The American Academy of Pediatrics strongly endorses universal immunization. However, for childhood immunization programs to be successful, parents must comply with immunization recommendations. The problem of parental refusal of immunization for children is an important one for pediatricians. The goal of this report is to assist pediatricians in understanding the reasons parents may have for refusing to immunize their children, review the limited circumstances under which parental refusals should be referred to child protective services agencies or public health authorities, and provide practical guidance to assist the pediatrician faced with a parent who is reluctant to allow immunization of his or her child.