During the pandemic, many adults put off their own routine medical appointments and cancer screenings – and there is a similar trend for children.
The latest data from the US Centers for Disease Control and Prevention shows a steep decline in childhood immunizations across all age groups. The CDC and the American Academy of Pediatrics have urged that children get caught up on their shots.
How soon should this be done? What about adolescents who are also getting their Covid-19 inoculations – do these need to be spaced out? What other medical appointments should parents be catching up on?
We asked CNN Medical Analyst Dr. Leana Wen to help us with these questions. Wen is an emergency physician and visiting professor of health policy and management at the George Washington University Milken Institute School of Public Health. She’s author the forthcoming book “Lifelines: A Doctor’s Journey in the Fight for Public Health” and the mother of two young kids.
CNN: Why is it a problem to be behind on immunizations?
Dr. Leana Wen: It’s important to discuss why it is that we have childhood immunizations. There are diseases that used to kill and cause long-lasting harm to countless children. Now, we can prevent those illnesses by giving vaccines. These provide immunity so that children will no longer be afflicted by once-common diseases.
Polio, for example, used to infect young children and caused permanent paralysis for many. Because of childhood vaccinations, the US has not had a case of polio in children since the 1970s. Measles, too, used to be a major cause of death in children in the US, and remains a problem in some parts of the world. In 2018, according to the World Health Organization, 140,000 people died from it worldwide, most of them children. All of these deaths could have been prevented by safe, effective vaccines.
The United States has been able to essentially eradicate these diseases because of widespread immunization programs. But if vaccination rates fall, we are at risk once again. This is not a theoretical concern. In 2018, when vaccination rates in the U.S. declined due to hesitancy, there were localized measles outbreaks in New York that sickened more than 300 people in Rockland County, most of them children.
This could happen again, with so many kids behind on vaccinations. I’m particularly concerned about what happens in the fall, when schools restart and children are gathered in close quarters, indoors. That’s why it’s so crucial for children to be caught up on their vaccinations as soon as possible, especially before the beginning of the school year.
CNN: For parents who have postponed pediatrician appointments, when they should they go back to get caught up on immunizations?
Wen: They should call their pediatrician right now and get caught up as soon as possible. Immunizations follow a particular schedule. There are some shots that are given together, and others that are given after these with a certain period of time elapsing between shots.
Your child’s doctor will know how to catch up after missing some shots. If you’ve missed several appointments, it may take weeks or months to get caught up, so it’s really important that you call now to get the process started. Your child’s school may require that all shots are up to date by the start of the next school year, so that’s another reason to restart the appointments now.
CNN: Can I go to the local pharmacy to get these shots?
Wen: Generally, no. Many pharmacies don’t stock all of these vaccines, and they may not have people on staff who are able to administer shots to young children. Some local health departments have public clinics for kids to get their immunizations. The best place to start is with your pediatrician. They are used to giving childhood vaccinations from their offices.
CNN: Is it safe to go back to the pediatrician, when children under 12 are not yet eligible for the vaccine?
Wen: Yes. All doctors’ offices have put in place many safety protocols to protect against Covid-19 spread. At a minimum, they will require masks for health care workers and parents, and probably for children 2 years of age and older, too. Many will require symptom questionnaires to be filled out, and they have eliminated waiting room spaces and other higher-risk settings.
I know that many parents have been putting off vaccinations because of concern for Covid-19 safety. In most parts of the country, the rates of coronavirus are much lower than back at the peak.
CNN: What if I also want to get my child the Covid-19 vaccine? Does that need to be timed in a certain way regarding other immunizations?
Wen: The CDC has said that it’s safe to get the Covid-19 vaccine alongside other vaccines. Children 12 and older are eligible to receive the coronavirus vaccine, and parents don’t need to worry about spacing out the two doses of this vaccine from the others that may have been missed.
CNN: Some parents may be embarrassed about having missed several doctors’ appointments. What’s your advice for them?
Wen: There are so many reasons why parents and caregivers may have missed medical appointments. Fear of Covid-19 is one. Another is just how much other parts of life took over. Many people lost their jobs during the pandemic; others had terrible family tragedies of losing loved ones and caring for ill family members.
Know that your pediatrician is not there to judge you or your family. Your child’s doctor only has one goal, and that’s to help your child. Feel free to explain what’s been going on with your lives if you wish, but know that the pediatrician just really wants to assist with keeping your child and your entire family healthy.
CNN: What else will happen at the pediatrician’s visit?
Wen: That depends on the age. A well-child visit for a baby will include weight and height measurements, questions about feeding, and checking for developmental milestones. Older kids might also get blood pressure, vision, and hearing screenings, and questions around physical activity and to assess growth and development. There will be a physical exam that, again, will look for different things depending on the age.
In addition to a discussion about updating immunizations, the doctor may order some tests. Young children, for example, may need lead testing, and there may be specific tests as needed to look for anemia or other specific issues.
CNN: Are there things the parents should be sure to bring up while at the catch-up appointment?
Wen: As with adults who have missed their own medical appointments, you should make a list of all the concerns that you might have about your child’s health. Include any symptoms that you might have noticed – for example, if your child is complaining of a scratchy throat or allergies. If you have questions about your child’s sleep or nutrition, make sure to ask about these too.
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Also, many young people have experienced mental health challenges during the pandemic. Make sure to talk about your child’s mood if that’s something that’s worrying you. This is also the time to ask your doctor about what else you may need to catch up on, including dental visits. And have a conversation about the Covid-19 vaccine. If your child is 12 and older and eligible now to get the vaccine, you should consider doing so, to best protect your child and your family.