Recently, my son turned one year old, and with this milestone, he was due for his 12-month wellness visit. Or—wait—was he? I thought navigating appropriate finger foods for my son was tricky, then the world threw me a pandemic curveball. I wondered if the stay-at-home order in my state of Indiana, and the necessary additional medical precautions, would cause his visit to be cancelled and rescheduled. But, I soon learned, it wasn’t.
With information and misinformation intertwined together in social media feeds everywhere, many parents like me are scared and unsure of the do’s and don’ts of doctors’ visits. This uncertainty has caused a significant decrease in in-person child health visits since the pandemic began, according to the American Academy of Pediatrics. But the AAP is urging pediatricians to:
Prioritise in-person newborn care, newborn well visits and immunization of infants and young children through 24 months of age whenever possible.
Continue well visits for children through telehealth, with the acknowledgement that some elements of the well exam will need to be completed in-clinic once community circumstances allow.
Complete in-person elements when circumstances permit. These elements include, at a minimum, the comprehensive physical exam; office testing, including laboratory testing; hearing, vision and oral health screening; fluoride varnish; and immunizations.
Conduct acute or chronic care via telehealth and complete some elements of the acute or chronic care visit in clinic as indicated and when circumstances permit.
Why in-person visits are important
American Academy of Family Physicians (AAFP) President Dr. Gary LeRoy says he has personally lost three-quarters of his in-person patient contact since the quarantine began—and he’s concerned about that.
“From birth to 24 months is a critical point of life,” LeRoy says. “Kids grow so rapidly, and things can change so quickly. We can’t put wellness checkups off and say, ‘We will see you in six months.’”
The CDC agrees and encourages parents to continue wellness visits as scheduled. Particularly with children who are 24 months old and younger, wellness appointments are critical for maintaining a vaccination schedule, but there are also developmental goals that need to be tracked and assessed.
“Wellness visits are critical for monitoring developmental milestones, slippage, or if a child is falling off their growth curve,” LeRoy says.
And while telehealth visits are recommended if your child has a cold or an ailment, it’s simply not the answer when it comes to wellness visits.
“Phone and audio-visual visits are a tool, but not a replacement, especially when it comes to children,” LeRoy says. “You need to give a physical assessment. I don’t care how sophisticated the tool is. You can’t measure a child on the phone and hope the parent got it right.”
Preparing for your visit
As eager as everyone is to see life outside of their own four walls, a paediatrician appointment is not the family’s chance to bust out of quarantine. When attending your child’s wellness visit, operate with a less-is-more approach, particularly in regards to who comes along.
“We are recommending not to bring the whole family,” LeRoy says. “We don’t want a full room of people. Just one parent versus both parents. This helps with keeping the waiting area and the examination room uncrowded.”
You do not need to wear gloves to your appointment, but parents and children ages two and older are encouraged to wear a face mask—likewise, you should expect to see staff in face masks when you arrive.
As always, stay vigilant with you and your child’s hand-washing. As a courtesy to the staff, wash or hand-sanitize right before making contact in the office. Once you arrive, you shouldn’t expect to walk right into the exam room. Before you can be seen, you and your child will likely be asked a series of questions associated with COVID-19 symptoms and exposure, and you’ll have your temperatures taken.
While the overall precautionary principles are the same, not every practice will do it exactly the same way. In the spirit of safety and preparedness, it’s a good rule of thumb to contact your paediatrician’s office in advance of your visit for their location’s specific rules and practices.
“Some offices may have you wait in the car versus in the office,” LeRoy says. “It depends from practice to practice.”
Should your child exhibit COVID-19 symptoms, LeRoy recommends scheduling a telehealth visit with your paediatrician first.
“Try as best as you can to be aware, but not anxious,” he says. “Practice good parental care. When your spidey senses go off as a parent, check it out with your child’s paediatrician to make sure you are doing the right thing for your child.”
A new “normal”
Even once states start to reopen, it’s not likely that doctors’ visits are going to go back to business as usual right away. In fact, some of what we’re experiencing right now might be part of our new post-pandemic “normal.”
“Given the nature of the infectious disease process with COVID-19, the social distancing will continue for an undetermined period of time,” he says. “Masks and six feet apart will continue until it’s official that the pandemic has ceased.”
And going forward, the increase in telehealth use is likely here to stay.
“That’s one genie we won’t get back in the bottle again,” LeRoy says. “Telehealth has been around for decades, but there was never an overwhelming necessity to invest in it. But COVID-19 came along and caused that tool to be pulled out of our toolbox. We became used to it very quickly out of necessity, and now it’s an extra convenience for parents and patients.”