Keeping Up With Routine Pediatric Care During the Pandemic
Vaccinations and checkups for kids are still vital even with restrictions in effect
Pediatrician Shelly Vaziri Flais, M.D., discovered something surprising while caring for young children during the coronavirus pandemic. In normal times, she’ll smile at her infant patients, and they’ll often smile right back, a typical reaction for babies. Now, she keeps a mask on during every patient visit, to protect herself and her patients from potential COVID-19 transmission, and she didn’t expect her patients to be able to see her smiling at them from behind her mask. But they do.
“They still sense your smile in your eyes,” she says. And they smile right back.
Unfortunately, Vaziri Flais, who practices in the Chicago area and is an assistant professor of clinical pediatrics at Northwestern’s Feinberg School of Medicine, hasn’t been seeing enough of those infant smiles, or infants at all, lately.
Why Parents Delayed Getting Routine Care
Amid lockdowns and stay-at-home orders, pediatricians’ offices—like those of other healthcare providers—were considered essential businesses. Still, the American Academy of Pediatrics (AAP) has noted “a significant drop in well-child visits” since the beginning of the pandemic. That’s led to too few children receiving their vaccinations and key checkups on time, the AAP says.
As cities and states undergo various stages of reopening, plenty of Americans are still being cautious. In a recent nationally representative survey conducted by Consumer Reports, 76 percent of Americans said that they were either “somewhat” or “very” concerned about continued COVID-19 spread in their communities. And in many states, cases of COVID-19 are still on the rise.
Some parents may also be extra wary about the risk of their kids developing a serious but rare complication of the disease that’s been in the news, known as multisystem inflammatory syndrome in children, or MIS-C.
But pediatricians are taking great caution to make sure the children who come in for visits are as safe as possible from COVID-19. And evidence so far suggests that children may be less susceptible to the coronavirus than adults and that in most cases, the disease isn’t severe in kids—though it seems they can spread it to others.
Still, says Vaziri Flais, “the greater risk would be to not stay up to date with your routine medical care and your vaccinations.”
The Importance of Regular Pediatric Care
Health experts recommend that babies be seen by a pediatrician at least 10 times by age 2. One critical consequence of skipping regular pediatric care is missing vital vaccinations.
Data from Michigan, published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, show that the percentage of children who were up to date with their vaccinations dropped in May when compared with the same months in previous years, dipping below 50 percent for kids ages 2 and younger.
And in a May 20 news conference, New York City mayor Bill de Blasio announced that vaccination rates for children had fallen precipitously in that city: down by 43 percent for children 2 and younger, and down by 91 percent for children older than 2.
If too few people get vaccinated against the various diseases for which we have vaccines, new outbreaks of these diseases could occur. Different diseases have different thresholds of vaccination rates that public health officials say are necessary to keep outbreaks from happening. For measles, for example, which caused numerous outbreaks in various parts of the country throughout 2019, scientists think that vaccination rates below about 93 to 95 percent could lead to outbreaks.
That’s never good, but especially not in the current public health climate, says Sally Goza, M.D., president of AAP and a primary care pediatrician in Georgia. “We cannot afford to have another disease outbreak in the midst of the pandemic,” she says.
And while coronavirus appears, generally speaking, not to cause much severe disease in children, vaccine-preventable diseases, such as whooping cough, measles, and rotavirus, can be highly dangerous to kids. “Coronavirus is probably not that big of a risk for most children,” Goza says. “But those other diseases are.”
The other key reason regular checkups are critical for kids is so that pediatricians can identify signs of any emotional, developmental, or other health problems. They check whether newborns are getting adequate nutrition and hydration, whether toddlers are meeting milestones like saying enough words, and whether older children are displaying any signs of mental health difficulties.
That’s especially critical right now, because the pandemic has taken a heavy emotional toll on parents and kids alike, according to Goza. “I’m seeing anxiety as young as 4 and 5,” she says.
What to Expect at Your Pediatrician’s Office
The AAP is pushing one major action to take in order to make sure your children get their vaccinations and checkups on time: Call your pediatrician.
The reason this is the first step is that different doctors have come up with different solutions for keeping their waiting rooms and practices safe, making sure visitors maintain social distance, and keeping sick patients separate from well ones coming in for preventive care.
The Centers for Disease Control and Prevention has offered guidance to pediatricians for keeping patients safe during office visits. Strategies include scheduling sick visits and regular checkups at different times of day or asking families to remain in their cars while waiting rather than using the waiting room.
Some doctors have set up mobile units for providing vaccinations, or have even been making house calls. Others have set up tents in their parking lots, providing drive-through vaccinations.
Plenty are relying on telehealth visits for checkups and visits that can be done virtually. The AAP says that telehealth can be useful for children who have gotten sick or who have chronic illnesses needing care. Some parts of well-child visits can also be taken care of via telehealth, although the physical exam, any necessary lab tests, and hearing and vision screenings must be done in person.
If your child gets sick and you think it might be COVID-19, call your pediatrician with your concerns to find out whether you should seek testing. In general, though, a case of COVID-19 can be managed at home by making sure a sick child gets rest and fluids. Monitor symptoms and call the doctor if it seems like your child's condition takes a turn for the worse.
Severe COVID-19 in Children: What to Know
In the spring, doctors and scientists began reporting cases of what appeared to be a severe complication of COVID-19 in children: an abnormal immune response to the disease now termed multisystem inflammatory syndrome in children, or MIS-C. Symptoms include a persistent fever over several days, abdominal pain, diarrhea, vomiting, rash, headache, lethargy, confusion, respiratory symptoms, and more.
Scientists are just beginning to gain an understanding of MIS-C, and it’s unclear why some children develop this syndrome. It seems to appear in some youngsters in the weeks after recovering from a case of COVID-19—long enough after a case for a regular SARS-CoV-2 test to be negative but for an antibody test (which shows whether someone has been exposed to the virus in the past) to be positive, according to UpToDate, an online decision-making tool for healthcare professionals.
While the true incidence rate of MIS-C isn’t yet known, it’s thought to be very rare. Still, mirroring the trends found for regular cases of COVID-19, Black and Hispanic children accounted for a larger proportion of cases than white children did in two early analyses, one from the U.K. and one from New York, according to the CDC.
This severe complication of COVID-19 has produced some frightening headlines, and Vaziri Flais says she’s gotten plenty of questions from parents about it. It’s another reminder of the importance of social distancing, masks, and frequent hand-washing for people of all ages.
But given that MIS-C is so rare, Vaziri Flais says she would be more worried about an unvaccinated child contracting measles once people begin going out and about again.
Still, keep an eye out for the severe symptoms associated with this syndrome, and call your pediatrician if you’re concerned. Your child’s doctor can help you figure out whether you need to bring your child in to the office to be evaluated, or whether you should go directly to the ER—and they can help you make a plan for doing so safely. If symptoms are serious and you can’t get a hold of your pediatrician, go directly to the ER.
Symptoms that should prompt you to get emergency help, according to the CDC, include: difficulty breathing, pain or pressure in the chest that doesn't let up, a new bout of confusion, being unable to awaken or stay awake, bluish lips or face, and severe abdominal pain.