How does the COVID-19 pandemic affect the medical care of children?
May 25, 2020 | The COVID-19 pandemic is keeping clinics and hospitals very busy. How does this situation affect the medical care of children?
How does the pandemic modify the medical care of children?
“At the onset of the pandemic, medical care appointments slowed down, says Dr. Marie-Claude Roy, a pediatrician at the Sherbrooke University medical centre and the director of its developmental pediatrics clinic. However, as soon as we felt that the situation would last for a while, we reminded that basic care and follow-up visits needed to resume, especially for children 0 to 2.”
The situation is similar at Montréal’s CHU Sainte-Justine. “Over the last few weeks, we have tried to increase the number of appointments we do in person, confirms Dr. Marie-Joëlle Doré-Bergeron, a pediatrician at that hospital. We must, however, follow strict rules and we are not allowed to see the same number of patients as before.”
According to Lin Quach, some clinics had to close because they did not have the safety equipment required to maintain their services. It is recommended to call ahead to make sure that a clinic is open instead of just showing up. If the clinic is closed, a voice message will indicate how to reach the required resources.
“Follow-up visits are maintained for children 0 to 2, says Lin Quach, interim coordinator of perinatal and pediatric services at the Direction du programme jeunesse at CISSS de Laval. But for children 2 and up, it is done via telemedicine.”
That is the preferable approach according to Dr. Roy. Follow-up visits are an opportunity to detect issues and to answer the questions their parents might have. These visits are also essential for prevention and vaccines.
“Children under 2 need in person follow-ups because we need to examine them, she explains. If, for example, a child seems to have a motor delay, we must make sure the neurological examination is normal to determine if there is an underlying issue.” In the case of a 4 or 5 year-old with a normal development, the annual follow-up may be delayed by a few months.
What Happens During a Telemedicine Appointment?
“This depends on each family medicine group (GMF), says Patricia Rhéaume, spokesperson for the CISSS de l’Outaouais. For appointments, we ask parents to contact their GMF or clinic. Someone will answer and will proceed to a telephone assessment to determine if an in-person appointment is necessary.”
That is also how L’Autre maison clinic, in Longueuil, operates. “If a parent has questions or is concerned about their child, whether it is their eating or sleeping habits or something else, they should call us, confirms Dr. Chantal Ouellet, a physician. We will plan an appointment with them. If, for example, they have a bathroom scale, they can weigh and measure the child. They should also prepare a short list of questions that may be of concern to them.” It is also possible to send pictures to the clinic via email when that is necessary.
The pandemic has transformed the way medicine is carried out. “As telemedicine evolves, we learn new ways of doing things, says Dr. Roy. We can accomplish quite a bit when it comes to follow-ups through secure virtual platforms or on the phone. We carry out a remote preliminary appointment and if we feel we need to see the child, we plan an in-person visit.”
Are Children Still Vaccinated?
“All vaccines up to 18 months are maintained according to the normal schedule, says Lin Quach. However, as per the public health guidelines, vaccination of children older than 18 months has been suspended.”
Dr. Roy believes it is a wise decision. “We want to maintain vaccination to avoid a resurgence of infections such as measles and meningitis, and those are the main vaccines children receive in their first two years.” Vaccines given between the ages of 4 and 6 are mainly boosters. Moreover, the timeframe to receive them is more flexible. It is therefore possible to delay them by a few months. “These vaccines have to be administered before the age of 7, however, if we do not want them to become less efficient.”
Dr. Doré-Bergeron does note that some CLSC have reduced the number of vaccination appointments during the pandemic. “Because of the pandemic, over the last few months, we have noticed some backlogs in the vaccination of children. It is crucial that we catch up as soon as possible.”
What Should I Do If My Child Is Hurt or Sick?
“Because of the pandemic, people seem to think they should not go to the clinic or call, says Patricia Rhéaume. That can lead to very worrisome situations.”
Parents should not hesitate to seek medical attention, according to Dr. Roy. “If you are even a little concern, seek medical attention,” she insists. For diseases that manifest suddenly, the recommendations are the same as usual. If, for example, a 4- or 5-year-old child has a fever but is generally well, you can wait up to 72 hours before seeking medical attention. In the case of accidents or injuries, you should not hesitate to consult a doctor.
“Even in the case of problems that are considered less urgent, you should not hesitate to ask for an appointment, says Dr. Roy. Certain situations can amplify during this stressful period.” That is why it is useful to have a telephone appointment with your family doctor or your child’s pediatrician.
Children who are not followed by a family doctor often have access to walk-in clinics. “Your CLSC can also offer you some support, says Dr. Roy. Their personnel can point parents towards the appropriate resources. Moreover, there are several telephone hotlines that offer psychosocial support and support for parents.”
Is There a Risk That My Child May Catch COVID-19 in a Clinic or Hospital?
According to Dr. Doré-Bergeron of CHU Sainte-Justine, some patients and some parents are afraid of visiting a hospital since the pandemic began and they turn down appointments. “Fear should not prevent us from taking good care of ourselves, says Dr. Roy. One might put the necessity of some consultations in perspective, but not consulting at all is not an option. Care facilities are safe places.”
Indeed, the safety measures implemented in clinics and hospitals are extremely strict. “At the hospital’s entrance, you will see a security guard that points people to the right place, says Dr. Roy. We make sure that people who might have COVID-19 symptoms are never in contact with people who are considered ‘cold.’”
At CHU Sainte-Justine’s outpatient clinic, a triage system is in place to deal with the coronavirus’s risks. “We ask questions on the phone, first, to determine if the child or their family is at risk of carrying the virus,” says Dr. Doré-Bergeron. The goal is to make sure that children with COVID-19 or similar symptoms do not visit the outpatient clinic. These children can be seen in a separate section of the hospital.
The situation is similar at L’Autre maison clinic. “Children with symptoms that are linked to a cold or the flu are not seen in our offices,” says Dr. Chantal Ouellet. These children are evaluated in designated clinics that are able to implement the required disinfection and protection measures for their personnel.
Kathleen Couillard—Naître et grandir