Tina Q Tan, MD, FAAP, FIDSA, FPIDS

As the COVID-19 pandemic continues, we are learning more about the various ways that the infection can manifest and the significant mental health impact that it is having on the pediatric population. There are various 

 that are unique to COVID-19 that the practicing clinicians should be aware of. These manifestations are discussed in the cover story of this issue by Dr Bellodi Schmidt and Ms Vivien Chen.

Other articles that are must-reads include:

The respiratory section study on how primary care providers are the key to 

 in teenagers. This is extremely important, given the increasing number of teenagers that vape, especially during the pandemic.

The nutrition section article that reports on the 

 and whether or not it had an impact on improving school lunch programs.

The mental/behavioral health section article in which Dr Jellinek discusses a 

 for pediatric health care providers to know when a child needs formal mental health services. This is a very timely article given the significant mental health impact that COVID-19 has had on children, especially those with underlying mental health issues.

Another issue that has recently come up is the US Department of Health and Human Services announcement authorizing state-licensed pharmacists to order and administer all vaccines to children and adolescents aged 3-18 years. The American Academy of Pediatrics (AAP) came out with a statement that strongly opposes this policy change. I am in complete agreement with the AAP who stated that “this move is incredibly misguided” and that “the action supersedes state laws governing the scope of pharmacists’ ability to administer vaccines, using the COVID-19 pandemic as justification to make policy change that goes well beyond care related to COVID-19.” This policy should be a call to action for all of us that provide care to the pediatric population. Now more than ever, we need to communicate with our patients and their parents and emphasize the importance of the medical home. We need to stress that pediatric health care provider offices are open and are the best, safest, and optimal places for children to be vaccinated and for the provision of routine care, developmental and mental health screenings, anticipatory guidance and counseling about nutrition, injury prevention, and chronic disease management. This is the time for us to make a statement that we are the best providers of all things that pediatric medicine has to offer with vaccines making up a big portion of the care that we provide.

Please stay safe and well. I welcome your suggestions, comments, and questions.

Articles

Dr. Tina Tan addresses the recent change that allows pharmacists to administer vaccinations to pediatric patients.

COVID-19 and the future of vaccinations

As the COVID-19 pandemic continues to surge in many states around the United States and as the incidence of disease is significantly increasing in the 10- to 18-year-old population, the subject of the whether schools will reopen in the fall for in-person learning is at the top of the minds of a multitude of people including parents, teachers, students, pediatricians, and public health officials. This is a decision that needs a lot of thought in order to ensure that the setting for in-person learning is as safe as it can be for students, teachers, custodians, lunch room workers, school crossing guards, and other personnel that work in the school setting. It is a decision that is not “one size fits all” but needs to be individually adapted to specific school settings. Even though many national organizations including the American Academy of Pediatrics (AAP), the Centers for Disease Control and Prevention (CDC), the National Education Association (NEA), and the National Academy of Sciences (NAS) support the reopening of schools for the many social and psychological benefits of in-person learning, these benefits must be balanced with the threat posed by COVID-19 and schools should not be forced, under any conditions, to reopen in an unsafe manner. One of the key factors that needs to be considered is the level of COVID-19 disease that is circulating in the community at the time that a school district plans to reopen, especially the amount of disease being seen in children 10 to 18 years of age. If these levels are high, it would be unwise to reopen schools at that time. For many school districts, e-learning will be what is rolled out at the beginning of the year. For others, a hybrid model of part in-person and part e-learning will be feasible. The model of all in-person learning will probably comprise a minority of school districts.

As we continue to address the emerging issues that have been impacted by COVID-19, I want to personally thank all of our pediatric health care provider heroes for providing the safest and most comprehensive care to our patients. As the actor Christopher Reeve stated, “A hero is an ordinary individual who finds the strength to preserve and endure in spite of overwhelming obstacles.”

The articles focusing on Back to School include:

 by Hallas and colleagues, which provide detailed guidance on different areas where protocols need to be developed and in place to ensure that the in-person learning environment is as safe as possible.

“Guidelines for the best hand sanitizers”

 dovetails nicely with the Safe Return to School articles as hand hygiene is critically important in any in-person learning protocol. The biggest obstacle will be the purchase of hand sanitizers, difficult to find in stores.

As the battle with COVID-19 continues, so does the difficult decision about how to educate our children this fall.

Back to school, or back to remote learning?

