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Objectives To examine the relationship between vaccine hesitancy and children’s developmental diagnosis, medical conditions, and family health characteristics in a developmental-behavioral pediatrics outpatient population.Methods A retrospective chart review was conducted for 895 children who attended the Developmental Pediatrics Clinic at City Hospital between January 2024 and January 2025. Children with missing vaccination information or medical contraindications were excluded. Sociodemographic data, developmental profiles, parental health status, and vaccination adherence were extracted.Results A total of 861 children were included. The rate of parental vaccine hesitancy was 2.3% (n = 20). No significant association was found between vaccine hesitancy and children’s developmental diagnosis (p = 0.62) or socioeconomic status (p = 0.42). However, children with chronic medical conditions associated with developmental risk were significantly more likely to exhibit vaccine hesitancy compared to children without such conditions (p = 0.041). Maternal chronic illness was inversely associated with vaccine hesitancy (p = 0.030), while paternal or broader family health status showed no significant associations.Conclusions Vaccine hesitancy in this developmental-behavioral pediatrics sample was not associated with developmental delays but was linked to parental health conditions. These findings emphasize the need for family-centered counseling approaches when addressing vaccine decisions in developmental pediatric populations.