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Background. A growing number of parents adopt alternative vaccination schedules for their children. A better understanding of parents’ rationales for these choices is needed to guide vaccine decision making. Methods. We conducted 24 semistructured telephone interviews with parents of 12- to 36-month-olds and analyzed data using an inductive approach. Results. We identified 5 alternative vaccination approaches: “Dr Sears” schedule, shot-limiting approach, selective delay or decline, visit-by-visit decisions, and refusal of all vaccines. Parents who adopted alternative approaches expressed a desire for more control of exposure to vaccine ingredients; vaccine safety, immune system burden, and perceived disease risk were articulated as concerns. Conclusions. Parents who adopt alternative vaccination schedules can be classified in defined subgroups based on their decision-making approaches, and many describe considered reasons to support their actions. Communications that acknowledge and address those reasons may be better able to engage parents and ultimately enhance the process of decision making about vaccines. [ABSTRACT FROM PUBLISHER]