A nurse disregarded the wishes of a four-year-old's parents by giving her the MMR jab.

The girl's mother and father had chosen to pay privately for separate injections for measles, mumps and rubella, as they feared the combined jab might be linked to autism.

But practice nurse Zubaida Khan gave their daughter the combined vaccine anyway, as "parents often change their minds".

Khan, 58, had recently started working at the surgery when the girl, who has Down's syndrome, arrived with her childminder for a booster jab of the vaccine for diphtheria, tetanus and polio, the Nursing and Midwifery Council heard yesterday.

The child's mother, referred to as Miss B, had sent a note giving permission for that vaccine, and the girl's vaccination record book - but Khan gave her the combined MMR vaccine instead.

Miss B had agonised over whether to give her daughter the MMR vaccine, because of concerns over links to autism, the hearing was told.

"There wasn't enough evidence either way. There was too much of a question mark to, as I saw, take a risk.

"Any chance she would be exposed to any other type of affliction was something I wasn't ready to consider."

But when the girl came home, Miss B discovered she had not been given the booster she went for and instead had been given the MMR jab.

She complained to the Florence Road Surgery in Ealing, West London. Khan was dismissed later that month.

Khan admitted to bosses having read in the girl's record book that she had been given the separate jabs. But she said in her experience parents "often change their minds" about the combined MMR vaccine.

Miss B added: "The nanny told me there had been some problem at the surgery and that the nurse had tried to call me and hadn't got through, then had given her the MMR."

Miss B phoned the surgery and spoke to Khan, the panel heard.

"It didn't seem as if it was a mistake," she added. "It was as though 'one had one's view' and the view was potentially I was in the wrong."

Khan was found guilty of misconduct and handed a caution. In a written judgment it said she "ignored the fundamental principle of informed consent".

Khan, of Hanwell, West London, admitted giving the vaccine without consent, in September 2005. Her solicitor said she apologised for causing anxiety.