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COVID-19 or not, the world keeps turning. If you have children, what this means is that they continue to grow, develop, and learn. They need for us to ensure that they have the best possible chance to do it all well—and to avoid illness and injury while doing it.
This is where your pediatrician comes in. Historically, up to 10 visits over the first two years, and generally annually thereafter, have been recommended to monitor growth, development, and physical condition. During those visits there are usually conversations about such topics as injury prevention, nutrition and reading, as well as those all-important immunizations.
Clearly, these visits are important. Also, despite our best intentions (and even with sheltering in place), kids still do get sick enough to check in with their provider. Yet you might be a little apprehensive setting foot in a doctor’s office. Even doctors think twice about bringing patients in during these times. Let’s explore a little more about how providers—and parents—might decide whether and when kids should seek medical care, and a couple of options for doing it.
Your pediatrician is always available to discuss with you whether it’s a good idea to make and/or keep your child’s appointment. Lots will depend on what the pandemic is doing in your area, what measures the office is taking to keep everyone safe, and what the appointment is for.
As far as well visits are concerned, it’s generally important to visit your baby’s provider soon after discharge. At this stage in your baby’s life, previously undetected problems may crop up. This is especially true if you and your newborn were discharged early (before 48 hours of age), which may happen more often during the pandemic.
Historically, most babies have been recommended two visits before age two months. Under the current circumstances, some providers may cut this down to one for otherwise healthy babies. Do discuss anything that’s on your mind with your pediatrician, even if no appointment is booked!
From two months onward, probably the number one reason to come into the office is to receive immunizations. This is particularly true during the first year, when our youngest patients are most vulnerable to vaccine preventable diseases. In addition to immunizations, growth and development monitoring, and recommendations for the home, the pediatrician can examine the baby for abnormalities that might not be apparent—for example, a hip that can come out of joint.
Kids over the age of one need booster shots, but for most, there is some flexibility as to when they’re given. Of course, growth, development and physical health are still important. But if your community is undergoing peak COVID-19 activity, talk with your pediatrician as to whether he might want to postpone the visit—even if just for a few weeks—or whether there might be alternative ways of getting parts of the visit done.
There is an alternative to an office visit that’s getting a lot of attention these days: telemedicine. But is a virtual visit the right thing for you and your infant or young child?
Obviously, a visit that’s accomplished entirely by telehealth won’t work if an immunization or procedure is needed, or if a hands-on provider examination is required (like that hip problem). But there’s a lot that can be accomplished during a video visit if none of the above is needed. If you’ve got a scale at home, the baby can be weighed, and her provider can look at her for jaundice. Older children can be seen virtually for development and behavior visits. And some practices can get a lot of the routine physical visit done by telehealth and schedule the in-office portion separately for vaccines (and vision and hearing in older children).
Some minor illnesses take well to telehealth. Perhaps you’re concerned about your baby’s breathing. An experienced pediatric provider can tell a lot by just watching a baby breathe. Many rashes, of course, are naturals for telehealth visits. Something like an ear infection or a strep throat (which, by the way, is very rare under the age of 2 years) may require a little more creativity and educated guessing if the visit is done virtually; however, there might be COVID-19-related circumstances where a virtual visit would be your child’s provider’s choice, at least for starters.
If telehealth is everyone’s choice for a visit, there are things that parents can do to make it go well. First and foremost, get a thermometer and know how to use it! While the presence or absence of a fever doesn’t tell us 100% about how severe an illness is, it usually gives a pediatrician something to go on. Even pre-COVID-19, I’ve witnessed a lot of emergency room visits that might have been avoided if a parent had just been able to take a temperature.
It’s also good to know how to take a child’s pulse and count respirations. If you do have a scale, be prepared to use it. Also be prepared to have your baby or child at least partially undressed for the visit. Finally, check your Wi-Fi connection!
There are two parts to the “when to visit” question. We’ve already talked a little bit about when a well visit might be able to be put off a little, and when it should be done ASAP. The other part has more to do with “What time?” It’s an important one, because many providers have divided their day into “sick times” and “well times.” Well visits are often in the morning, right after the office has been cleaned. Again, the lesson here is to communicate with your provider to see how she wants to handle the visit.
And what about the common situation where the child has a well visit scheduled, but is “sick” on that day? In that case, a call to the office is very important. Your child’s provider may want to reschedule the visit, even if it’s only moved to the “sick hours.” It’s also worth letting the office know in advance if you have other concerns about your child in addition to the one that prompted the visit. Providers may have a little more time these days to address everything, and it just might avoid an extra sojourn out of the house.
We haven’t talked a lot about other measures providers are taking to ensure a safe and effective pediatric visit (you can read a little more here about that). Rest assured, though, that’s it’s all done with the goal of keeping kids healthy through the COVID-19 pandemic and beyond.