Health (Still) Interrupted: Pandemic Continues to Disrupt Young Children’s Healthcare Visits
Key Findings
This week we report on how the coronavirus pandemic has impacted preventative health care measures for young children — specifically, well-baby/well-child health check-ups and scheduled vaccinations.
We find that, since the start of the pandemic, 28% of families with young children in our sample have missed a well-baby/well-child visit. This represents a threefold increase compared to before the pandemic.
In addition, we find that 12% of children have not received a recommended vaccination. We find that this is due primarily to caregivers’ concerns about contracting COVID-19.
Attending preventive health care visits is particularly challenging for families with children 18 months and older.
Overall, lower-income households are significantly more likely than middle/upper-income households to have difficulties making a preventive health care visit or a vaccine.
We also observe differences in rates of disruptions to preventive health care based race and ethnicity.
Background and Methods
Well-baby/well-child visits and vaccinations are core components of preventive healthcare in the US. Currently, the American Academy of Pediatrics recommends ten visits in a child’s first two years and then annually through the end of adolescence, in order to track developmental milestones and intervene as early as possible when health issues are identified. In addition to these wellness checks, the Centers for Disease Control and Prevention recommends a scheduled series of vaccinations for young children, in order to prevent 14 deadly childhood diseases.
The American Academy of Pediatrics has issued guidance and information regarding the pandemic, and has emphasized that wellness visits and vaccinations are still essential during the coronavirus pandemic . However, barriers related to the pandemic have prevented participation in these and other forms of preventative care. In a previous post published in late May, we observed approximately 27% of young children were not able to attend a well-child visit since the start of the the pandemic. This represented an almost 300% increase in the rate of missed visits compared to before the pandemic.
As the pandemic continues into the fall, we return to the topic of preventive health care. We analyze data from our recurring nationally representative survey of households with children age 5 and under to determine the extent to which, as households have adjusted to life during the pandemic, there has been a return to pre-pandemic levels of participation in preventive healthcare. If obstacles to accessing preventive health care services have continued to affect these families, it would raise concerns about early identification and screening of children’s physical and mental health, developmental status, physical safety, and other important domains of well-being.
In order to address these questions, we examined data from our surveys across time about missed child’s wellness visits or vaccinations, as well as which visits were missed (i.e., what age) and the reasons for not attending these visits. We looked at patterns for the overall sample, as well as by household income level (above or below 150% of the federal poverty line), and race and ethnicity. The data we present below are cumulative from April 6 through October 6.
Overall, we found that many children are continuing to miss wellness checks and scheduled vaccinations as the pandemic continues.
29% of caregivers reported a missed wellness visit for their child.
12% of caregivers reported a missed scheduled vaccination for their child.
Wellness checks and vaccinations for older children (18 months to 5 years old) are being missed the most.
These data show that eight months into the pandemic missed child wellness visits and vaccinations are continuing at a steady rate. These rates are similar to those observed in May and show no evidence of decreasing over time.
Concern about contracting COVID-19 is preventing caregivers from attending wellness visits.
We asked participants why they were unable to attend visits. Options included concern about contracting COVID-19, caring for other family members, inability to find childcare, cost, time away from work, vaccine hesitancy, and other. Concern about contracting COVID-19 was by far the most common response, endorsed by 78% of those who had been unable to attend a visit. No other option was identified by more than 20% of caregivers in the survey.
Lower income children experience more obstacles to attending wellness visits than upper-income children.
Overall, lower-income children were significantly more likely to miss wellness visits and vaccinations than middle/upper-income children (32 % compared to 25%).
Lower-income caregivers reported significantly more (1) inability to find childcare and (2) difficulty finding care for other family members.
Differences in ability to attend wellness visits based on income were especially pronounced among White respondents (33% for lower income vs. 23% for middle/upper income).
Middle/upper income Black and Latinx households experience more obstacles to attending wellness visits than their White counterparts.
Middle/upper-income Black children missed more wellness checks than middle/upper-income White children. This difference appears to be tied to caregiving responsibilities — middle/upper-income Black caregivers reported significantly higher rates of caring for other family members as the reason for a missed visit.
Middle/upper-income Latinx children missed more vaccinations than middle-upper-income White children. Latinx caregivers reported significantly higher rates of concern about contracting COVID-19 as the reason for forgoing vaccinations than did White caregivers.
Implications
The high number of families with young children who are experiencing obstacles to child wellness checks and vaccinations is concerning for several reasons:
At wellness visits, young children are screened for gross and fine motor delays, behavioral abnormalities, autism spectrum disorders, speech delays, social difficulties, learning delays, and genetic syndromes. Diagnosing and addressing these issues as early as possible is essential for achieving optimal outcomes over time. Lack of access to preventative care means that for many children, this isn’t happening.
Diminished vaccination rates could lead to higher rates of contracting deadly childhood illnesses and new outbreaks of diseases that were largely eliminated until recently (eg, measles, whooping cough).
Wellness checks provide supports for families and can help prevent abuse and neglect and address it when it is occurring. Typically, teachers and caregivers outside the home provide a first line of defense for observing signs of abuse and neglect. With limited access to these care providers, doctors and nurses at wellness checks are a vital way of preventing and addressing child abuse and neglect. Our data show that these supports are not available to many families.
