Gillick competence and vaccinations

[bathsh3ba]

My understanding of Gillick competence is that a 13+ young person can in some circumstances decline or consent to treatment against the wishes of their parent if they are deemed able to understand the full ramifications.

Does this apply to vaccinations? I know this may not apply to the Covid vaccine (though it may in due course) but I'm thinking of my 13yo's upcoming HPV vaccine which she insists she won't have. She has severe needle phobia.

And what about tests? Can a teen be made to take a test?

[Squiffany]

Does she understand the pros and cons? If so she is deemed competent and can refuse if she wishes.

[TotoroPotoro]

Yes teen can be deemed competent to understand risks and abstain from vaccination.

However, it really is in their best interests to have it, so I would expect parents and the nurses to try their best to support them through their phobia to have it.

[SnowmanDrinkingSnowballs]

You cannot force a 13 year old to have a vaccine she doesn’t want. What would you do hold her down? All you can do is have a serious conversation about cancer, the extreme treatment (much worse than one injection) and the fact a jab is just a few seconds of pain. Then maybe ask if there is anything she would want as a treat afterward and see if she can be pursaded.

[DottyWott]

Technically they can’t refuse a treatment that a person with parental responsibility consents to, however it is very difficult to make a teen have any treatment they refuse so unless it’s life threatening it doesn’t happen.
I have a needle phobic nephew who refused a vaccination at school, they booked him with GP so he could go with mum - he refused again. 2 years later they did a catch up program at school and he just went and did it! Sometimes they just need more time, she could have it a few years down the line.

[bathsh3ba]

She would refuse lifesaving treatment if it involved a needle and she had the choice ...her phobia is that bad. So I don't think it would be a reasoned decision, it would be an emotional one. But of course I can't and wouldn't physically force her, it just worries me.

2 years ago she had to have a local anaesthetic injection in her toe and she refused and she was screaming even though the needle was nowhere near her and we had gone way over the appointment slot, it was horrible. In the end I was so stressed I refused her a hug, she asked for one and I said 'not now, I'm too cross and disappointed' and then she let them do it 'as long as I would hug her while they did it'. For context this was after half an hour of me hugging her while she said she was doing it then as soon as the needle appeared, screaming and refusing. I felt awful afterwards as I felt like I'd manipulated her though it wasn't deliberate.

God knows how I'd ever persuade her again...

[Mollyboom]

In theory a 13 year old can be said to be GIllick competent to refuse treatment. If it is live saving treatment the medics treating would normally refer the matter to court, who would generally rule in favour of treatment as being in the best interests of the child. In the case of vaccinations I think they would probably accede the wishes of the child provided she was GIllick competent.

[DPotter]

MY DD also had / has a severe needle phobia, but it was the HPV vaccine which persuaded her to have treatment for it. She still has a phobia, but she was able to have the vaccinations with a lot of support and encouragement.

She's also had the meningitis one which they have in late teens- that one is really important to have. Rather than having them at school, DD had them at the GP surgery by the practice nurse on a double appointment so no time pressure. As the GP had referred DD for CBT they were happy to do this.

I don't know whether or not Gillick competency applies to vaccinations but it's not so easy to sit a 13 yr old on your lap, like a toddler, and hold her still for the injection. And HCPs aren't going to chase her around the room and force the injection on her.

It's not just a matter of your DD understanding the pros and cons. That's the thing about phobias - the person can totally understand the logic of something but reacts emotionally against the logic.

Ask for help from GP and then have the injection done at the surgery rather than school

[overoptimism]

She needs therapy for this-what have you tried? Other than very unfortunate withdrawal of love when she's in the grip of a phobia (please don't do that again)!

The HPV vaccine is the one I'm personally hesitant about. I wouldn't force it on anyone. So I wouldn't make it about that

You need to get the needle thing sorted with a good therapist, rather than waiting until there's a reason to have an injection and panicking then.

[overoptimism]

I think it's interesting that her anxiety about your approval and affirmation is bigger than the phobia, by the way. I would definitely flag that up to the therapist. This is about more than needles.

[FippertyGibbett]

Is she also going to refuse the Diptheria, Tetanus and Polio, and the meningitis ACWY she is due ?

[Ohalrightthen]

In the 2 years since the toe thing has she had any therapy or similar to overcome this?

[DottyWott]

I agree, best thing would be to seek some CBT for her phobia with a Pyschologist

[lunar1]

What therapy is she having to help overcome it?

