The Cochrane database of systematic reviews, 3(3), CD008524. https://doi.org/10.1002/14651858.CD008524.pub4 Lyles, J. L., & Carson, R. A. (2026). Prevention and post-exposure prophylaxis for measles in children with inflammatory bowel disease. Journal of pediatric gastroenterology and nutrition, 10.1002/jpn3.70336. Advance online publication. https://doi.org/10.1002/jpn3.70336 National Institutes of Health. (2025). Vitamin A and carotenoids. Health Information. https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/ Rhodesia, R.E. (2025). Public health wake-up call: Will the US lose measles elimination status? News. Contagion Live. https://www.contagionlive.com/view/public-health-wake-up-call-will-the-us-lose-measles-elimination-status- Sheikh, I.N., Kamdar, K.Y., & Ardura, M.I. (2023). Ensure proper immunization for patients who received chemotherapy or transplantation. AAP News. https://publications.aap.org/aapnews/news/23569/Ensure-proper-immunization-for-patients-who?autologincheck=redirected World Health Organization [WHO]. (2024). Provisional measles and rubella data. Retrieved from https://immunizationdata.who.int/global?topic=Provisional-measles-and-rubella-data WHO. (2025). Measles. https://www.who.int/news-room/fact-sheets/detail/measles

Welcome to the Choosing Wisely Campaign series! This is the fifth and final episode of our 5-part series exploring the ABIM Foundation’s Choosing Wisely Lists. This campaign aims to promote conversations between clinicians and patients to avoid unnecessary medical tests, treatments, and procedures. Our last case-based episode focuses on a school-aged male presenting with new-onset enuresis. After a discussion of the differential diagnosis and evidence-based evaluation strategies, we apply recommendations from multiple AAP Choosing Wisely lists to create a care plan that is safe, resource-conscious, and child-centered. Throughout this episode, we’ll highlight how ethical care principles—beneficence, nonmaleficence, autonomy, and justice—guide high-value decision-making and help us avoid unnecessary imaging, laboratory studies, and interventions that add cost without improving outcomes. This familiar case in pediatrics is worthy of a rewind to relisten to a throwback episode that will reinforce your skills and emphasize the clinical diagnosis and management without added diagnostics, referrals, or medications.  This case closes out our series on Choosing Wisely in Pediatrics, but the principles we’ve explored should continue to inform your practice every day. If you missed earlier episodes, rewind to learn more about the campaign’s background and listen to cases on fever and cough, gastroenterology presentations, and more.   Series Learning Objectives: Introduction to the Choosing Wisely Campaign: Understand the origins, historical precedent, and primary goals of the campaign. Case-Based Applications: Explore five common presentations in primary and acute care pediatrics, applying concepts from various Choosing Wisely lists to guide management and resource stewardship. Effective Communication: Learn strategies for engaging in tough conversations with parents and colleagues to create allies and ensure evidence-based practices are followed. Modified rMETRIQ Score: 15/15 What does this mean?   Competencies: AACN Essentials: 1: 1.1 g; 1.2 f; 1.3 d, e 2: 2.1 d, e; 2.2 g; 2.4 f, g; 2.5 h, i, j, k 7: 7.2 g, h, k 9: 9.1i, j; 9.2 i, j; 9.3 i, k NONPF NP Core Competencies: 1: NP 1.1h; NP 1.2 k, m; NP 1.3 f, j, h 2: NP 2.1 j, g; NP 2.2 k, n; NP 2.4 h, i; NP 2.5 k, l, m, n, o 7: NP 7.2 m 9: NP 9.1 m, n; NP 9.2 n; NP 9.3 p References: AAP Section on Emergency Medicine & Canadian Association of Emergency Physicians. (2022). Five things physicians and patients should question. Retrieved from https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWEmergencyMedicine.pdf AAP Section on Gastroenterology, Hepatology, and Nutrition. (2023). Five