As the Covid-19 pandemic tears across the country, pediatricians are facing a unique challenge: determining what to do about well child check-ups. As you probably know, typical well child visits occur at regular intervals throughout the first three years of life and then yearly thereafter. Pediatricians assess growth and development, provide vaccination, perform lead and anemia screenings and offer supportive anticipatory guidance for parents.
We know vaccines save lives. According to the CDC, vaccination for children between the years of 1994 and 2018 will prevent 936,000 future deaths and 419 million illnesses. And yet, a recent study published by the Measles & Rubella Initiative reported that 117 million kids internationally are at risk of missing the measles vaccine due to the current pandemic, even though the CDC and American Academy of Pediatrics are still recommending routine well child care for vaccination at the discretion of the providers.
As the experts in disease prevention, we pediatricians are finding ourselves in a bind. We are asking healthy parents and babies to leave the safety of their home to come into a medical office. And there is no clear statistical analysis available yet to weigh the risks of COVID-19 acquisition through an office visit against the risks of illness from a vaccine preventable illness. We also know that children are more mildly affected than their parents by COVID, which complicates the picture even further.
I work in New Rochelle, NY, where the first case of community spread in the U.S. began in early March, and have grappled with this question personally. And while I initially felt fearful of bringing healthy families out of their homes, I have conceded that this virus is going to be with us for longer than we hoped for and we must do our part to ensure the health and safety of our babies during these times.
The medical group that I belong to, Westmed Medical Group, is taking very clear measures to limit foot traffic and keep visits as safe and brief as possible. Flexibility and creativity is helping us better serve our parents, and many practices like mine are designating “well baby” morning schedules and seeing sick patients later in the day or in a separate location.
In just a few short weeks, I have used telemedicine as a tool to guide parents to splint digits, perform a full neurologic assessment after a head injury, check for oropharyngeal lesions and even palpate abdomens. In short, we are trusting our parents as able students and experts in their children’s health. We are often erring on the side of time, patience and hope that children's illnesses and injuries will improve on their own, while also still identifying when it is most prudent to bring our patients back into the office for our hands-on expertise. And it is my feeling that the power of telemedicine in pediatrics may stay with us long after the COVID-19 pandemic has passed.
But what about well visits and vaccines?
If parents don’t want to vaccinate during these unprecedented times, I absolutely support their decision, though I hope we can work together to find a time when they feel safe to do so. Still, I believe from a public health standpoint, we must continue to vaccinate our patients, so we do not create the threat of a new pandemic once this one has passed. After all, we’ve now seen firsthand how terrifying infectious diseases can be, and the life-saving promise of vaccination is hard to ignore.
Some closing thoughts: Many pediatricians are not on the front lines in ICUs. We are, however, still essential workers–fighting for prevention and making sacrifices to avoid future epidemics. In a world where it all feels upside down, your pediatrician is still there to support you and your family, as your trusted advisor and friend.