[BungleandGeorge]

I can absolutely understand why you denied her a hug, don’t feel bad for that. Local anaesthetic into your foot is pretty painful though, she obviously needed it but it may have exacerbated the phobia. I’d definitely look into what therapy is available as it’s going to be quite a difficult phobia for her to cope with.
Yes I think she probably would be judged as competent to make a decision about vaccination. HPV is given at 13 because some children become sexually active very early but it’s probably not going to be the end of the world to delay. Boys being vaccinated now so that will provide her some protection. I think they get some other jabs at about 14, including meningitis??? So I’d definitely try and address the issue sooner rather than later

[DPotter]

Overoptimism

There's a lot of emotion going on in a phobia, one way or another, so it's not surprising that a child, will try to please their mother, even when in the throes of high anxiety from the phobia.

Therapy for the needle phobia, before even trying to have the injections. DD was 15-16 before she had hers

[bathsh3ba]

She doesn't seek my affirmation and approval. She is a very independent, resilient young lady who happens to have a needle phobia. That she asked for a hug when she was frightened doesn't mean she fears my disapproval. I would know the signs of that because I feared my parents' disapproval. She really doesn't.

I feel bad for something I said in the heat of the moment, yes. But that was a one-off.

She hasn't had any therapy because I didn't realise what a big thing it was until she started panicking about this vaccination.

[FixTheBone]

@DottyWott

Technically they can’t refuse a treatment that a person with parental responsibility consents to, however it is very difficult to make a teen have any treatment they refuse so unless it’s life threatening it doesn’t happen.
I have a needle phobic nephew who refused a vaccination at school, they booked him with GP so he could go with mum - he refused again. 2 years later they did a catch up program at school and he just went and did it! Sometimes they just need more time, she could have it a few years down the line.

Congratulations on the first correct answer.

A child can be compelled to have treatment against their will, however this practically never happens unless its either a life or limb threatening emergency, or, a court has ruled the treatment should proceed.

The fraser ruling (Gillick) only concerned a competent child's ability to consent against their parents wishes. It does not address children without competency to make a decision and it does not address refusal of treatment.

[PurpleDaisies]

If she’s planning to engage with the cervical smear programme, I wouldn’t worry too much about not having the hpv vaccine. Obviously it would be better to have it than not but I wouldn’t try to force her. She could meet a health professional to discuss the positives and negatives. Long term, it’s hard being needle phobic. I’ve really struggled with dental treatments and had to decline one of the anaesthetic injections for a root canal because I couldn’t cope with it. If you think you were cross and disappointed with her, that’s nothing compared to how she would have been feeling about herself.

[RoseAndRose]

If it is a school vaccination team, they will not have time to deal with DC who are downright refusing to have the injection (similarly, they will not be assessing Fraser/Gillick competence of DC whose parents/guardians have not provided consent)

Those DC will have to get the jabs at the GP

[bathsh3ba]

I think I'll try to persuade her to talk to the school counsellor about it. I've had phobias so I know how horrible it can feel. It was horrible for both of us and doubtless the HCPs too... She had the flu vaccination but that was a nasal spray. I don't know when she is next due boosters for MenC etc, I have a horrible feeling that's 13 too.

I'll sit down with her and talk about it

[FippertyGibbett]

Where I live it’s the first HPV in year 8, second in year 9. Then the DTP and ACWY in year 9 also.
If she doesn’t have her first HPV before she is 15 she will need 3 injections to complete the course.

[Keepdistance]

Maybe it's also about being in control?
My dc1 at 5 became phobic after medical treatment. Had horrible issues then having cp vax, refused flu spray had to go to other appt and hold her down.

[Sockwomble]

"And what about tests? Can a teen be made to take a test?"

I have been told by several HCPs that if a child refuses they would take it as them not consenting and and the HCP would not do the test. This includes children who do not have Gillick competence.

[Sockwomble]

That is covid tests.

[Ginfilledcats]

Op I had severe needle phobia until this year, when I had my baby (yep, took getting pregnant to get me to have my first needle since age 4).

I managed to avoid men c, hpv and bcg to my now shame and disappointment- I wish I'd had them, but too late now.

I was absolutely terrified, if someone had an injection on a tv programme I'd throw up and shake and couldn't watch, if people spoke about vaccinations I'd practically have a panic attack.

You need to find a really calm, supportive and understanding HCP to meet and work with your daughter. What is her fear sound? The pain? The thought of something going in her body? The lack of control? She needs to address these things in a nice calm controlled manner.

Honestly I never thought I'd get over it, started with a flu jab, ended with a cannula and epidural in labour and didn't bother me one bit!

Good luck