The American Academy of Pediatrics (AAP) says states should get rid of laws which allow children to go unvaccinated for diseases like measles for non-medical reasons and advises individual physicians to consider excluding families who continually refuse immunizations from their practice.

The AAP’s policy statement was released along with a study in the journal Pediatrics on how pediatricians can address growing sentiments of “vaccine hesitancy” among parents.

Among AAP members, 87 percent said they’ve been challenged by a parent who refused immunizations for their child in the past year, up from 75 percent in 2006. The group puts much of the blame for this change on state laws that allow exemptions from child care and school vaccination requirements based solely on personal beliefs.

“It’s clear that states with more lenient exemptions policies have lower immunization rates, and it’s these states where we have seen disease outbreaks occur as the rates slip below the threshold needed to maintain community immunity,” said Geoffrey R. Simon, MD, immediate past chair of the AAP Committee on Practice and Ambulatory Medicine, who wrote the policy statement.

The policy statement notes that the best argument physicians and public health officials can make for vaccinations is by educating parents. In one example, Oregon, which in 2014 began requiring parents to complete “educational module on the benefits of vaccines” before allowing a non-medical exemption before allowing a certified exemption, saw a number of exemptions granted decreased by 17 percent in a single school year.

Talking to concerned parents is the main theme of the AAP’s policy. The group encourages physicians to take their concerns seriously, and when faced with unfounded or disproven theories about the danger of vaccines—such as beliefs they can contain mercury or can cause autism—doctors are advised to directly provide information that can illustrate the lack of evidence behind such fears.

This extra work can be time-consuming, according to the AAP study, and could “actually increase misperceptions and reduce vaccination intention” among hesitant parents. The group says if some parents refuse to change their minds after attempts to educate them, it may be “acceptable” for physicians to dismiss a family and direct them to a new physician.

“The decision to dismiss a family who continues to refuse immunization is not one that should be made lightly, nor should it be made without considering and respecting the reasons for the parents’ point of view,” the study said. “Nevertheless, the individual pediatrician may consider dismissal of families who refuse vaccination as an acceptable option. In all practice settings, consistency, transparency, and openness regarding the practice’s policy on vaccines is important.”

AAP notes there are many considerations physicians should make before dismissing patients who refuse to vaccinate. Some hospitals or health systems won’t allow dismissals, or there may not be another qualified provider in the area. In all cases, the group says the family should be notified and the current treatment and emergency care should be provided for a “reasonable period of time, usually 30 days.”