Two core issues are clear in the data:
First and foremost, families with young children continue to see accessing preventive health care as a significant safety risk. Put simply, both real and perceived risk of well-baby/well-child visits (especially for children 18 months an older) to family health is a barrier to care. In order to address this, it is essential that public health and safety measures be implemented to more effectively bring the virus under control; as we have said repeatedly in prior postings, the absence of effective measures to control the spread of COVID-19 is at the core of all the challenges families in our survey are facing. In addition, it is necessary for the pediatric health care system to both do more to insure safety and enhance efforts to communicate about how safety is being maintained.
Second, as has been true of a number of prior topics on which we have reported, different issues — requiring somewhat different solutions — exist based on income and race/ethnicity. For example, lower-income households need help with structural barriers to accessing care, including difficulty finding childcare and caring for other family members. Similarly, middle/upper income Black households need solutions that address barriers related to caring for other family members. In contrast, for middle/upper income Latinx households concerns about contracting COVID-19 are leading to lower rates of vaccination. These concerns are understandable, given the elevated rates of infection among Latinx individuals.
If barriers to childhood preventative health measures are not addressed as the coronavirus pandemic continues, we are likely to see many children experience serious health consequences. This will have immediate consequences for the health of the US population; for example, we may see an uptick in childhood diseases that were previously eradicated through widespread childhood vaccination regimens. Increased rates of illness will have economic impacts in terms of lost work productivity and income for parents. Over the long term, lack of early identification and support for children with developmental disabilities and for those experiencing maltreatment will affect well-being, academic achievement, and related areas. These are likely to increase costs to the health care and education systems. In contrast, addressing the barriers to preventive healthcare for young children will help buttress young children and their families from many impacts of the pandemic and ensure that needs are adequately addressed in a timely manner.
Recommendations
The AAP has launched a campaign called #CallYourPediatrician, designed to encourage parents to schedule wellness checks for their children. Efforts like these are needed to insure that rates of preventive care return to pre-pandemic levels.
Policy makers must take action to more effectively control and contain the spread of COVID-19, and to prioritize the preventive healthcare needs of households with young children in the face of the pandemic.
Pediatric health care providers must continue to improve communications about the measures being taking to ensure the safety of preventive health care visits and vaccinations.
Policy makers must provide funding to support the capacity of healthcare practices to provide outreach related to safety and perceived safety of well-child visits.
“One size fits all” solutions won’t work. Differential efforts must be undertaken by both policymakers and health care practitioners to address the barriers to preventive pediatric care in specific subgroups. Inequalities associated with access, which existed in low income households and households of color prior to the pandemic and continue to exist, must be taken into account in developing strategies.
Policies must be implemented that allow time away from work, child care, and other structural supports for well-child visits, and that make it possible to obtain reliable and affordable sources of care for other family members to make such visits possible may increase access.
Additional readings
Critical Updates on COVID-19. American Academy of Pediatrics.
Recommendations for Preventive Pediatric Health Care. American Academy of Pediatrics.
#CallYourPediatrician Campaign. American Academy of Pediatrics.
Health Officials Fear Postponing Preventive Care Has Long-Term Risks. New York Times.
Children’s Health and Well Being During the Coronavirus Pandemic. Kaiser Family Foundation.
AAP Schedule of Well-Child Care Visits. American Academy of Pediatrics.
Well-Child Visits Are Essential. Centers for Disease Control and Prevention.
Guidance on Providing Pediatric Well-Care During COVID-19. American Academy of Pediatrics.
Health, Interrupted. Center for Translational Neuroscience.
The Fullest Look Yet at the Racial Inequity of Coronavirus. New York Times.
About the project
When the COVID-19 pandemic emerged last winter, there were over 24 million children age five and under living in the United States. This period of early childhood is a critical window that sets the stage for health and well-being across the lifespan. As such, it is essential during the current health and economic crisis to listen to the voices of households with young children.
The weekly survey of households with children age five and under launched on April 6, 2020. Since then, we have been gathering weekly data about child and adult emotional well-being, financial and work circumstances, availability of healthcare, and access to child care/early childhood education.
These analyses are based on responses collected from 7312 caregivers between the dates of April 06, 2020 and October 06, 2020. These caregivers represent a range of voices: 9.38% are Black/African American, 19.08% are LatinX, and 29.13% live at or below 1.5 times the federal poverty line. Proportions/percentages are calculated based on the item-level response rates, not out of the total sample size. The data for these analyses are not weighted.
We will continue to report on these issues as we learn more from each new weekly survey. We will also be producing policy briefs that make concrete recommendations about how to address the challenges we are seeing emerge from the family surveys.
Our goal is to use what we are hearing from families to improve the well-being of all households with young children, during the pandemic and beyond.
Suggested Citation
Center for Translational Neuroscience (2020, October 13). Health (Still) Interrupted: Pandemic Continues to Disrupt Young Children’s Healthcare Visits. Medium. https://medium.com/rapid-ec-project/health-still-interrupted-pandemic-continues-to-disrupt-young-childrens-healthcare-visits-e252126b76b8