Health Related Concerns

During the pandemic, families are experiencing unprecedented stress, changes in economic and employment circumstances and challenges with mental health. Primary care practices may be the only contact a child has with a mandated reporter for child abuse over the course of school closures. 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.

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.

Medical Exemptions from Masking

Children under 2 years 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 AAP and 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 with students doing virtual learning, they may not have access to mental health supports that 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. Some school-based mental health programs are still operating via telehealth visits, so a good first step would be to advise the family to contact the child’s school and connect with a counselor or other mental health provider.

Over 30 million schoolchildren nationwide depend on school meals for nutrition. School closures and the transition to online learning have created many challenges for families in accessing food. Primary care practices can screen families for food insecurity using this two-question, validated screening tool. Most schools are still providing some form of access to school meals, so providers should 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.

Many families will be asking their primary care provider for advice on whether their child should return to school and/or daycare in-person. Providers can counsel families that there is no one right answer to this question and can discuss with families their individual needs including how their child did with online learning, whether their child needs more socialization, how much risk a family is willing to take on, who lives at home and who may be at higher risk from COVID-19 infection, and what infection control measures (PDF) a daycare and/or school are taking. 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 on the websites 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?
  
• 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, which many people predict may happen if clusters of infections arise locally.