While knowledge of COVID-19 transmission and its clinical manifestations is rapidly expanding, many questions remain unanswered regarding the effects of this pandemic on children. Research suggests that most children develop mild illness with COVID, and the development of severe disease is generally limited to infants and patients with pre-existing medical conditions (e.g. cardiovascular disease, chronic lung disease, immunosuppression). Although children and adolescents seem to fare better against COVID than adults do, this blog post will explore how the recent shelter-in-place orders—which are certainly necessary to combat the spread of the virus—may produce unintended, negative consequences for pediatric health.
Delayed Well Child Checks and Vaccinations
According to the American Academy of Pediatrics, the rate of childhood vaccine administration has fallen dramatically throughout the pandemic, likely due to parental fears around visiting healthcare clinics for routine medical care. Over the time period from mid-March to mid-April 2020, physicians in the Vaccines for Children program ordered 2.5 million fewer non-influenza routine vaccinations compared to the same time period last year, as well as 250,000 fewer doses of measles-containing vaccines. These reports raise the concern for outbreaks of preventable diseases in the near future, particularly once daycares, schools, and parks reopen. Similarly, children in need of developmental screenings, pre-participation physicals for sports, and full physical exams are falling behind on their routine care. Many pediatric practices across the county are attempting to address these issues by encouraging families to attend their regularly scheduled appointments while taking special infection control precautions, such as separating sick visits from well child visits (via time and location). The Centers for Disease Control and Prevention (CDC) published recommendations for the prevention of COVID transmission in the outpatient setting in April 2020.
Under Increased Risk of Domestic Violence
In times of crisis and social disruption, there is heightened risk of domestic violence, which has been widely demonstrated throughout the COVID pandemic. This concern certainly includes children who may be at increased risk of witnessing, or becoming the victims of, interpersonal violence while being quarantined in unsafe or unstable environments. Furthermore, children are no longer regularly seen by teachers, doctors, or other mandated reporters, which may lead to serious delays in detecting and addressing child neglect or abuse. Healthcare providers should consider making special calls or regularly checking in with families of children who are at higher risk for maltreatment at baseline, either due to known history of abuse or existing behavioral or developmental issues. Providers should also encourage families to attend well child checks, thereby making it possible for healthcare providers to thoroughly assess each patient’s risk for domestic violence.
Inactivity and Increased Screen Time
In addition to an unprecedented interruption in education, nation-wide school cancellations are likely to generate unintended health consequences for children and adolescents. Two likely repercussions of school closures include prolonged inactivity and increased screen time among youth. For many children and adolescents, recess and physical education classes are major sources of safe, daily activity. Now, with the closures of schoolyards, parks, and public playgrounds, and with youth sports put on indefinite hold, it is difficult for families and children to engage in the one hour of daily recommended activity by the American Academy of Pediatrics. In addition, many recreation centers and libraries across the country are closed, making it hard for families to provide their children with adequate alternatives to watching TV, playing on their computers, or using their phones. This lack of healthy diversions, coupled with the necessity of online schoolwork, will likely lead to an increase in children’s screen usage, and youth may quickly exceed the recommended two-hour daily limit of recreational screen time.
Although children appear to have milder illness with COVID-19, they may be especially vulnerable to the downstream effects of shelter-in-place orders, school closures, and other necessary public health measures. It is important for healthcare providers to consider these unintended consequences and engage with social workers, therapists, and other health professionals to mitigate these effects.
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Tatiana Patsimas, MD, is a Pediatric Resident Physician at the University of Colorado, where she will also continue for Pediatric Sports Medicine Fellowship in July 2020.