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Pediatricians across the U.S. are seeing a steep drop in the number of children coming in for appointments right now — only about 20 percent to 30 percent of the volume they would normally see this time of year, according to the American Academy of Pediatrics.

Though telemedicine can make up part of the difference, doctors say the size of the drop-off in some routine well checks is a big problem — for those children and for the nation — though parents are understandably concerned about exposing their kids to the coronavirus.

"People are scared to come in," Dr. Sally Goza, president of the AAP, 

tells NPR's Mary Louise Kelly on All Things Considered

. "I do a lot of cajoling over the phone to get people to come in for their visits."

From doing extra sanitizing of each treatment room between patients to setting up drive-thru clinics for vaccinations, pediatricians across the U.S. are going the extra mile to assuage fears.

"We are trying to reassure parents that we are doing everything we can to make our offices safe so that they feel comfortable to bring these babies in and these young children in to get their vaccines," says Goza, who practices medicine outside Atlanta.

To prevent outbreaks of serious diseases that pose an even greater threat to children than COVID-19, it's imperative that the kids not skip their usual shots, Goza says.

Measles is one big worry. According to the Centers for Disease Control and Prevention, there were 1,282 individual cases of measles confirmed in 31 states last year — which 

broke the nation's 25-year-old record for most cases

. Of those cases, most of which occurred 

, 128 were hospitalized and 61 developed serious complications, including pneumonia and encephalitis. And that's not the only outbreak threatening.

"We could have a whooping cough, and we could have young children still get meningitis if they don't get the vaccines to protect against meningitis," says Goza. "It is critical for those children to come in and get their vaccines as close to as on time as they can. Delaying can cause major problems."

That's partly because vaccinations protect not only the individual child receiving the shot; they also help build up "herd immunity" that protects a community as a whole.

When a large enough percentage of people are vaccinated against a disease — a number that varies for different types of illness — the population as a whole is better protected because there are very few people who can contract the infection and then infect others.

For a highly contagious disease like measles, doctors note, that target threshold for immunity is 

Herd immunity is especially important to protect those people who can't be vaccinated themselves — whether because of their age or because their immune system has been compromised by underlying illness or medication.

The AAP recommends that, even in these "stay-at-home" times, 

pediatricians still see patients who are under 2 years old for well visits

 in the office. It's during this period that children generally complete the initial set of 

 — for everything from measles, mumps and rubella, to rotavirus, polio and the pneumococcal bacteria that can cause serious infections, such as pneumonia and meningitis.

Many health care providers have already updated their office procedures in response to parents' worries about in-person doctor visits.

When possible, pediatricians these days are diagnosing and prescribing treatment to ill patients over the phone or via videochat. Most clinics have designated specific, separate hours for well visits, or divided up their space in a way that keeps healthy children away from those who are sick — in some cases, erecting tents in parking lots as improvised treatment rooms

At Goza's practice, there's no waiting room at all anymore.

"Everyone waits in their car," she explains. "We call them when we're ready for them to come in. We put them directly in a room that's just been cleaned. We clean the room when they leave. We clean all of our equipment. We all wear masks. So they're not in there with anybody, really, but the doctor and the nurse."

 in Rockville, Md., is providing curbside vaccines for children from ages 6 weeks to 2 years, while a handful of 

 are using them for older children, too. Boston Medical Center is dispatching an ambulance 

to take vaccines to children in their homes

Other precautions include temperature checks for everyone who enters an office and scheduling extra time between appointments.

These are among the measures implemented by HealthWorks, which operates community clinics serving some 17,000 patients in two counties in Northern Virginia. HealthWorks clients are primarily low-income or uninsured, and many don't speak English as their first language.

Staff at community health centers and free clinics say they are keeping in close contact with their patients ahead of appointments to make sure routine issues don't become emergencies and to assure them it's safe to come in, if they need to.

"We explain all of the precautions we have taken at HealthWorks and answer any questions they have. We instruct them that only one parent should come in at a time, that the parent and the child, if over 2 years old, should wear a mask," Dr. Medhine Wijetilleke, a pediatrician with HealthWorks, tells NPR. "We try to convey this the best we can to keep our parents and patients at ease."

She says the parents of her patients are generally very conscientious about getting their kids vaccinated on time.

But she does worry that if too many other parents delay or skip their well-child checks and vaccinations, "we may have a generation that may be under-vaccinated. You run the risk of these diseases making a 'come back,' " she says, especially in this vulnerable population.

Of course, there are also other benefits to in-person visits.

Early detection of potentially dangerous developmental or congenital issues is easier through in-person check-ups of newborns.

Sometimes, the AAP's Goza says, it's hard to pick up expressions or symptoms on a screen as clearly as when the patient is in the room with you.

"We know that there are a lot more things going on than just the pandemic," she says, noting that many people are experiencing a lot of extra stress at home in general these days, and some parents might need help, too — and be more willing to confide in a doctor in-person.

"In this unprecedented time," Goza says, "we need to do what we can to keep our eyes on the children, and to take care of the patients as we need to." 

Health

COVID-19

Maureen Pao

Author

Telemedicine has its limits. And postponing shots could lead to a resurgence of diseases like measles. Doctors are taking steps to make their offices safe for kids who need to come in.

Don't skip your child's well check: Delays in vaccines could add up to big problems

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