BELLEVILLE — To cope with job losses and changes, remote learning and lockdowns, parents have had to push aside a lot in order to get their families through the COVID pandemic.
For many adults, that meant missing normal doctors appointments. It might have also have meant skipping early childhood appointments for their children.
Now that the school year is about to start — in-person and often without required masking — pediatricians say it's not too late to make sure your child is healthy and on track for school.
"Adults have largely returned to their primary care offices, but children are not," said Dr. Cassandra Pruitt, a general pediatrician at St. Louis Children's Hospital and associate professor of pediatrics of Washington University. "I think parents are much more protective of their children than themselves."
Childhood vaccinations dropped during COVID
The St. Clair County Health Department reported about a 19% drop in the number of children receiving vaccines in January through June 2020, compared to the same time period of 2019. The data provided by the department includes only those who were vaccinated through the health department, not of all children in the county.
Since the strictest COVID lockdown, the health department's vaccinations have climbed back up. In the first half of 2021, there's been a 20% increase from 2019's numbers as parents made up missed appointments.
In 2020, Illinois required 10 vaccinations for those enrolling in childcare facilities or schools. Many of these vaccines are given to babies and toddlers, long before they start school. The vaccine schedule for these shots are set based on federal recommendations.
That doesn't mean families who had to miss or postpone well-child appointments are too late to vaccinate their children.
"Vaccines are best when given on the schedule that have been outlined, but there is absolutely no reason we cannot catch them up," Pruitt said. "There is a very clear schedule for how we help people catch up on vaccines they may have missed."
During the pandemic, there's been a flurry of conspiracy theories and misinformation about the COVID-19 vaccines, especially for children. One piece of good news, Pruitt said, is that it does not seem to have hindered public trust in other long-standing vaccines.
Public health during COVID
While most public health news over the last year and a half has been dominated by COVID, there's concern that if too many kids are behind on their normal immunizations, there could be other outbreaks as well.
"I think as pediatricians, we are concerned that we'll see a concentration of illnesses that are typically well-managed by having a large part of the population vaccinated," Pruitt said, specifically mentioning whooping cough as a concern.
With nearly universal mask mandates last fall, one side effect was that the flu season was minimal. However, that could make flu season this year that much worse: with fewer people having been recently exposed to the flu virus, there's less natural immunity.
And the masking mandates that were largely responsible for staving off the flu last year have mostly disappeared.
In Illinois, masks are generally not required for fully vaccinated people except in certain environments, like public transportation. Fewer still are the businesses that actually ask for proof of vaccination for customers that are not masked.
Schools have been given far more local control this year than last year, when universal masking mandates were required by IDPH. Now, with a new emphasis on mitigations tailored to local infection rates, the new CDC and IDPH guidance give school districts the option to not require masks of any of their students — vaccinated or not.
In Madison County, a group called Speak for Students has been advocating at different school boards that families be given "parental choice" when it comes to mask, testing and vaccination requirements. Individual school districts do not have the authority to require new vaccines to attend; vaccine requirements are set at the state level.
Freeburg High School 77 and Highland CUSD 5 have already adopted mask-optional policies.
It's more than just vaccines
For young children, well-child checks aren't just about vaccinations, though Pruitt said that's certainly an important part of them. Early doctor visits also look at a child's physical, social and emotional development.
During the pandemic, Pruitt said pediatricians and family care doctors have seen an increase in emotional and behavior issues, as well as developmental delays that parents might not notice when they spend so much time with their child.
For adults, COVID has taken a toll on mental health, whether they've lost their job, were adapting to working from home, or coping with factors that put them or their loved ones at higher risk for the virus.
Children, too, may be nervous or anxious about going back to school, whether they spent the entire last year remote or not, Pruitt said.
In a poll of parents conducted by Ann & Robert H. Lurie Children's Hospital of Chicago, 64% of the 1,000 parents polled said they thought the pandemic would have a lasting effect on their child's development, and 71% said the pandemic had taken a toll on their child's mental health.
"It can't be underappreciated that kids might not be ready to go back to in-person," Pruitt said, adding that pediatricians are well-equipped to have those conversations with families. "Parents might be seeing their child become anxious, but don't know what to do about it."
Besides mental health, well-child visits can alert parents and doctors of dental, hearing or vision problems. Sometimes there are specialized tests, like looking for lead toxicity.
"Missing all of those things can make a child poorly prepared to restart school in the fall," Pruitt said. "We know a large number of children never returned to the classroom last year, but they will be this year."