things physicians and patients should question. https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWGastroenterology.pdf AAP Section on Urology. (2022). Five things physicians and patients should question. Retrieved from https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWUrology.pdf Daniel, M., Szymanik-Grzelak, H., Sierdziński, J., Podsiadły, E., Kowalewska-Młot, M., & Pańczyk-Tomaszewska, M. (2023). Epidemiology and Risk Factors of UTIs in Children-A Single-Center Observation. Journal of personalized medicine, 13(1), 138. https://doi.org/10.3390/jpm13010138 McMullen, P.C., Zangaro, G., Selzer, C., Williams, H. (2026). Nurse Practitioner Claims and the National Practitioner Data Bank: Trends, Analysis, and Implications for Nurse Practitioner Education and Practice. Journal for Nurse Practitioners, 22(1), p. 105569, https://doi-org.proxy.lib.duke.edu/10.1016/j.nurpra.2025.105569 Tabbers, M. M., DiLorenzo, C., Berger, M. Y., Faure, C., Langendam, M. W., Nurko, S., Staiano, A., Vandenplas, Y., Benninga, M. A., European Society for Pediatric Gastroenterology, Hepatology, and Nutrition, & North American Society for Pediatric Gastroenterology (2014). Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. Journal of pediatric gastroenterology and nutrition, 58(2), 258–274. https://doi.org/10.1097/MPG.0000000000000266 UCSF Benioff Children's Hospitals. (n.d.). Constipation & urologic problems. https://www.ucsfbenioffchildrens.org/conditions/constipation-and-urologic-problems Vaughan, D. (2015). The Challenger Launch Decision: Risky Technology, Deviance, and Culture at NASA. University of Chicago Press. DOI: 10.7208/chicago/9780226346960.001.0001 Wilbanks, Bryan A. PhD, DNP, CRNA. Evaluation of Methods to Measure Production Pressure: A Literature Review. Journal of Nursing Care Quality 35(2):p E14-E19, April/June 2020. | DOI: 10.1097/NCQ.0000000000000411

Welcome to the Choosing Wisely Campaign series! This is the fourth episode of a 5-part series exploring the ABIM Foundation’s Choosing Wisely Lists. This campaign aims to promote conversations between clinicians and patients to avoid unnecessary medical tests, treatments, and procedures. Our third case-based episode presents a child with fever and cough. After a clear discussion of the case and thoughtful consideration of the etiology and treatment strategies, we use the AAP’s Choosing Wisely Hospital Medicine and Infectious Diseases lists to create a resource-conscious care plan that is safe and patient-centered. In the coming episodes, we’ll explore the pediatric lists and apply our knowledge to cases of common presentations seen in primary and acute care pediatrics.    Series Learning Objectives: Introduction to the Choosing Wisely Campaign: Understand the origins, historical precedent, and primary goals of the campaign. Case-Based Applications: Explore five common presentations in primary and acute care pediatrics, applying concepts from various Choosing Wisely lists to guide management and resource stewardship. Effective Communication: Learn strategies for engaging in tough conversations with parents and colleagues to create allies and ensure evidence-based practices are followed. Modified rMETRIQ Score: 14/15   Competencies: AACN Essentials: 1: 1.1 g; 1.2 f; 1.3 d, e 2: 2.1 d, e; 2.2 g; 2.4 f, g; 2.5 h, i, j, k 7: 7.2 g, h, k 9: 9.1i, j; 9.2 i, j; 9.3 i, k   NONPF NP Core Competencies: 1: NP 1.1h; NP 1.2 k, m; NP 1.3 f, j, h 2: NP 2.1 j, g; NP 2.2 k, n; NP 2.4 h, i; NP 2.5 k, l, m, n, o 7: NP 7.2 m 9: NP 9.1 m, n; NP 9.2 n; NP 9.3 p   References ABIM Foundation. (2019). Communicating about overuse with vulnerable populations. Retrieved from https://www.choosingwisely.org/files/Communicating-About-Overuse-to-Vulnerable-Population_Final2.pdf American Academy of Pediatrics [AAP] Committee on Infectious Diseases & Pediatric Infectious Diseases Society. (2018). Five things physicians and patients should