Children slower than adults to resume medical care 

NEW DATA RELEASED Wednesday by the Massachusetts Health Policy Commission show that while adults are returning to the doctor at near pre-pandemic levels, children are not.  

The national data show that doctors’ visits for adults – including both in-person and telehealth – were back to within 10 percent of pre-pandemic levels by early June. But visits by children, from birth through age 17, remained more than 30 percent below where they were before the coronavirus outbreak. Toddlers ages three to five showed the biggest drop, at more than 40 percent below normal.  

Since early May, pediatric visits have consistently lagged behind adult visits in returning to pre-pandemic levels.   

Similarly, national data that examined changes in visits by specialty found that pediatrics had the biggest continued drop in visits. As of the week of June 14, pediatric visits were still 30 percent below normal. Only one other specialty – pulmonology – was more than 20 percent below benchmark, and most specialties were within 10 percent of their normal levels. Comparing the total deficit in visits, from March 15 through June 20, pediatrics was one of three specialties where visits were down the most, along with ophthalmology and otolaryngology.  

The commission did not provide Massachusetts-specific age or specialty data. 

At a Health Policy Commission meeting Wednesday, David Auerbach, senior director for research at the commission, noted the large difference between children and adults returning for care but did not provide an explanation. “People don’t know exactly why that is, but it’s dramatic,” Auerbach said. Auerbach was not available for an interview after the meeting.  

But Dr. Lloyd Fisher, president of the Massachusetts chapter of the American Academy of Pediatrics, speculated that several factors are contributing. In the spring and summer, most pediatric visits are for preventive, well-child care, rather than for illness. Early in the pandemic, when almost all visits were being conducted via telehealth, there were some questions about whether doctors could receive insurance reimbursement for well-child visits. And many types of preventive care, like immunizations or newborn screenings, cannot be done via telehealth. 

Massachusetts allowed medical practices to resume providing preventive pediatric care in mid-May as part of Phase 1 of the state’s reopening plan. 

But Fisher said even once doctors’ offices started reopening for more in-person visits, “there was sort of a slower return for those preventive care visits.” Doctors tended to prioritize patients with chronic illnesses or acute problems, where delaying care could worsen problems. “Because so many pediatric visits are well-child care, the feeling was there was less urgency to bring them back in,” Fisher said.  

Pediatricians also tend to have a high volume of patients in their waiting room, since they have shorter visits than many adult specialties, and children cannot always wait quietly in a chair. Many pediatricians consciously cut back the number of patients they could see so waiting rooms would not get overcrowded. 

However, Fisher said four months into the pandemic, pediatricians are now getting increasingly worried about delays in preventive care.  

One problem that has been documented is that many children are delaying childhood vaccines. A national study published by the US Centers for Disease Control and Prevention in May found that orders for measles vaccines and other non-flu vaccines dropped and the administration of vaccines declined substantially during the pandemic. Fisher said the Massachusetts Department of Public Health has also seen declines in numbers of lead screening tests, which are done at well-child visits.  

“We’re now at a point where many pediatricians are very concerned that we have delayed preventive care visits long enough that we are going to see negative effects, especially when it comes to a delay in routine immunizations,” Fisher said. 

Anecdotally, parents are often nervous about bringing children in to see a doctor. Fisher said he has personally had to reassure patients that his practice is taking safety precautions.  

State Sen. Cindy Friedman, Senate chair of the Committee on Health Care Financing, added that a lot of children’s health care is driven by school requirements. “I’m sure parents are saying, why do we have to do this? I don’t know if my kid’s going back to school,” Friedman said.