AIM: In June 2006, the human papillomavirus (HPV) vaccine, Gardasil, was licensed for use in the United States. We examined whether paediatricians would recommend the vaccine, obstacles they encountered and characteristics associated with not recommending the HPV vaccine to all eligible patients. METHODS: Four hundred fifty general paediatricians, 200 members of the section of infectious diseases and 200 members of the section of adolescent medicine of the American Academy of Pediatrics web-based directory were surveyed. RESULTS: Of 752 eligible paediatricians, 373 (50%) responded. Eighty-eight percent (292 of 332) of respondents stated that they would give the vaccine to all, 36 (11%) would give it to some and 4 (1%) would give it to none of their eligible patients. The main obstacles were cost and safety; a minority expressed concern about the vaccine's potential impact on adolescent sexual activity. Physicians who would not recommend HPV vaccination to all eligible patients were more likely to be generalists, have higher intrinsic religiosity, self-describe as conservative, report later adoption of new drugs/vaccines, and would not encourage vaccinating their own daughter or the daughter of a close friend. CONCLUSION: Although paediatricians are highly supportive of the HPV vaccine, certain characteristics may predict reluctance to immunize.