question. Retrieved from https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWInfectiousDisease.pdf de Benedictis, F. M., Kerem, E., Chang, A. B., Colin, A. A., Zar, H. J., & Bush, A. (2020). Complicated pneumonia in children. Lancet (London, England), 396(10253), 786–798. https://doi.org/10.1016/S0140-6736(20)31550-6 Kato, H. (2024) Antibiotic therapy for bacterial pneumonia. J Pharm Health Care Sci 10, 45. https://doi.org/10.1186/s40780-024-00367-5 Schlapbach, L. J., Watson, R. S., Sorce, L. R., Argent, A. C., Menon, K., Hall, M. W., Akech, S., Albers, D. J., Alpern, E. R., Balamuth, F., Bembea, M., Biban, P., Carrol, E. D., Chiotos, K., Chisti, M. J., DeWitt, P. E., Evans, I., Flauzino de Oliveira, C., Horvat, C. M., Inwald, D., … Society of Critical Care Medicine Pediatric Sepsis Definition Task Force (2024). International Consensus Criteria for Pediatric Sepsis and Septic Shock. JAMA, 331(8), 665–674. https://doi.org/10.1001/jama.2024.0179 Smith, D. K., Kuckel, D. P., & Recidoro, A. M. (2021). Community-Acquired Pneumonia in Children: Rapid Evidence Review. American family physician, 104(6), 618–625. Society of Hospital Medicine, AAP, & Academic Pediatric Association. (2021). Five things physicians and patients should question. Retrieved from https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWHospitalmedicine.pdf Yun K. W. (2024). Community-acquired pneumonia in children: updated perspectives on its etiology, diagnosis, and treatment. Clinical and experimental pediatrics, 67(2), 80–89. https://doi.org/10.3345/cep.2022.01452

Welcome to the Choosing Wisely Campaign series! This is the third episode of a 5-part series exploring the ABIM Foundation’s Choosing Wisely Lists. This campaign aims to promote conversations between clinicians and patients to avoid unnecessary medical tests, treatments, and procedures. Our second case-based episode presents an infant with diarrhea and diaper dermatitis. After a clear discussion of the case and thoughtful consideration of the etiology and treatment strategies, we use the AAP’s Choosing Wisely dermatology and gastroenterology, hepatology, and nutrition lists to create a resource-conscious care plan that is safe and patient-centered. In the coming episodes, we’ll explore the pediatric lists and apply our knowledge to cases of common presentations seen in primary and acute care pediatrics.    Series Learning Objectives: Introduction to the Choosing Wisely Campaign: Understand the origins, historical precedent, and primary goals of the campaign. Case-Based Applications: Explore five common presentations in primary and acute care pediatrics, applying concepts from various Choosing Wisely lists to guide management and resource stewardship. Effective Communication: Learn strategies for engaging in tough conversations with parents and colleagues to create allies and ensure evidence-based practices are followed. Modified rMETRIQ Score: 15/15   Competencies: AACN Essentials: 1: 1.1 g, 1.2f, 1.3de 2: 2.1 de, 2.2g, 2.4fg, 2.5 hijk 7: 7.2 ghk 9: 9.1ij, 9.2ij, 9.3ik NONPF NP Core Competencies: 1: NP1.1h, NP 1.2km, NP 1.3fjh 2: NP2.1jg, NP2.2kn, NP 2.4hi, NP2.5 klmno 7: NP7.2m 9: NP9.1mn, NP9.2n, NP9.3p   References ABIM Foundation. (2019). Communicating about overuse with vulnerable populations. Retrieved from https://www.choosingwisely.org/files/Communicating-About-Overuse-to-Vulnerable-Population_Final2.pdf AAP Section on Dermatology. (2021). Five things physicians and patients should question. https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWDermatology.pdf AAP Section on Gastroenterology, Hepatology, and Nutrition. (2023). Five things physicians and patients should question. https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWGastroenterology.pdf Harriet Lane Service (Johns Hopkins Hospital), Anderson, C. C., Kapoor, S., & Mark, T. E. (2024). The Harriet Lane handbook: a manual for pediatric house officers (23rd ed.). Elsevier.  