Guidance on Providing Pediatric Well-Care During COVID-19

The American Academy of Pediatrics (AAP) strongly supports the continued provision of health care for children during the COVID-19 pandemic. Specifically, well-child care should be provided consistent with the Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents (4th Edition) and the corresponding Bright Futures/AAP Recommendations for Preventive Pediatric Health Care (Periodicity Schedule).

Since the onset of the pandemic, a significant drop in well-child visits has resulted in delays in vaccinations, delays in appropriate screenings and referrals and delays in anticipatory guidance to ensure optimal health. Pediatricians rapidly adapted to provide appropriate elements of well examinations through telehealth when clinically warranted and also implemented measures to provide in-person care as safely as possible. Despite these efforts and a rebound increase in outpatient visits to near pre-pandemic levels, a significant cohort of children remain behind on regular well-child care and routine immunizations. Concern exists that delays in vaccinations may result in secondary outbreaks with vaccine-preventable illnesses.

Primary care pediatricians are prepared to ensure all newborns, infants, children and adolescents are up to date on their comprehensive well-child care, inclusive of appropriate screenings, complete physical examination, laboratory examinations, fluoride varnish and vaccines. Pediatric practices can also serve as COVID-19 vaccination sites.

See below for additional guidance.

• Consistent with previous guidance, all well-child care should occur in person whenever possible and within the child’s medical home, where continuity of care may be established and maintained. For practices that have successfully implemented telehealth to provide appropriate elements of the well examination virtually, these telehealth visits should continue to be supported, followed by a timely in-person visit.
• Outpatient newborn care should not be compromised because of COVID-19, and newborn visits should take place in person. See AAP interim guidance FAQs: Management of Infants Born to Mothers with Suspected or Confirmed COVID-19 and Post-Hospital Discharge Guidance for Breastfeeding Parents or Newborn Infants With Suspected or Confirmed SARS-CoV-2 Infection. If the mother is positive for SARS-CoV-2 and still in her recommended isolation period and the infant is negative, an alternate caregiver (if available) who is SARS-CoV-2 negative and masked should accompany the infant to their visit to minimize risk of transmission. If no alternate caregiver is available, the mother should accompany the infant to the visit if she is not too ill to do so. Appropriate PPE should be used in the ambulatory care setting, per AAP interim guidance. If the infant is positive for SARS-CoV-2, close outpatient follow-up beyond the initial in-person visit via telephone, telemedicine, and/or additional in-office visits through 14 days after birth is recommended. Additionally, pediatricians should continue to follow federal and state guidelines on newborn screening and ensure timely follow-up for out-of-range results per AAP interim guidance on newborn screening.
• Pediatricians should identify children who have missed well-child visits and/or recommended vaccinations and contact them to schedule appointments inclusive of newborns, infants, children and adolescents. Pediatricians should work with families to bring children up to date as quickly as possible, particularly confirmed decreases in childhood and adolescent immunization rates and the potential for other vaccine preventable disease outbreaks. State-based immunization information systems and electronic health records may be able to support any catch-up immunizations.
• Pediatricians should inquire about any SARS-CoV-2 infections and vaccination status since the last evaluation and should document it within the patient’s medical record. Patients with a history of SARS-CoV-2 infection should be monitored for ongoing symptoms per the AAP interim guidance on post-COVID conditions. Pediatricians should encourage eligible infants, children, and adolescents to receive the COVID-19 vaccine.
• Pediatricians should integrate surveillance and screening for social, emotional and behavioral concerns into every office visit and provide age-appropriate anticipatory guidance as part of well-child care. Special consideration should be given to populations with higher baseline risk, such as populations of color, communities living in poverty, historically under-resourced communities, children who are refugees and seeking asylum, children and youth with special health care needs, and children and youth involved with the child welfare or juvenile justice systems. Pediatricians should continue surveillance for children and youth at risk for abuse and neglect. In addition to screening for signs of maltreatment, an assessment of family well-being and the potential need for additional resources and supports that promote family strengths and decrease the risk of abuse and neglect should occur.
• Pediatricians should ensure timely referral to pediatric medical subspecialists and pediatric surgical specialists, inclusive of regularly recommended dental and eye examinations.
• Pediatricians should also inform families about the strategies already implemented in primary care medical home offices to reduce risk of viral transmission. These strategies may include these examples:
  • Regular cleaning and disinfecting.
  • Promotion of physical distancing of both staff and patients in the office.
  • Use of source control (face masks) by all patients, families, clinicians, and staff if SARS-CoV-2 Community Transmission level is high.
  • Providers and staff who are up to date on COVID-19 vaccination.
  • Use of personal protective equipment by providers and staff.
  • Upgraded ventilation system or installation of HEPA filters.
  • Scheduling well visits and sick visits at different times of the day or using telehealth.
  • Separating patients spatially, such as by placing patients there for sick visits in different areas of the primary care clinic, outdoors, or another location from patients attending well visits.

Additional Information 

• Providing Acute Care in the Ambulatory Setting During the COVID-19 Pandemic
• Face Masks and Other Prevention Strategies
• Infection Control Guidance for Health Care Professionals About COVID-19 (CDC)