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July 23, 2020

Parents Are Delaying Children’s Well Visits—Here’s Why That’s Risky

Parents Are Delaying Children’s Well Visits—Here’s Why That’s Risky

Updated July 17, 2020; 3:30pm ET

Is your child overdue for a checkup with a pediatrician? If so, you’re not alone. Stay-at-home orders and worries about exposure to COVID-19 have prevented many parents from scheduling routine well visits for their children.

Even if kids aren’t sick or in need of immediate medical attention, skipping these important yearly doctor visits isn’t a good idea. In some cases, it may even be risky.

The American Academy of Pediatrics (AAP) recommends yearly well-child visits from age 3 through 21. The group urges parents to stay up to date with them during the pandemic. Here’s why.

Vaccination rates have been falling
Before 1950, thousands of people died each year from highly contagious diseases, such as whooping cough, polio and measles. Today, these diseases have been nearly eradicated from the United States due to widely available vaccines.

The COVID-19 pandemic, however, threatens to roll back some of these gains as a growing number of children have missed their routine annual checkups—when they would normally receive essential immunizations.

Vaccination rates dropped sharply in the spring of 2020, increasing children’s risk for vaccine-preventable diseases. Making matters worse, children who become infected with one of these preventable diseases who also develop COVID-19 may have a tougher time recovering.

It’s essential to make sure your children are fully vaccinated to protect them and others. The more people who are vaccinated, the lower the odds that a disease will spread. This concept, known as “herd immunity,” can help protect babies too young to be vaccinated as well as those at high risk due to weakened immune systems.

Looking ahead to the fall, it’s also more important than ever for everyone to get a flu shot. With rare exceptions, people aged 6 months and older should receive the seasonal flu vaccine. It can not only help prevent the flu but also reduce the severity of the illness for those who do become infected.

“That's particularly important for children, because many who die from the flu every year are children who were not vaccinated,” explains Irene P. Mathieu, MD, a pediatrician and assistant professor of pediatrics at the University of Virginia School of Medicine in Charlottesville.

Getting your child a flu shot this year is especially critical. Not only can it help minimize the impact of COVID-19 infections in the coming flu season, but it can ease the load on healthcare providers (HCPs), many of whom will be caring for other patients during the pandemic.

Call your pediatrician’s office to ask when flu shots are available and book an appointment as soon as possible.

Visits help catch early warning signs
Routine well-child visits also provide pediatricians with an opportunity to monitor your child’s growth and development.

“We want to make sure that children are developing cognitively, socially, emotionally and physically the way that we expect them to,” says Dr. Mathieu.

This is especially important for younger children. “If we miss an appointment or two, we can sometimes miss problems that will lead to issues with their social or emotional functioning later in life,” she explains.

During a typical well-child visit, your pediatrician will perform a physical exam, update your child’s medical history and address any new health or well-being concerns. They may also screen for vision or hearing problems, or conditions such as anemia, high blood pressure or lead toxicity. Older kids may also be evaluated for depression.

“All of these are really important because these are things that can change over time,” Mathieu says. “We need to be checking on these things annually to make sure kids aren't developing any diseases that are silent that you wouldn't notice as a parent.”

Checkups provide a ‘green light’ for sports
Children who hope to play sports either for their school or in an outside league usually need clearance from a doctor first. During a routine checkup, your child’s pediatrician can often perform a sports physical exam that’s required for participation in a number of physical activities.

During the standard sports physical, kids are typically screened for heart-related conditions, bone and joint issues, mental health concerns and other problems that could affect their ability to participate safely.

Even if students aren’t back in school full time by the fall, many teams may still be registering players and finalizing team rosters so that they are ready to go once restrictions are lifted and it’s safe to resume play.

How offices are keeping families safe
While the checkup itself will mostly remain the same, you may notice differences in the logistics surrounding your child’s well visit during the pandemic. Pediatricians’ offices across the country have implemented a number of safety measures to help minimize exposure to SARS-CoV-2—the virus that causes COVID-19—and to prevent the spread of the disease.

These precautions include:

Using additional locations. When you call to schedule a well visit for your child, make sure to confirm the appointment location. You may be asked to go to a different facility than usual. Many pediatricians are spreading patients out to comply with social distancing recommendations.

Limiting the number of people in exam rooms. Some pediatricians’ offices may request that only one parent or guardian attend the checkup. Others are designating separate times for well-child and sick-child visits.

Clearing out waiting areas. Some practices, including Mathieu’s, are asking parents and their children to not wait for their appointment in the office waiting room. Instead, they’re asking people to stay in their cars until it's time to come in.