Happy summer! As we move into the now fourth month of the COVID-19 pandemic, we have had to adjust to new ways of providing comprehensive care to all our patients. The pandemic has led to some unintended consequences in our ability to provide this care, the most critical being the immunization of infants and children in a timely manner.

Studies have shown that up-to-date vaccine status for the recommended childhood vaccines has significantly decreased since the start of the pandemic, with less than 50% of infants and children in many areas of the United States being reported as current on their vaccines. This decrease has been most striking for infants and children enrolled in Medicaid insurance programs. The marked drop in immunization rates has a major impact on herd immunity and leaves these infants and children susceptible to vaccine-preventable diseases such as measles and pertussis. As pediatric health care providers, we need to make a concerted effort to get patients back into the office for their vaccines against all the vaccine-preventable diseases.

COVID-19 infection for many children is milder than that seen in the adult population. However, as we continue to learn more about COVID-19, there are new issues that have a significant impact on our ability to care for our patients. The emergence of multisystem inflammatory syndrome in children (MIS-C) has demonstrated that COVID-19 infection in some children can be serious and life threatening, and that has added a sense of urgency in the diagnosis and treatment of these patients.

This issue of Contemporary Pediatrics is dedicated to Infectious Disease, with many articles exploring different aspects of COVID-19 infection in infants and children and intended to provide health care providers with guidance in diagnosis and management. The articles focusing on COVID-19 include:

—This article is an interesting opinion piece addressing the impact that the presence of fever may have in recovery from COVID-19 infection.

Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19

—Here is a summary of information presented in a most successful webinar on MIS-C that provides comprehensive guidance for the pediatric practitioner on the diagnosis and treatment of this potentially life-threatening syndrome.

AAP guidance: Managing infants born to mothers with COVID-19

—This document provides very practical guidance on the recommended testing and management of neonates born to mothers with COVID-19 in a variety of different settings.

Even as we continue to work through the COVID-19 pandemic, remember to get outside once in a while and enjoy the sunshine. Summer really can be the best time of the year.

The coronavirus pandemic keeps complicating the care of children in critical ways.

COVID-19: It’s not the same-old same old!

Warm greetings! It is hard to believe that summer is almost upon us.

Over the last 4 months, the spreading COVID-19 pandemic has made us rethink how we practice medicine in order to continue to provide outstanding comprehensive care to all our patients. This is especially important for our patients aged younger than 2 years for whom it is critically important that they receive their recommended vaccines on time and for medically complex patients who require close follow-up for the management of their conditions.

The pandemic has challenged us to be creative in the ways we evaluate patients and provide reassurance to their parents. In this issue of 

COVID-19: A battle plan for pediatricians

—This article highlights some strategies that pediatric practitioners can incorporate into their practices to safely and effectively provide care to their patients.

CDC issues preliminary information on MIS-C

—Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 was first described in the United Kingdom in late April 2020 and has since been reported in Spain, Italy, France, and the United States. This is a serious condition with some symptoms that overlap those seen in Kawasaki disease and/or toxic shock syndrome. Preliminary data indicate that many individuals who develop this syndrome have either COVID-19 infection or a history of exposure and that MIS-C may be a postinfectious inflammatory process. This article presents the CDC case definition of MIS-C and the need to report MIS-C to local, state, or territorial health departments.

Updated consensus guidelines issued for unexplained pediatric death

—There is limited medical awareness of SUDC, which is the sudden and unexpected death of a child aged 12 months or older that remains unexplained after a thorough investigation including autopsy. This document provides comprehensive guidance for the pediatric practitioner on the investigation of the event and the important role that they play in serving as liaisons to help families maneuver through the processes that occur after the death.

Chronic care management: Increase the value of your practice

—Fifteen to 25% of children in the United States have one or more chronic health conditions that require some level of chronic care management. This is an important Practice Improvement article that provides the information to properly code for the management of children with multiple chronic conditions and ensure proper reimbursement.

As we continue to work through the COVID-19 pandemic, remember that:

“No matter how hard things may seem, don’t get down and don’t give up. The clouds will clear and there are brighter days ahead.” —Anonymous

The great unknown caused by COVID-19 has led to many questions and few answers. The one certainty is that pediatrics will have to change in order to ensure proper care.


Author | Tina Q Tan, MD, FAAP, FIDSA, FPIDS

Articles

COVID-19 and the future of vaccinations

Back to school, or back to remote learning?

COVID-19: It’s not the same-old same old!

Pediatrics’ new paradigm for practice in the era of COVID-19