Well-Child Care, Routine Childhood Immunizations and Screenings
The AAP strongly supports the continued provision of health care and developmental screenings for children during the COVID-19 pandemic. The pandemic has highlighted the existing inequities and structural barriers to accessing health care and quality early education. The evidence has clearly shown that Black and Latinx adults and low-income families are disproportionately affected by COVID-19, face barriers to accessing care, and experience negative health outcomes. Child deaths related to COVID-19 have disproportionately affected historically disadvantaged racial and ethnic groups and youth with underlying medical conditions. Access to well-child care and vital health screenings helps to ensure the optimal development of young children.
Specifically, well-child care should be provided consistent with the recommendations in 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). Pediatricians have rapidly adapted to provide appropriate elements of well-child examinations through telehealth when clinically warranted. Primary care pediatricians are prepared to ensure that all newborns, infants, children, and adolescents are up to date on their comprehensive well-child care, inclusive of appropriate screenings, complete physical examinations, laboratory tests, fluoride varnish, and vaccines.
Early care and education programs are often required to collect health data related to well-child care, such as immunization schedules, developmental screenings, oral health examinations, lead screening, hearing and vision screening, etc. Many regulatory organizations for early care and education relaxed these requirements during the pandemic. However, the AAP recognizes the vital role early care and education providers play in the support of families to access routine and appropriate health care. 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. Up-to-date immunizations are a cornerstone to protecting children from vaccine-preventable illnesses and are a crucial part of maintaining health, especially in group settings. COVID-19 is not the only devastating infection that can affect young children, and timely immunization can prevent the recurrence of previously epidemic diseases such as measles and polio.
Early care and education play an important role in the identification of developmental delays and referrals to appropriate services. Early intervention (EI) is essential to supporting optimal outcomes for children and families. EI services may need to adapt in order to provide care during the pandemic; however, if children qualify for services, they should still receive them. EI services have adapted to virtual and coaching models to support child care providers and families to implement strategies in the child’s natural environment including the early care program and home environment. The AAP recommends that early care and education providers continue to support EI services as safely as possible and support families in receiving needed care.
Further, many early care and education programs support the development and transition of Individualized Family Service Plans (IFSPs) and Individualized Education Programs (IEPs) in the program environment and during the transition to school settings. It is essential that evaluations to determine eligibility continue and that services are implemented to meet the related special education needs of that child. These evaluations and services may look different but should not be postponed. Early care and education programs can support the delivery of services as appropriate, inform families of their rights to receive services, and partner with the child’s pediatrician to adapt services during the pandemic.
Social media resources to promote well-child visits:
- AAP #CallYourPediatrician campaign toolkit.
Daily Health Checks and Screening
Programs should design a daily health check for staff and children before drop-off/check-in that expands the Caring for Our Children Standards: Standard 3.1.1 Daily Health Check to include at least a daily temperature check, other COVID-19 symptoms, and any history of contact with a confirmed case of COVID-19.
Temperature can be determined using any method: axillary (armpit), oral or other, and contactless. A fever is temperature ≥100.4°F. For additional information, please see the CDC Guidance for Operating Early Care and Education/ Childcare Programs During COVID19. This protocol relies on parent/caregiver access to a thermometer as well as knowledge and skills to use a thermometer, which can vary. It may be helpful to provide resources on how to obtain a thermometer as well as instructions on measuring the temperature accurately.
Not all children with fever have COVID-19, and not all children with COVID-19 have fever. Regardless, stopping a febrile child from entering a child care setting can help to prevent the disruptive series of consequences that would follow given the current circumstances.
Print and Post this Symptom Checklist
The CDC offers testing guidance for staff members. Please be aware that testing does not determine whether someone is contagious. It is possible to receive a positive result for SARS-CoV-2 but not be currently contagious. A person can continue to test positive for up to 3 months. It is also possible to receive a negative result and be contagious. If a staff member tests positive for SARS-CoV-2 or has come into contact with a person with confirmed SARS-CoV-2 , that person should follow the CDC recommendations for self-isolation or quarantine. Consultation with your local health department is recommended when questions arise.
Exclusion Policy: When Someone Becomes Sick With COVID-19 or Has History of Contact With Someone With COVID-19
All programs should have a plan for what to do if a child becomes sick during the day. Caring for Our Children Standards provide guidance on caring for ill children (3.6.2) and exclusion policies. The CDC recommends keeping sick children separate from well children and staff, in an area that can be used to isolate a sick child with appropriate supervision until the child can return home. A staff member should stay with the isolated child to monitor symptoms and care for the child. Staff should continue wearing their masks, washing their hands routinely, and changing clothes, smocks, or gloves that become soiled. If possible, other personal protective equipment such as eye protection and a surgical mask should be worn. Surfaces should be cleaned and disinfected in the area used for isolation after the sick child leaves. A sufficient number of staff should be available to maintain the designated staff-to-child ratio.
Recommended exclusion criteria, as outlined by the CDC, should be used during this time. If a sick child does have a suspected or confirmed case of COVID-19, the child should be excluded from the in-program services according to existing program exclusion policies (Caring for Our Children 188.8.131.52).
Each program must keep current with CDC guidance on the duration of self-isolation (for suspected or confirmed cases) and quarantine (for people with a history of close contact to a confirmed case of COVID-19). If a child or staff member is a confirmed or suspected case of COVID-19 (because of signs and symptoms or because the person has been in close contact with a confirmed case), then the family should be encouraged to self-quarantine accordingly and instructed on when the child or staff member may return to the program. Notify local health officials immediately if a child or staff member has a confirmed case of COVID-19. These officials will help your program leadership determine an appropriate course of action. Work with your local health officials to determine appropriate next steps, whether closure is needed for a short duration (eg, for cleaning and disinfection) or to slow further spread of COVID-19.
Considerations for Closure
Notify local health officials immediately if a child (or household member) or staff member has a confirmed case of COVID-19. These officials will help your program leadership determine an appropriate course of action. If the child care program has maintained cohorts of children and staff, the child care may not need to close entirely. Instead, the exposed cohort would most likely need to remain home for the CDC’s recommended self-isolation period. This would allow child care services to continue for the remaining cohorts.
If health officials recommend closing your entire program, you may be closed for 2 to 5 days. This initial short-term closure allows time for local health officials to gain a better understanding of the COVID-19 situation affecting your program and allows you to plan to clean and disinfect the affected facilities. Work with your local health officials to determine appropriate next steps, including whether an extended duration is needed to stop or slow further spread of COVID-19 (COVID-19 Guidance for Operating Early Care and Education/Child Care Programs (cdc.gov)