For Dr. John O’Reilly, chief of the division of general pediatrics at Baystate Medical Center, back-to-school physicals have always been about more than ensuring his young patients are current with year-to-year immunization requirements.
The long-time pediatrician uses these sessions to keep updated on patient lives, and especially so this summer as the many lifestyle disruptions and health care concerns ushered in this spring by the coronavirus disease 2019 pandemic continue until a vaccine can be safely developed and administered against the new respiratory virus first identified in China earlier this year and known as SARS-CoV-2.
“The pandemic has made it clear that there will be no ‘business as usual’ for the new school year,” said O’Reilly who sees patients at Baystate’s High Street Health Center.
Many of O’Reilly’s patients started with him as newborns and he was asked here what impact he sees from COVID-19 on them and their families as they prepare for a new academic year shaped by infection control precautions to reduce community spread of the novel virus.
How much are families talking to you about the impact of COVID-19 on their lives?
A. I bring up the topic in every patient encounter that I have, whether that be on the phone, on a video visit, or in person. COVID-19 has created great stress on many levels for everyone. Every patient and every family is unique, and it is important to understand how everyone in the family is dealing with that stress to begin to care for any individual patient.
How anxious are families to have their children back to attending school in the fall? Or, are they worried about exposure risks to their children and family?
A. Many parents are anxious about their children going back to school. Like many aspects of the pandemic, parents are trying to find the proper balance between their desire to see their children get a good education and their need to keep their children safe.
Parents know that for many school-aged children the last few months of web-based home schooling has not provided the educational, experiential and social experiences that children need to grow and thrive. Parents want their children to have the full experience of school, but they want to do that in a safe manner.
As a pediatrician do you feel it is better for children to be in school if community transmission appears to be low?
A. A good school experience provides the academic, social, and experiential, that is, band, theater, sports, art, that lead to maximal personal and brain development. Our goal should be to create the conditions that will allow our children to go back to school safely.
What food insecurity are you seeing among your patients?
A. The COVID-19 pandemic has highlighted the great disparities in food access, especially in Springfield.
The majority of our patients qualified for subsidized or free meals at school, and that guaranteed them access to two nutritious meals a day.
I applaud the Springfield school and city’s efforts to provide outreach to families, but food insecurity persists despite their best efforts.
With parental layoffs or furloughs family income decreased which increases food insecurity when money for food did not last all month.
The pandemic also had an impact on food banks and other community sources for food for our most vulnerable families. Community agencies are working hard to fill in the gaps, but it will take everyone’s advocacy and action.
Infants, children and adolescents need adequate nutrition to grow and develop.
Food insecurity has a delirious impact on the physical and psychological development of my patients and prevents them from reaching their full potential.
How have you been reaching out to parents to continue to bring in their children for checkups and vaccinations? Are kids falling behind in getting their checkups?
A. Children of all ages are falling behind on their immunizations.
COVID-19 has for the most part only produced mild illnesses in children. I fear that the drop off in well-child visits and vaccinations due to fears of COVID-19 will create a far more devastating outbreak of vaccine preventable illnesses such as measles, whooping cough (pertussis), and meningitis.
I have not seen any of my patients have severe cases of COVID-19, but I have seen over my career many children die and become permanently disabled from those vaccine preventable diseases.
To prevent such a catastrophe, we have been reaching out to our families to come into the office to get their child’s well child visits and vaccines. We have put in great efforts to reassure parents that it is safe to come into the office.
We have changed schedules and patient flow so that we can ensure social distancing and separation of patients coming in for sick or well visits.
We have enhanced cleaning protocols to ensure that all spaces within the clinic are safe.
We screen everyone prior to entering the clinic for fever and COVID symptoms, and require everyone in the clinic to wear masks and do frequent hand washing.
Many children have lost grandparents to COVID-19. Are you seeing the impact of this loss on your patients and their families?
A. Many of our families have lost friends and relatives to COVID -19, and that has had a traumatic impact on many of our patients.
