As shelter-in-place restrictions begin to gradually loosen in the Bay Area, parents may be wondering whether they should be taking their child to a doctor’s office for a previously scheduled visit, immunizations or a minor injury. And if you are planning a doctor’s visit, in person or via telemedicine, what should you expect?
Stanford Children’s Health pediatrician Katya Gerwein, M.D., lead physician for the Bayside Medical Group’s offices in Alameda, Berkeley and Pinole, says the first rule of thumb is to call your pediatrician’s office if you have questions or concerns about your child’s health or a previously scheduled visit.
Her practice has been seeing children 15 months and younger for well-checks and immunizations throughout the coronavirus pandemic, given the importance of those vaccinations. They added visits for children under 2 in recent weeks, just extended to children ages 4 and 5, and expect to open appointments for kids ages 11-13 soon.
She said parents’ qualms about coming into the office are lessening with time and with the drop in coronavirus cases in the Bay Area, but that the logistics are "totally different" now due to new precautions. While details differ among pediatricians’ offices, many are taking similar steps for the safety of patients and staff.
At Gerwein’s office, all well-child visits are done in the morning.
"Everybody is screened when they make the appointment, the night before and when they arrive at the building to make sure that no one has been sick. There’s a list of 12 different symptoms," she says. "Everyone has their temperature checked upon entering the building, and everyone over 3 (years old) wears a mask." Doctors and medical staff are also wearing masks and gloves.
Visits are being spaced so no one is within 6 feet of another family and "ideally not in the same hallway at the same time," she adds.
And while rooms were always cleaned between patients, they are now being cleaned even more thoroughly.
If a child is sick, he or she is first screened through a telemedicine visit. "If a kid has a fever, we’re bringing them in at the end of the day and wearing full (personal protective equipment)," she says.
Some doctors’ offices have added separate entrances for sick patients or those with respiratory symptoms.
While Gerwein’s practice is not using telemedicine, or telehealth, visits for well-child checkups, some pediatricians are. She and her colleagues are using such visits to determine whether a sick child needs to come in for an in-person visit.
"A lot of it is the same as when you come into the office. We take a thorough history and try to learn as much as possible and really take our time to delve into what’s going on in the same way we would in a regular appointment," she says.
If you’ve not previously connected with a doctor through a video chat, Gerwein offers the following advice:
• Sit in a place with good Wi-Fi so you have the best video and audio connection with the doctor.
• Have a flashlight handy, preferably one that’s not attached to a phone. "It’s helpful if we need to look into a kid’s mouth," Gerwein says.
• Have a camera that can be moved or placed somewhere that allows the child to be seen lying down. If possible, have two adults present for the visit – one to hold the camera and the other to assist the doctor. "If it has to do with the belly, we can have the child lie down and can direct the parent how to do an abdominal exam," she says.
• If there are physical signs of an illness, such as a skin rash, your doctor may ask you to send a photo, for better resolution, before the visit.
Pediatricians are advising that parents not skip or delay scheduled immunizations.
"We were seeing a spike in whooping cough right before COVID hit," Gerwein says. "We definitely have concerns that if people put off their immunizations, especially whooping cough, polio and measles, we could see a huge spike in preventable diseases."
She says immunizations for children under 16 months are the most urgent, followed by those for 4- to 5-year-olds and then 11- to 12-year-olds. Some vaccinations can be delayed by "a month or so" without incident, though doctors prefer not to do so, Gerwein says, but those for rotavirus – given at 2, 4 and 6 months – must be given on a strict schedule.
In general, she says, parents should pay attention to what is happening with COVID-19 in their area when deciding whether to visit the pediatrician.
"Everything is changing so much week to week. Right now, we seem to be a in good place, so this is a good time for people to come do their well checks and immunizations," Gerwein adds. "We don’t know what the future holds."