In their first three years of life, even the healthiest children visit their doctors a lot. The American Academy of Pediatrics (AAP) recommends 11 check-ups or well-child visits by age three, with six of those visits happening before a child’s first birthday. As we move into month four of state-wide shelter-in-place orders, California’s 1.4 million children ages zero to three are coming due for check-ups, and parents are navigating how to get their children preventive care during a pandemic.
For some families, visits have moved online. The AAP has released guidance stating that, although in-person visits are preferred, when circumstances like a pandemic require pediatricians to limit in-person visits, well-child care may be conducted through tele-health. Of course, this is easier for some elements of a comprehensive well-child visit than others. Parts of the exam, like vaccinations, must be completed in person.
The California Department of Health Care Services, which oversees Medi-Cal, encourages providers to follow the AAP guidance. Medi-Cal’s tele-health policies allow providers to provide and bill for medical care by tele-health, but if well-child visit components are broken up, with some happening via tele-health and others happening in person, providers are only able to bill for one encounter.
Providers may request that children be seen in person, especially for visits prioritized by AAP, such as in-person newborn care, and well-visits and immunizations of infants and young children. Yet many parents are reluctant to bring their young children into a health care facility for fear of contracting COVID-19.
Recent data show that well-child visits are down across the country. Many specialties experienced a drop in outpatient visits at the start of the pandemic, and pediatrics has been slow to rebound. In addition, vaccination rates are free-falling. In comparison to April 2019, in April 2020, the number of shots given to children 0 through 18 years old in California decreased by more than 40%.
The California Department of Public Health released a statement on Monday urging parents to stay up to date on well-child visits and vaccinations and to call their providers if they have safety concerns:
"This pandemic has disrupted so much, including how we’re seeking preventive health care services,” said Dr. Sonia Angell, Director of the California Department of Public Health and State Health Officer, in the statement. “During and after the pandemic, unvaccinated infants and children will be more vulnerable to dangerous diseases like measles and whooping cough. It’s so important that parents make sure their children are up-to-date on their immunizations.”
Providers are working to raise awareness too. #CallYourPediatrician is showing up across social media, as part of a campaign by AAP highlighting the importance of well-child care and the many measures clinics are putting in place to make sure visits are safe and comfortable for families.
Alexandra Parma • Jul 7, 2020
For a child with a developmental delay or disability, timely and accessible intervention services can be critical to that child’s wellbeing, as well as that of her parents or caregivers. COVID-19 has disrupted services for many families, compounding the stress related to changes to employment, child care, and overall routines. As a result, rates of stress, depression, and anxiety during the pandemic are significantly higher in households where a young child has a disability.
Sarah Crow • Sep 25, 2019
We’re thrilled to release our first paper today, along with California Children’s Trust, discussing how the Medi-Cal system can best support young children as they grow up.
Alexandra Parma • Jun 19, 2020
This week California released an important new policy making family therapy a covered benefit for children in Medi-Cal. This is a significant step forward in approaching children’s health from a whole-family wellness perspective.