As the COVID-19 pandemic continues into 2021, hesitancy in tending to routine health care isn’t just affecting adults – it’s having an impact on children too.
In May, the reported that nearly 80% of children were missing their well-child, routine appointments, due to the pandemic.
“While visits have significantly increased since the spring shutdown, well-child visits are still lower than pre-pandemic levels,” says pediatrician Carlos Lerner, MD, Professor of Clinical Pediatrics and Jack H. Skirball Endowed Chair in Pediatrics.
Though several “unknowns” have contributed to the confusion many parents are experiencing during this time, skipping preventative pediatrics visits could lead to health consequences down the road, he says.
“I do think families are having to make difficult choices with confusing information presented to them, in terms of what activities to continue and what not to resume,” he says.
Dr. Lerner says families and caretakers should prioritize well-child or wellness visits, especially when it comes to vaccinations.
The Centers for Disease Control and Prevention published which show in the spring, 2.5 million fewer doses of routine vaccines were ordered, compared to the same period in 2019.
With vaccination rates going down due to the pandemic, Dr. Lerner says there is an increasing risk of other diseases spreading in the community.
“This is a particular time to make sure that we're protecting children from other diseases such as measles,” he says. “For the youngest of babies, whooping cough and influenza remain significant concerns and are for them potentially more dangerous than COVID-19.”
Marisa Peters and her husband Josh, parents to three sons ages 11-months-old, 4-years-old and 7-years-old, say the pandemic has added uncertainty to what has typically been routine for their family. In addition to navigating adjusted hours, closures and stay-at-home orders, families are having to weigh the risks and benefits of whether to continue such visits.
“When COVID-19 first started, we were in contact with Dr. Lerner on an hour-to-hour basis before our well-child visits,” says Peters. “I think we were obviously hesitant about the safety of our doctor’s visit because there was just so much unknown at the time.”
Because of concerns that protocols had not yet been put in place in March, the Peters family postponed appointments originally set for their two youngest sons, only bringing in the baby for his initial vaccines. Under Dr. Lerner’s guidance, the family were able to resume with their 4-year-old’s visit and get back on track with his boosters in June.
“Getting your vaccines – despite the slight inconvenience of doing so in a COVID world – is far better than if your child were to become ill with any of the things that are preventable with these vaccines,” Peters says.
The importance of monitoring
Aside from routine vaccinations, Dr. Lerner says there are many other reasons for continuing wellness visits, such as behavioral and mental health, growth and nutrition.
Concerns around obesity are increasing, Dr. Lerner says. “Many kids are more sedentary, spending more time in front of screens and may have more access to food in the home.”
Helping to address sedentary behavior is Matt Flesock, executive director of Sound Body Sound Mind, a UCLA Health program which combats childhood obesity in middle and high schools.
“Traditionally, schools serve as a backstop for many health concerns,” Flesock says. “Without in-person physical education, we’ve had to shift towards more holistic ways for teaching kids how to stay active, such as hiking, yoga and even dancing at home.”
In April, Sound Body Sound Mind pivoted their fitness center model in schools to provide an online PE and nutrition curriculum. In August, they partnered with local community organizations, like the Lakers Youth Foundation and Los Angeles Dodgers Foundation, to provide more than 4,000 families with at-home physical education kits.
“Combating obesity during this time has shown us that there are many other interconnected issues that affect the health of the whole child,” says Flesock. “It has also shown just how critical the school environment is for children developmentally, socially and emotionally.”
Child anxiety is also of concern after months of remote education, lack of interaction with friends and other pandemic-driven stressors. In a UCLA Health Connect Blog by Kate Sheehan, LCSW, managing director of the UCLA Center for Child Anxiety, Resilience, Education and Support (CARES), says anxiety can make kids argumentative, illogical and angry. Some children may become avoidant, or lash out in a tantrum.
Dr. Lerner says after families and caretakers, schools are where many health concerns may come to light.
“It could be as simple as not being able to see the board or speech issues,” he says. “In some cases, the schools help us identify more serious issues that may be going on in the home. With remote learning, we've really lost one of the few remaining sources of expert contact with the child.”
At the start of fall, Los Angeles Unified School District (LAUSD) reported more than hadn’t enrolled in classes for online learning, a sharp decline from prior years.
With fewer children enrolled in school, routine well-child visits become much more critical, “particularly in vulnerable communities that are affected by poverty,” Dr. Lerner says. “As schools stop having that day-to-day contact with kids, [pediatricians] serve as an important safety net for the children.”
Which is why Dr. Lerner believes it is important to stay in communication with your pediatrician.
Pandemic safety and well-child visits
At UCLA, several protocols have been put in place to ensure patient safety and ease concerns. Such measures include newsletter mailings with important health-related information, pre-screening symptom checks, temperature and symptom screenings once patients arrive to their visit, added disinfection and cleanings between visits, a mask mandate for all visitors and physically distanced waiting areas.
“For us, we've been very conscious about staying at home and limiting interaction with others,” Peters says. “Even with those kinds of precautions that we’ve put in place, visiting Dr. Lerner has been one of the only things that we leave our home to go do. It’s a completely safe, normal and adjusted environment for the current times.”
Aware that families are struggling in various ways, or may be fearful about coming in, Dr. Lerner says most pediatricians are able to schedule telehealth or virtual visits, as well as communicate over the phone.
He says even if you’re unsure about whether something is worth coming in for, to call.
“You don’t have to make this decision alone,” he says.