Jauregui, J., Nelson, D., Choo, E., Stearns, B., Levine, A. C., Liebmann, O., & Shah, S. P. (2014). External validation and comparison of three pediatric clinical dehydration scales. PloS one, 9(5), e95739. https://doi.org/10.1371/journal.pone.0095739 Johnson, H., & Yu, J. (2022). Current and Emerging Therapies in Pediatric Atopic Dermatitis. Dermatology and therapy, 12(12), 2691–2703. https://doi.org/10.1007/s13555-022-00829-4 Semon, A. K., Keenan, O., & Zackular, J. P. (2021). Clostridioides difficile and the Microbiota Early in Life. Journal of the Pediatric Infectious Diseases Society, 10(Supplement_3), S3–S7. https://doi.org/10.1093/jpids/piab063

Welcome to the Choosing Wisely Campaign series! This is the second episode of a 5-part series exploring the ABIM Foundation’s Choosing Wisely Lists. This campaign aims to promote conversations between clinicians and patients to avoid unnecessary medical tests, treatments, and procedures. The first of our case-based episodes presents a school age child with syncope. After a clear discussion of the case and thoughtful consideration of an acute care differential, we use the AAP’s Choosing Wisely cardiac list to create a resource-conscious care plan that is safe and patient-centered. In the coming episodes, we’ll explore the pediatric lists and apply our knowledge to cases of common presentations seen in primary and acute care pediatrics.    Series Learning Objectives: Introduction to the Choosing Wisely Campaign: Understand the origins, historical precedent, and primary goals of the campaign. Case-Based Applications: Explore five common presentations in primary and acute care pediatrics, applying concepts from various Choosing Wisely lists to guide management and resource stewardship. Effective Communication: Learn strategies for engaging in tough conversations with parents and colleagues to create allies and ensure evidence-based practices are followed. Competencies: AACN Essentials: 1: 1.1 g, 1.2f 2: 2.1 de, 2.2g, 2.5 ij 6: 6.1 i 7: 7.2 ghk 9: 9.1ij, 9.2ij, 9.3ik NONPF NP Core Competencies: 1: NP1.1h, NP 1.2km 2: NP2.1jg, NP2.2kn, NP2.5 lo 6: NP6.1o 7: NP7.2m 9: NP9.1mn, NP9.2n, NP9.3p References: AAP Section on Cardiology and Cardiac Surgery. (2020). Five things physicians and patients should question. https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWCardio.pdf Gilpin, K., & Goode, Z. (2024). Syncope. Pediatrics in review, 45(10), 606–608. https://doi.org/10.1542/pir.2023-006053

Welcome to the Choosing Wisely Campaign series! This 5-part series will explore the ABIM Foundation’s Choosing Wisely Campaign, its historical precedent, and its goals. We will discuss how this initiative aims to promote conversations between clinicians and patients to avoid unnecessary medical tests, treatments, and procedures. The introduction episode dives into the historic 2010 editorial in the New England Journal of Medicine that inspired over 80 professional societies to write their “Top 5 Lists” of tests and procedures that could be avoided in evidence-based care. To better understand the problem, we then pick apart the survey that provided insight into why we over order and the harm it causes to vulnerable populations.  In the coming episodes, we’ll explore the pediatric lists and apply our knowledge to cases of common presentations seen in primary and acute care pediatrics.  