Well Child Visits during COVID-19

Erika Phelps Nishiguchi, MD
Developmental Behavioral Pediatrics Fellow
Seattle Children’s/University of Washington

To keep patients safe, clinics around the state are triaging care and converting as many visits as possible to telehealth visits. A key consideration has been how to handle well child visits. The WCAAP has been working closely with community providers and infectious disease physicians at Seattle Children’s Hospital to ensure that we promote policies for well child care that appropriately consider the risks and benefits of in-person compared to virtual visits.

At this time, priority in-person well child visits include newborn care and children through age two to complete the primary vaccination series. Newborn visits provide essential in-person care such as weight checks, jaundice and newborn screening, and provide an opportunity to assess feeding issues and parental support, particularly concern for unmet needs that the clinic or social work may be able to assist with.

The current consensus for vaccination is that the benefits of continuing the primary series outweighs the risk of possible exposure to COVID-19. Infants and young children who are out-of-cycle with the AAP periodicity schedule for the primary vaccination series for any reason should be vaccinated as efficiently as possible. Vaccines can be safely administered to children with mild illness and fever less than 101⁰F.

Visits on the AAP periodicity schedule that do not include a vaccination, for example the 9-month visit, could be considered for a telemedicine visit. Older children due for the 4- or 11- year vaccines should be rescheduled for a later date. Their vaccines are primarily boosters for the earlier series and are not considered essential amidst the COVID-19 pandemic.

Although well child care is ideally provided in person, many elements of these visits can be addressed via telemedicine if there is no urgent indication to bring the child in-person. Conversations assessing parental concerns, social needs, feeding and elimination, developmental surveillance, and anticipatory guidance can occur over the phone. Screening questionnaires for post-partum depression and development can also be administered through the phone or patient portal.

Communicate with parents about the steps your clinic is taking to keep their families safe when scheduling or confirming well visits. Many clinics are restructuring such that well visits occur in the mornings, and/or in separate spaces or facilities from sick visits. Please view the “Promising Practices” document on the WCAAP website for more information and updates. We have also created this flyer that you can edit to include your own clinic contact info. We will have versions in Spanish, Vietnamese and Chinese available soon and will send those out to you as soon as possible.

The WCAAP website has several resources for parents and families on the COVID-19 resource page. This includes general information about COVID-19, parenting during a pandemic, managing stress and anxiety, and several resources for social or economic concerns.