Screening for COVID-19 symptoms. When you call to make your appointment and when you arrive, the office staff will likely ask if you or your child have any symptoms of the disease. This is especially important if you’ve been in contact with someone known or suspected to have the illness, or if your family has traveled recently.

“It depends on the level of concern that you and your pediatrician have about your child's risk of having COVID-19,” Mathieu advises. “That's really a conversation for you and your pediatrician.”

Your pediatrician will advise on what to do if you suspect you or someone in your family is infected.

Routine disinfection. During the pandemic, doctors’ offices have implemented procedures to disinfect office space more frequently and thoroughly to help curb the spread of SARS-CoV-2.

Social distancing reminders. Inside the pediatricians’ office, you may find signs or other physical markers asking you to maintain 6 feet of distance between you and others.

More personal protective equipment (PPE). It may seem worrisome to see HCPs wearing gowns, goggles and masks. But rest assured, this is in everyone’s best interest. “This is really important not only to protect us, but also to protect you and your child,” Mathieu says.

Other steps parents can take
First, don’t wait to schedule a checkup. “Make an appointment as soon as is convenient for you and your child,” says Mathieu. You may experience longer waits than usual, since many HCPs are rescheduling canceled appointments. Some offices have had to lay off staff, as well, leaving them shorthanded.

The morning of your child’s visit, call ahead to double-check what is expected. “Depending on what's going on, your pediatrician may change what they ask you to do when you come into the clinic,” says Mathieu. For example, you may be asked to come in at a different time that you had originally scheduled.

Pack hand sanitizer and face masks for you to wear to the appointment. Children age 2 and older should also wear a face mask when out in public and around other people.

“Many practices and hospital systems do provide patients with masks at the front door, but you never know,” Mathieu says. “And as much as possible, please make sure that you and your child remain masked if asked to while you're in your pediatrician’s office.”

Ask the staff about specific policies regarding face masks.

If you’re still concerned
You may be worried about the status of the pandemic in your community, especially as COVID-19 has continued to spread in many areas of the country. It’s wise to take appropriate precautions, such as handwashing, wearing a mask and social distancing. But don’t cancel or postpone a well-child visit before reaching out to your provider first.

“If you have any questions, concerns or reservations, it's worth a discussion with your pediatrician before deciding to delay your child's care,” Mathieu says. “You may not know the things that your child is due for or the things that we screen for—and those could be really lifesaving interventions.”

Medically reviewed in July 2020.

Sources:

American Academy of Pediatrics. “Guidance on Providing Pediatric Well-Care During COVID-19,” “COVID-19 Planning Considerations: Guidance for School Re-entry,” “Recommendations for Preventive Pediatric Health Care.”
Centers for Disease Control and Prevention. “Vaccines and Immunizations: What Would Happen If We Stopped Vaccinations,” “Coronavirus Disease 2019 (COVID-19): Information for Pediatric Healthcare Providers,” “Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration — United States, 2020,” “Coronavirus Disease 2019 (COVID-19): Considerations for Wearing Cloth Face Coverings,” “Who Needs a Flu Vaccine and When,” “The Flu Season,” “CDC Reports About 90 Percent of Children Who Died From Flu This Season Not Vaccinated,” “Frequently Asked Influenza (Flu) Questions: 2020-2021 Season.”
Eliza Shapiro. “Child Vaccinations Plummet 63 Percent, a New Hurdle for N.Y.C. Schools.” The New York Times. July 1, 2020.
KidsHealth. “Coronavirus (COVID-19): Kids & Medical Care During the Pandemic.” May 2020.
Gypsyamber D’Souza and David Dowdy. “What is Herd Immunity and How Can We Achieve It With COVID-19?” Johns Hopkins Bloomberg School of Public Health. April 10, 2020.
HealthyChildren.org. “AAP Schedule of Well-Child Care Visits,” “Sports Physical: When, Where, Who Should Do It?” “Should Your Child Be Tested for COVID-19?” “Is it OK to call my pediatrician during COVID-19?” “Return to School During COVID-19.”
Jan Hoffman. “Vaccine Rates Drop Dangerously as Parents Avoid Doctor’s Visits.” The New York Times. April 23, 2020.
Children’s Health. “Resuming Appointments and Surgeries.” May 8, 2020.
Johns Hopkins Medicine. “Routine Vaccinations, Wellness Visits for Babies and Kids During the Coronavirus Pandemic.” May 15, 2020.
Dr. Nancy A. Anoruo and Dr. Heather J. Kagan. “Even nation's largest health systems laying off health care workers amid COVID pandemic.” ABC News. April 24, 2020.

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