Due to the coronavirus (COVID-19), many non-urgent appointments and surgeries have been canceled or postponed. Pediatricians throughout the country have seen a significant decline in the number of well-check visits and vaccinations.
During well-checks, pediatricians are doing a lot of things to make sure kids are continuing to thrive. One thing we evaluate at these visits is your child’s growth. Children grow really quickly, so growth is one of those early signs that can indicate that maybe something isn’t going as it should and we can intervene. Along that same line, we’re checking on your child’s development. As parents know, kids are changing constantly and we want to make sure they’re meeting milestones on time and, again, identifying early if there is something that isn’t on track
Vaccines are a critical part of these checkups for most children in their early life. We’re giving those vaccines on the Centers for Disease Control and Prevention’s schedule to help keep kids safe and healthy.
Lastly, pediatricians provide critical counseling to families that is specific to their child’s age and unique health history. This guidance helps families continue to foster their child’s growth and wellness.
This changes depending on age. Infants are usually coming in every two months, then it spaces to every three months, then every six, then it transitions to yearly in early childhood. The main reason that it happens on that timeline is partly to do with vaccines, but also because of how quickly children are changing. This schedule allows us to adjust and give parents the advice and recommendations they need for those transition times.
I see a lot of children with special health care needs here at CHoR and depending on how complex or changing the child’s illness is, they may need to be seen every three months, or every six months – it really depends on their overall trajectory and what’s going on with them. We also have an option of doing telehealth visits when appropriate for those children with special health care needs to check in and see how things are going.
We’re very fortunate that the American Academy of Pediatrics has advocated on a national level for well-checks to be covered under telehealth visits by insurers. That being said, it’s not appropriate for every checkup because we can’t give vaccines remotely. It can be challenging to check on growth virtually, but it’s something we can do in a creative way if it’s appropriate.
There are circumstances when telehealth visits are absolutely the best option, but there are times when they’re not. It really is a case-by-case decision between the parent and the health care provider.
I would say the most critical visits for the vast majority of children are those infant appointments where we’re really closely watching growth and development and providing vaccines. There are going to be exceptions for older kids that we do need to see in person, but we can get a lot of information from telehealth visits. We can do a pretty thorough physical exam, get a great history, chat with the kiddo, see their family, see what’s going on at home…so those visits are very illuminating and for a lot of families are sufficient.
That being said, there are circumstances where we need to physically lay hands on our patients and do assessments that can only happen in person. Some examples of kids we would want to see in person include those who have a heart murmur that needs to be re-evaluated, children who need oxygen levels checked, blood pressure monitoring, etc. just to name a few. If your health care provider believes an in-person visit is more appropriate for your family, they will discuss this with you at the time your visit is scheduled.
Those ages will primarily be 4-year-olds and 11-year-olds and they are tied with school entry. We do want to make sure that if it’s a visit where the child is due for vaccines that we see them in person so we protect them, but also ensure their ability to enroll in school on time.
This is probably one of my most frequently asked questions right now and I’m so proud of everything that is happening to make sure patients, families and staff stay safe.
We are:
Every team member is also wearing a mask and checking in with their own symptoms every day to make sure folks are coming to work healthy and able to provide great care.
The American Academy of Pediatrics and the Centers for Disease Control and Prevention put out a press release looking at vaccine rates across the country. One of the things they’ve noticed in the data from mid-March to mid-April is that the number of vaccines ordered nationally was down 2.5 million doses for that month compared to the same timeframe the year prior. That was all vaccines, but what particularly worries them is measles-containing vaccines were down about 250,000 doses for the whole country.
As we know, measles is a vaccine-preventable disease that spreads very quickly in unvaccinated or unprotected people. We’ve seen a resurgence of measles, like in the Disney outbreak a few years ago, and that’s one of the things we’re worried about when we see vaccine rates trend down.
Some of these vaccines are for diseases that spread through person-to-person exchange, but remember also that your kids are going to be outside playing this summer. One of the important things we want to make sure they’re protected from is tetanus, which is present in the soil – thinking about those routine scrapes, cuts and just kids being kids. Receiving tetanus vaccines on time ensures kids are able to enjoy the outdoors without that additional worry.
There is a report in every patient’s portal of all the vaccines that have been given to date. If families are having trouble with the portal or they’re not signed up, they can definitely give us a call. They can also ask us to pull the report and fax it directly wherever they need it to go, in addition to completing any screening forms for school or college entry.
There are situations where a nurse visit only for vaccines is appropriate and then we can complete the rest of the checkup via telehealth. There are other times where if you’re going to come in anyway, you might as well finish the visit and it might be more appropriate for your child to do it that way. This is another case-by-case situation and we are doing a blend of some nurse visits and some full checkup visits.
There are a few – one of those being what we discussed previously. We pediatricians and public health folks are concerned about possible outbreaks on top of the COVID pandemic. If we start to see a whooping cough or measles outbreak, occurring on top of COVID-19, these could potentially overwhelm hospital systems and the health care infrastructure.
Another thing on an individual level that I counsel my families about is that their child’s fever plan looks very different if they’re up-to-date on vaccines than if they’re under or unimmunized. Fever is common with routine child illness, but the chance of it being something that is more significant is higher if the child is not protected by being vaccinated. Being behind on vaccines may mean your child will need bloodwork or a shot of an antibiotic with fevers, so the degree of how invasive that fever evaluation is really is dependent on your child’s vaccine status. It’s important to be well-informed about what choices you’re making as a parent and know that we may need to do more if a child is not properly vaccinated.
We’re here for you to answer all of your questions. I know right now there are probably more questions than ever about what’s safe and what’s not, what the biggest risks are for children, along with the risk-benefit ratios. We’ve been having a lot of these conversations and will continue to do so to help families navigate this time. Know that we are here, we’re encouraging families to come in and we’re taking every precaution we can to make experiences safe and meaningful for families.
Watch the full interview with Dr. Kimbrough:
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