Wellness exams are vital in pandemic times, and pediatricians worry about kids who miss theirs

As the pandemic wears on, our new routines have become a way of life. One thing that has fallen to the wayside for some — and shouldn’t — is wellness visits for children. 

It’s not just about vaccines. These visits take on extra importance during the pandemic, and East Tennessee doctors are worried kids who need care the most are missing their annual exams. 

Initial concerns about staying away from the doctor to stop the in-office spread of COVID-19 have given way to new concerns that kids’ health is falling through the cracks. 

In the those early months, a lot of families were “rightfully cautious” or “hesitant to maintain that routine care,” Dr. Jason Yaun, pediatrician and vice president of the Tennessee Chapter of the American Academy of Pediatrics, told Knox News.

© Caitie McMekin/Pool via News Sentinel
Audrey Brasher, 6, of Strawberry Plains receives the flu mist, administered by Tasha Ligon, at a Knox County Health Department flu shot clinic, held at the Carter Senior Center, Thursday, Nov. 5, 2020.

In May, the chapter noticed pediatricians across the country were seeing a reduction in visits and vaccinations. Tennessee reported a lower child vaccination rate in March and April compared to those months in 2019.

Checking in with a doctor each year helps assess a child’s growth, development and behavior. Doctors check on how school is going and look for signs of mental health concerns.

Parinda Khatri is the chief clinical officer at Cherokee Health Systems and oversees its medical and behavioral health services. She said the need for mental health services is growing especially as the length of the pandemic brings people stress.

“There is just tremendous need,” Khatri said. “People are very stressed because this is an abnormal stressor. I think people are having a normal reaction to an abnormal stressor.”

Early in the pandemic, the American Academy of Pediatrics issued guidance for medical offices on which age groups to prioritize for in-person visits. Khatri said the guidance has been updated several times, but some families need to reschedule their missed visits now.

“There was a build up of need because all those kids who needed their preventative care or vaccinations, they didn’t get them in part because they weren’t in a priority age group and places closed or slowed down or families didn’t feel comfortable visiting.”

Yaun said part of the early pandemic decline in visits was by design — doctors wanted to keep their patients safe.

“I think it’s coming back, we’re not quite all the way there,” Yaun said. “At least in my practice, things have kind of slowed down a bit for the last month or so once we got past the back-to-school visits.”

Despite the benefits of well-child exams, Yaun estimates most practices in Tennessee are seeing a 20% decline of visits as compared to what they would see in this time of year without the pandemic.

“We are just having to work extra hard for outreach and engagement for vaccinations,” Khatri said. “It’s always a balance because you don’t want to bring kids (in) unnecessarily, but you also don’t want to bring another epidemic or pandemic on top of this one.”

Use the flu shot as a starting point

Along with COVID-19 concerns, the community is bracing for flu season. A high number of hospitalizations due to the flu and COVID-19 could overwhelm hospitals. 

“If you’re older than 6 months old, you should get a flu vaccine,” said Dr. Mark Browne, chief medical officer at Covenant Health at a media briefing Tuesday. “There is a safe vaccine for nearly everyone today. There are very, very few reasons that anyone should not get a flu vaccine.”

Yaun said doctors are taking a lot of precautions to mitigate COVID-19 risk and those wellness visits are crucial. 

“I think a lot of pediatricians in our state have gone through great efforts to provide care and do it safely, Yaun said.

Nan Gaylord is a professor at the College of Nursing at the University of Tennessee at Knoxville. She is also the director of the Vine School Health Center where people across Knox County can receive health services. Gaylord stressed the importance of physical exams, immunizations and getting the flu shot.  She said appointments are picking up again with people realizing they need to get their flu shot.

“We gave more flu vaccines than we have ever given,” Gaylord said.

Safety has improved 

She said families should rest assured that medical providers are taking safety precautions.

“It’s safe, we all use PPE, we meet patients at their cars, there’s not a waiting room, you go directly to your car to the exam room and then back to the car,” Gaylord said. “Masks are required for everyone. There’s only one parent or guardian with one child. That has really changed how we provide services.”

Yaun said the extra COVID-19 precautions such as scheduling wellness visits and sick visits at different parts of the day or administering vaccines in the parking lot don’t contribute to any decrease in doctor availability.

But Khatri is concerned the pandemic has exacerbated issues with medical health access. 

She said some people are fearful of getting tested because they are worried they would not be able to go to work. Other concerns include other people knowing the patient is sick or not being able to pay for a hospital stay if it were necessary.   

“We see people regardless of ability to pay, we have seen a significant increase of demand for our services,” Khatri said. “People have lost their jobs and their health care, they have medications. So they are calling us.”

“I think there is a tremendous amount of anxiety and fear among those without health insurance,” Khatri said.

Along with the “build up” of people needing their preventive care appointments, Khatri said the pandemic makes reaching vulnerable populations harder. She said there are racial and ethnic disparities in health care coverage.

“The barriers and the issues that have impacted access to and engagement in preventative child health care are amplified during the pandemic,” Khatri said. ”So scheduling, transportation, we always see certain no-show rates particularly for our Medicaid Tenncare population and particularly for middle schoolers and high schoolers. It’s already challenging to get high schoolers to get preventative visits in. And now we’re in a pandemic, so it’s even more challenging.”  

What about kids being sent home from school? 

At Knox County Schools, parents and guardians of children are told their students must quarantine if they are a close contact with someone who has COVID-19. While some families choose to get their children tested during that time, a negative test is not required for students to return to school after they have completed the quarantine period.

Even before the pandemic, sometimes students were sent to school when they were sick. Now, temperature checks allow schools to identify a child with a fever at the beginning of the day and isolate the child until they can be picked up.

Khatri said she hasn’t seen a rise of sick children coming in for doctor appointments due to those temperature checks. 

“I would not say there is an uptick, but we certainly are getting calls from parents where their kids are getting sent home with a fever,” Khatri said. “At that point, that’s when we decide if it makes sense for them to have a COVID-19 test.”

Khatri said nurses determine if a test is necessary based on symptoms, risk factors and if the person has had close contact with a known case.

Other COVID-19 precautions such as wearing a mask may help slow the spread of other illnesses common in children, Yaun said. He said he isn’t seeing as many upper respiratory illnesses or ear infections but that could change in the coming months. 

More: Masks, social distancing to protect against COVID-19 may decrease flu spread, too

This article originally appeared on Knoxville News Sentinel: Wellness exams are vital in pandemic times, and pediatricians worry about kids who miss theirs