Aims to examine the role and significance of routine childhood vaccination, as defined by UK legal judgements.

Methods Analysis of four legal cases over past decade involving Best Interest judgements about childhood vaccinations in relation to parental conflict.

Results Two similar cases in 2003 involved mothers and estranged fathers who shared Parental Responsibility (PR) but disagreed about vaccine safety. A case in 2010 was brought by a Local Authority sharing PR during Care Proceedings where birthparents did not want their children to be vaccinated. The most recent case in 2013 involved two older children who, together with their mother, rejected MMR due to safety concerns and vegan health beliefs. Special consideration was given to the children’s opinions because of their age. This involved an assessment of their competence in relation to knowledge of vaccines and infectious diseases. The judgement included significant comments about parenting in such circumstances. In all four cases, vaccination was seen to be in the Best Interest of the children on a specific basis but no wider implications for vaccine programmes could be drawn. Paediatric expert advice was obtained in three cases.

Conclusions Childhood vaccination is a prophylactic intervention in well children. It is not compulsory in UK and does have rare but documented side effects. Although parents have a duty to act in the Best Interests of their children, their autonomy is repected if they choose not to vaccinate. Under ordinary circumstances, vaccination cannot be enforced if both parents are in agreement. However, courts are required to make welfare decisions if parents cannot agree. It has been argued that medical normative views favouring vaccination are seen to outweigh potential emotional and parenting factors in such cases. Parents opposed to vaccination tend to maximise the negative aspects of vaccination whilst minimising the effects of infectious diseases. In older children, an assessment of competence is needed to establish their understanding of the potential risks of both non-vaccination and vaccination. What is more difficult to assess is the emotional impact on children subjected to such intrusive parental animosity.