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When the COVID-19 pandemic first took hold in the U.S. last spring, many Americans skipped medical appointments or found those appointments canceled as doctors put nonurgent care on hold.
For kids, who often need to be seen more frequently than adults, especially at young ages, the impact was significant. In certain cases, experts say, if children’s care, screenings, and vaccinations are put off for too long, the negative effects could reverberate for years.
“We saw a decline from maybe seeing 20 patients a day to seeing four or five,” says Heather Felton, a pediatrician and an associate professor of pediatrics at the University of Louisville in Kentucky. And while patients have now started to return, they’re still coming in significantly less frequently than they did before the pandemic started.
Data from visits around the country matches Felton’s account from Louisville, with worrying consequences. CR spoke with pediatric and public health experts to find out how important these visits are, and how parents should prioritize getting back on track with care for their kids.
What Was Missed
Vaccinations: From mid-March to mid-April, childhood vaccination rates plummeted, according to a CDC report. Doctors ordered 2.5 million fewer doses of routine vaccines through the federal program that provides approximately half of routine childhood vaccines, according to that report.
By the end of June, vaccination rates were rebounding in places like New York City but remained 35 percent lower than they’d been at that time the year before, according to data from the Centers for Disease Control and Prevention.
“That’s what most pediatricians are concerned about,” Felton says.
Even before the COVID-19 pandemic began, there had been a rise in measles cases, she says. With a disease as contagious as measles, an extremely high percentage of the population needs to be vaccinated to prevent outbreaks.
With many kids returning to school, pediatricians worry that outbreaks of preventable diseases such as measles could emerge alongside the ongoing coronavirus pandemic.
Routine screenings: Especially in the first few years of a child’s life, doctors regularly check to ensure that children are growing as expected. They also test their hearing and vision, and screen for childhood cancers, autism, exposure to lead, and developmental delays that may affect speech and learning.
In many of these cases, “the earlier you initiate therapy, the better the outcome is,” Felton says.
The earlier that lead exposure is discovered, for example, the earlier health officials can work to identify where it’s coming from, remedy the source, and start to provide education support and services that can mitigate the harm, says Daniel Madrigal, a health educator with Tracking California, a program of the Public Health Institute.
“Lead exposure is irreversible,” says Madrigal, who co-authored a 2017 report that estimated that existing lead screening protocols from 1999 to 2010 probably missed about half of the kids between birth and age 5 with elevated levels of lead in their bodies. With children missing visits because the pandemic, and an overwhelmed public health infrastructure trying to cope with COVID-19, it’s likely that an increased number of cases could go undiagnosed, he says.
Dental care: Visits to pediatric dentists also significantly dropped off, especially in places that put nonurgent, scheduled procedures on hold for months, says Amr Moursi, DDS, PhD, a professor and chair of the Department of Pediatric Dentistry at New York University’s College of Dentistry and the vice president of the American Academy of Pediatric Dentistry (AAPD).
And while some people may view a cavity in a child’s tooth as something that can be put off for a while—especially because kids’ cavities aren’t always painful—this can cause serious complications, according to Moursi.
A cavity can be “the beginning of a downward cycle of complication,” he says. As the bacteria from that cavity work their way into the tooth pulp and root, that can affect the future development of adult teeth. An untreated cavity can also potentially cause an abscess, which in some rare cases can spread and cause severe infections.
Getting Back on Track
If it has been months since your kids saw their pediatrician and they are overdue, give the office a call to see exactly what sort of appointment they need.
You should also ask about the safety protocols your pediatrician has put in place to protect kids, parents, and staff. Pediatric offices may have changed the ways they operate, Felton says, doing well visits in the morning and sick visits in the afternoon, for example.
At a minimum, offices should ensure that masks are worn and that capacity is limited enough to allow for social distancing. Some have gone further, by improving ventilation, upgrading cleaning practices, and more.
If you’ve missed a couple of appointments with a younger kid, you may have to catch up on vaccinations by getting a few at the same time. This is safe, according to Felton.
“Get everything while you are here, so you don’t have to come back,” she says. During the same appointment, pediatricians can also perform important tests or screenings that your child has missed.
At these appointments, your doctor may also check to see if there’s any chance your child is dealing with aftereffects of a COVID-19 infection, such a heart murmur, according to Felton. Even an asymptomatic infection may leave lasting effects, which is another important reason to get your kids checked out.
Schedule a dental appointment if your kids are overdue, or if there is a dental problem you’ve been ignoring. Pediatricians advise having kids see a dentist every six months.
It’s especially important to get in for a visit if your child has never seen a dentist, which is recommended before they turn 1, Moursi says. It’s also especially important when kids are between 3 and 4, and could have cavities that need to be addressed; and when they are around age 7, when adult teeth start to come in.
If you’re having trouble finding a pediatric dentist, he recommends checking out the AAPD website.
If there’s still widespread COVID-19 in your area, talk to your doctor about whether an in-person visit is needed and how to handle it, especially if anyone in your home is at high risk for severe complications from the coronavirus, Felton says.
And this year in particular, with the coronavirus still very much a threat, make sure to have your kids get a flu shot. It’s worth doing so as soon as you can because it can take a couple of weeks after the shot for immunity to build up.
“You want to get it before you’re exposed,” Felton says.
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