The Impact of the Pandemic Response on Children’s Health

Recently, I saw a baby for a 15-month well visit who had not been seen in our clinic since she was two months old. My head spun with the number of routine childhood vaccines she had missed, and I immediately began formulating a schedule for how we might get her caught up and protected against all those pathogens. The irony was inescapable: her parents had stayed away from the clinic due to their fear of COVID, but missing all those vaccines left the baby vulnerable to infectious diseases with a much higher fatality rate for infants than COVID.

I work in a clinic that serves many Medicaid (low income) patients, and I noticed throughout the pandemic that my lower socioeconomic status and minority parents seemed to have more pronounced fears of COVID – even after being vaccinated – than anyone else encountered. Especially before widespread vaccine distribution, it was true that COVID hit minorities harder, and caution was warranted. But I had multiple parents convinced that sending their young child to kindergarten would result in the child’s certain death–a fear very far removed from reality. From my perspective, knowing how low-risk young children are for both COVID infection and transmission, the calculus fell on the side of sending young children to preschool and kindergarten in person. Many media outlets and special interests have culpability in exaggerating the risks of in-person school to parents. For those of us following the data, there was never any credible evidence that open schools increased the community spread of COVID; it is a relief to see this truth finally starting to be acknowledged in mainstream media outlets. 

It is essential to ask: What did young children miss by forgoing in-person preschool, kindergarten and well-child care? Since 2012, I have served as the Early Childhood Champion for the American Academy of Pediatrics for the state of New Jersey. I frequently work with Head Start providers in this role, and I am well aware of the benefits of in-person preschool for low-income kids. For some of my young patients, a Head Start child care/preschool is the only place they get healthy meals, the only opportunity for socialization with peers, and the only place where someone reads to them or practices letters and numbers. 

For special needs kids, the issues are even more dire. Because my clinic serves all types of families, I could see stark contrasts develop during the pandemic. When schools closed, higher-income parents immediately arranged for private in-person therapies for their unique needs kids. Lower-income parents had no such option, and there was no escaping the increasing desperation in their voices as the months dragged on, and they described to me how ineffective “Zoom speech therapy” or “Zoom OT” was. 

I acknowledge that as a paediatrician, I have a bias toward children. My entire professional life has been devoted to prioritizing children and their needs. In fairness, though, the guiding metric for public health has always been “years of life lost”–so you don’t have to love children to acknowledge that public health measures should always aim to minimize harm to them.

I fear that in our responses to this pandemic, we widely missed the mark on this. I fervently hope that we can do better next time around. 

Kristen Walsh, MD, FAAP is a Clinical Academic Pediatrician and Early Childhood Champion in the New Jersey Chapter of the American Academy of Pediatrics

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