The loss of grandparents may be particularly hard because they often played an integral part in a family’s daily life and had close connections to their grandchildren. The trauma is doubly compounded since both the parent and the children in that family have suffered a great loss and they may be experiencing grief differently.
Social distancing has prevented the usual community and ritual supports that we need to get through difficult times and that isolation only compounds distress and grief.
We have an integrated behavioral health team in our clinic who reaches out to families experiencing trauma and loss of any kind and helps arrange supports for both parents and children.
What is the biggest emotional impact the pandemic is having on children and does it differ by age group?
A. I think we all have experienced some degree of stress and anxiety during the pandemic. The same way each adult may process his or her stress differently, individual children will experience their stress and anxiety differently based on their temperament, their environment and their developmental stage.
Younger children interact with the world in a more concrete manner, and may react to stress through their behaviors such as sleep difficulties, irritability, and tantrums. Parents should treat those behaviors as a sign that their child is stressed and not as “being bad.”
Older children and adolescents have more abstract thinking and may have more existential concerns, that is, what will happen if…
For all parents the most important thing they can do is let their children know that they are safe and that they are loved. Parents who are concerned about their child’s behavior should contact their pediatrician’s office.
How are you trying to talk to them about coping with the academic year ahead?
A. Pediatricians are used to giving their “August speech” about getting kids ready for school. We always talk about getting kids into sleep and daytime routines that will get the kids ready for the school day schedules. Getting kids eyes off of screens and into books is always part of the speech.
Each age groups gets specific advice about how parents can prepare their student for the upcoming year. Now we will be incorporating pandemic safety routines such as frequent hand washing, social distancing, and mask wearing into the speech.
Pediatricians have always made sure that the returning athletes have been getting their bodies ready for their fall sport. After a few months of lounging have they been doing their stretches and their daily exercise program to get ready for a successful season?
We will now need to be sure that after many months of a layoff do all our students have their brains and bodies ready to learn? Are they doing some reading and writing daily? Have they used their YouTube time to look at any of the math or science videos for their grade?
The brain is the most important part of any student’s body, and it needs to get in shape for the school year ahead.
How much do you talk with kids about wearing masks and social distancing? What do you say?
A. Again, it depends on their developmental stage. For the youngest kids their mask may be part of their superhero costume with magic hand sanitizer and force field social distancing.
For older kids we can add a little more of the science, but address the social issues that are important developmentally for someone finding their identity and their group.
I think finding ways for children to be involved in their precautions such as helping design or draw on their masks may help empower them and make it more likely they will comply with the pandemic precautions.
Are you seeing any unexpected increase in any certain health conditions in kids?
A. Quarantine and social distancing have really limited the usual range of other infections such as viral illnesses and strep throats that usually fill our office.
I think we are seeing an increased number of patients who are experiencing stress and anxiety that manifests as a wide range of behaviors. It runs the gamut from kids who won’t go to bed and kids who won’t get out of bed or out of their rooms.
Parents should reach out to pediatricians with their behavioral concerns just as they would their physical concerns about their children. Behavioral health issues like most physical health issues are best treated when identifying issues early and getting the proper treatment as soon as possible.
What advice are you giving parents in terms of keeping up with their children’s medical needs?
Parents and pediatricians are partners in keeping children healthy and thriving. Good communication and good teamwork are an important part of any partnership.
Each child has unique needs and parents should feel free to contact their pediatrician’s office if there are any concerns about either acute illnesses or chronic conditions such as asthma.
Pediatricians are ready to help keep children healthy with needed vaccines, medications, and either in person or virtual visits.
Are you screening for multisystem inflammatory syndrome in children?
A. Yes. We have been trying to educate parents about the symptoms of MIS-C, and we have been asking parents to call in with any concerns. Our triage nurses are aware of the syndrome and ask about symptoms when they speak to parents. Luckily it is a rare complication of COVID-19 but we know early detection and treatment is key to successful treatment so we are on alert to detect it.
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