Coronavirus Update:What patients and families need to know
Returning to School: Health-Related Concerns
Primary care providers are an important resource as schools resume and families have many questions about immunizations, school safety, masking, medical exemptions, mental health care access and more.
During the pandemic, families are experiencing unprecedented stress, changes in economic and employment circumstances and challenges with mental health. Primary care practices are an important point of contact for children and families, particularly during periods of school closures for in-person learning. Primary care practices can refer families to the Child and Adolescent Protection Center at Children’s National if they have concerns about abuse and/or neglect.
Primary care practices should do outreach to patients who may be behind on their vaccinations and providers should include a discussion of immunizations as they prepare families for back-to-school, whether it is an in-person return to school or virtual learning. Due to disruptions in primary care during the pandemic, it’s critical for primary care providers to reach out to families and schedule visits for immunizations. For more information regarding vaccines, please visit these resources for D.C., Maryland and Virginia. In addition, primary care practices should discuss and offer flu vaccinations to every eligible patient.
Medical Exemptions from In-Person Attendance
Primary care practices will receive requests from families about exemptions from in-person attendance at school. Providers should consult with families about their individual and family risk factors, including students and family members with underlying medical conditions that place them at higher risk for COVID-19. Providers should follow the guidance and procedures of the school districts regarding exemptions from in-person learning.
Medical Exemptions from Masking
Children under 2 years of age and anyone who has trouble breathing or is unconscious, incapacitated or otherwise unable to remove a face covering without assistance should not wear cloth face coverings, according to the guidance from the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC). There should be very few indications for medical exemptions to masking.
Families often have questions about the right mask for their child or how to help their children become accustomed to mask wearing. Primary care practices can share helpful resources with parents and the visit to a primary care practice is an opportunity for a child to become accustomed to wearing a mask.
The mental health impact of the pandemic is far-reaching, and students who did virtual learning for long periods of time may have had less access to mental health supports than they did when they attended school in-person. Primary care practices should screen patients for mental health conditions. Practices should discuss with the child and family any mental health challenges they are facing as a result of the pandemic and help connect children and families to services. As students return to school in-person, providers should advise families to connect with their child’s school to identify mental health supports and resources that may be available in person or via telehealth.
Over 30 million schoolchildren nationwide depend on school meals for nutrition. School closures and the transition to online learning since the start of the pandemic created many challenges for families in accessing food. Primary care practices can screen families for food insecurity using this two-question, validated screening tool. In the event of future school closures, primary care practices should familiarize themselves with access to school meals and encourage families to connect with school staff. Many families have struggled with routines of healthy eating and exercise during the pandemic. View tips for families.
The ongoing pandemic has highlighted the importance of in-person school for children. Providers should encourage families to review the safety plans and infection control measures that their school and school district are implementing. Many families will be asking their primary care provider for advice on whether their child should return to school and/or daycare in-person. The AAP and the CDC strongly support in-person learning for students, with layered safety strategies in place including vaccination, universal mask use, ventilation, testing, quarantining, and cleaning and disinfecting. Providers can remind families that children should be up-to-date on all immunizations before returning back to daycare or school. Make sure your daycare and/or school is adhering to strict immunization requirements for all children.
Providers can recommend that families review the daycare and/or school reopening plans online and look for the response of the daycare and/or school to the pandemic, including:
- What are their cleaning plans?
- How many children will be assigned to each provider or classroom?
- Will there be room for some social distancing if possible? Note that both the AAP and CDC do not recommend social distancing if it is a barrier to children returning to school.
- Will adults/parents be kept out of the facility as much as possible to limit exposure?
- What is the plan if a child, provider or family member tests positive for COVID-19?
- Will there be contact tracing?
Providers can refer families to guidance published by the local health departments and the CDC. In addition, providers should advise families to think through contingency plans for intermittent daycare and/or school closures or if their child needs to quarantine due to COVID-19 infection or exposure.
Returning to School: Educational Concerns
Primary care pediatricians have been – and will continue to be – on the front lines of care for children who are exposed to COVID-19. The pandemic has created a number of ancillary health concerns among the children we care for. We’ve compiled some topics to consider as you conduct well child visits.