Making House Calls
Quarantining at home may be an effective way to stem the spread of COVID-19, but it may have the unintended consequence of increasing the risk of other serious diseases, including measles and pertussis, when parents are afraid to bring their children to the pediatrician’s office for vaccinations.
Pediatricians across the nation are finding creative ways to care for patients and their families, ensuring children get the care they need in a variety of innovative ways. The ABP has awarded pediatricians with MOC points in recognition of this work. In addition, it has been invigorating to listen to pediatricians’ stories and share them with all of you.
One of those innovative practices is Fairfax Pediatric Associates in Fairfax, VA. When they saw how many families were concerned about coming to the office, they rented a van so they could bring the office to their patients.
“The response has been tremendous,” says Sandy Chung, MD. “Families are incredibly grateful.”
The van travels up to 15 miles from any clinic location for well-child visits. They give vaccinations and screen for developmental and behavioral issues.
“At first, we were going to anyone who needed a (well) visit,” she says, “but the demand got so high. Now we have had to adjust and see only infants and children 12 and under.”
Like many other practices, Fairfax Pediatric Associates also has established telemedicine visits, examined sick children in the parking lot, and set up separate office hours for sick children and well children. Fairfax Pediatrics has several locations, so they have been able to designate some clinics to handle only sick children and others to handle only well children.
“We did a survey of practices across our state and found that we’re all seeing that the number of children and parents coming in for well visits was dramatically decreased over the past three months,” says Dr. Chung, who also is president of the Virginia Chapter of the American Academy of Pediatrics (AAP). “A reduction in well visits also means a reduction in vaccinations.”
Right now, she says, about one in three infants is behind on vaccinations, and about three in four adolescents are behind.
“We do rely on herd immunity,” she says. “If one in three infants are not vaccinated, when they get to pre-school, then there is certainly a potential for an outbreak. We’re asking families to prioritize child health by doing their well-child visits.”
Dr. Chung has other concerns, including a resurgence of COVID-19 cases.
“We potentially have another year of trying to keep this [virus] at bay until there is a vaccine and a treatment available,” she says.
If children do not go back to school this fall, she is concerned they will not have access to other critical resources, including access to counselors and other specialists.
“It’s been enlightening to see what an important role school plays in a child’s life as far as making sure that someone is able to work with them on developmental, behavioral, and mental health issues and special health care needs,” she says. “The absence of school has really exacerbated some of those conditions.”
She worries about parents, too. “What we are asking parents is to become is part-time teachers, part-time counselors, part-time specialists, and part-time therapists, and that’s not their training. It’s a challenge for any parent who suddenly has to play all those roles for their child while also balancing all the needs of the rest of life.”
For some people, the stress may be too great.
“We are concerned that there are cases of child abuse that are going unidentified,” she says.
Children studying at home also has causes a “digital divide,” she says, leaving children who do not have access to internet service or to a computer at a disadvantage. “We know that there are children who, once school went to online learning, completely stopped school because they had no way to access the materials.”
Dr. Chung advises pediatricians to look for resources that will help them help their patients. The AAP is a good source of information, including clinical guidance and help for practices during the pandemic. She also encourages pediatricians to help guide school and government officials as they made decisions that affect the health of children.
“Be the expert your families and communities need you to be,” she says.
About the Author
Keith J. Mann, MD, MEd, is Vice President for Continuing Certification at the American Board of Pediatrics (ABP). As lead of continuing certification (also known as Maintenance of Certification or MOC), his focus is on evolving the program to be increasingly relevant and valuable for pediatricians while upholding the high standards of being a certified pediatrician or pediatric subspecialist. He provides expertise in education, health care quality, and patient safety. Before joining the ABP leadership in 2018, he volunteered on various ABP committees for 15 years. He is certified in general pediatrics and is maintaining his certification.
Photo: Pediatric nurse practitioner Melodie Wuorinen (left) greets a patient in the well-child van.