Sir.—Despite the known value of vaccinations, the national goal of achieving a 90% vaccination rate among 2-year-old children by 1990 was not met.1 This suggests the need to develop new strategies to vaccinate preschool children. At high risk for undervaccination are the impoverished, the uninsured, and toddlers.2 Many of these children receive care in an emergency department (ED) at some time during the "vaccination window" of their lives.3 In fact, children seen in the ED are more likely to be undervaccinated than their age-matched peers from the same primary-care practice.4
Tifft and Lederman5 conducted a study in Baltimore, Md, on the documentation of vaccination status of hospitalized preschool-aged patients. The admitting physician documented parental report of vaccination status as being "up-to-date" in 36 (35%) of the 102 charts reviewed, specific age-appropriate vaccine documentation was available in 30 (29%), a deficiency was documented in 19