Author: Becky Carson, DNP, APRN, CPNP-PC/AC www.thepedsnp.com Instagram: @thepedsnppodcast Series Learning Objectives: Introduction to the Choosing Wisely Campaign: Understand the origins, historical precedent, and primary goals of the campaign. Case-Based Applications: Explore five common presentations in primary and acute care pediatrics, applying concepts from various Choosing Wisely lists to guide management and resource stewardship. Effective Communication: Learn strategies for engaging in tough conversations with parents and colleagues to create allies and ensure evidence-based practices are followed. Competencies: AACN Essentials: 1: 1.1 g, 1.2f 2: 2.1 de, 2.2g, 2.5 ij 6: 6.1 i 7: 7.2 ghk 9: 9.1ij, 9.2ij, 9.3ik NONPF NP Core Competencies: 1: NP1.1h, NP 1.2km 2: NP2.1jg, NP2.2kn, NP2.5 lo 6: NP6.1o 7: NP7.2m 9: NP9.1mn, NP9.2n, NP9.3p Modified rMETRIQ Score: 15/15 Learn more about our peer review process at www.thepedsnp.com/peerreview   References: ABIM Foundation. (2019). Communicating about overuse with vulnerable populations. Retrieved from https://www.choosingwisely.org/files/Communicating-About-Overuse-to-Vulnerable-Population_Final2.pdf Brody, H. (2010). Medicine's ethical responsibility for health care reform--the Top Five list. The New England journal of medicine, 362(4), 283–285. https://doi.org/10.1056/NEJMp0911423 Lipitz-Snyderman, A., & Bach, P. B. (2013). Overuse of health care services: when less is more … more or less. JAMA internal medicine, 173(14), 1277–1278. https://doi.org/10.1001/jamainternmed.2013.6181 PerryUndem Research/Communication. (2014). Unnecessary tests and procedures in the health care system. Retrieved from https://www.choosingwisely.org/files/Final-Choosing-Wisely-Survey-Report.pdf Smith-Bindman, R., Chu, P. W., Azman Firdaus, H., Stewart, C., Malekhedayat, M., Alber, S., Bolch, W. E., Mahendra, M., Berrington de González, A., & Miglioretti, D. L. (2025). Projected Lifetime Cancer Risks From Current Computed Tomography Imaging. JAMA internal medicine, e250505. Advance online publication. https://doi.org/10.1001/jamainternmed.2025.0505 Wyman, O. (2019). Right Place, Right Time: Health Information & Vulnerable Populations. https://www.oliverwyman.com/RightPlaceRightTime.html  

This is the final episode of The Peds NP Acute Care PNP Faculty series. The series was created and peer-reviewed by national leaders in acute care PNP education in collaboration to meet the needs of our current and future colleagues. In the push for competency-based education where faculty verify the skills of what a student can do, rather than their knowledge, our series focuses on the application of didactic content with a practical approach so that you can learn nuances of clinical skills before you reach the bedside.    As I come to an end of my time as a faculty member at the Catholic University of America and our Acute Care PNP Faculty series, I remember my graduation from Johns Hopkins. These terminal moments are likened to a graduation, and serve as a wonderful time for reflection. The episode recollects the student speaker commencement address given at my graduation, filled with vehicular metaphors and acknowledgements of failure. A common theme of “Onward” is woven throughout to remind listeners that, at whatever graduation you find yourself celebrating right now, be hopeful and excited at the good that is left to do in the world.    The Peds NP will return in 2025 from Duke University… Author: Becky Carson, DNP, APRN, CPNP-PC/AC   Peer Review: This episode was peer reviewed using a modified revised METRIQ (rMETRIQ) Score. Learn more about The Peds NP's formal peer review process at www.thepedsnp.com/peerreview rMETRIQ Score: 12/15 What does this score mean? This episode underwent a formal quality assurance and peer review process. It received a lower score because of the editorial nature of the content that could not achieve the highest score for question 1 and 4 criteria. There is sufficient background to situate the listener, but there are no referrals to other valuable sites. References are sited, but they do not correspond to specific statements. Financial disclosures/conflicts of interest: None Connect with The Peds NP email: [email protected] Instagram: @thepedsnppodcast   References: Carson, R.A. (2024). Student speaker commencement address [Speech transcript]. Johns Hopkins School of Nursing Commencement. https://alumni.jhu.edu/commencement-2016(Original work published 2016).