Routine Child Care in the COVID-19 Context

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Please note that at this time, the content on this page is not being regularly updated.

Now more than ever it is important for your patients to look after their health and receive care from you as their healthcare provider. It’s essential that patients continue to seek out care that they need.

This tool has been developed to support primary care providers in navigating and providing patient care in a world where COVID-19 is the ‘new normal’, with considerations and recommendations on what’s ‘new’ and what’s ‘changed’ in the delivery of routine care for paediatric patients. While how care is delivered has changed, efforts should be made to ensure that the quality has not. As always, when treating your patients, continue to use your clinical judgement and follow standards of care, best practices, evidence and guidelines.

Key takeaway

Routine childhood immunizations should be kept up to date through in-person visits, since delay or omission could put children as risk for common and serious childhood infections (CPS, April 30, 2020). As such, children who have missed recommended well-child visits and/or vaccinations should be identified and contacted to schedule an appointment (American Academy of Pediatrics, June 1, 2021).

Click on the sections below to get started:

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What’s new, what’s changed

Caution must be taken when hand sanitizers are within reach of young children, and when being used by or around children, due to risk of accidental contact with the eyes and mouth. When using hand sanitizer on yourself or others, apply a dime-sized amount to dry hands and rub hands together until completely dry (CPS, April 3, 2020).

Well-child visits and immunizations

See Wave 2: Flu vaccination and flu vaccination clinics for information on providing flu vaccinations during the 2020-2021 season.
Continue offering routine well-child visits and immunizations, switching to virtual/telephone visits, as appropriate.
Grade 7 school vaccination clinics were cancelled this spring due to school closures. While most public health units are planning catch-up clinics, individuals may contact their family physician for missed doses of Hepatitis B, Meningococcal and HPV vaccinations (MOH, August 25, 2020).

Putting it into practice

Screening for travel risk and symptoms should take place before in-person visit, and symptomatic caregivers should be discouraged from accompanying children to the office, clinic, or other healthcare setting (CPS, March 25, 2020). See the Primary Care Operations in the COVID-19 Context resource for details on delivering patient care remotely and in person.
If well-child visits are converted to virtual/telephone appointments, questionnaires such as the Rourke Baby Record and Nipissing District Developmental Screen (18-months) can be emailed to parents prior to the appointment.
In some jurisdictions where public health capacity has been severely limited by the pandemic, delaying booster doses while providing parents with catch-up plans before re-opening schools and child care settings may be reasonable (CPS, April 29, 2020).

Proposed schedule for well-child visits

Newborn (0-2 weeks) visit

In-person for weight/jaundice/feeding issues

1 month visit

Virtual/Telephone (can be converted to in-person if concerns)

Ask parents to check baby’s weight at home if possible [(parent’s weight with baby) – (parent’s weight without baby) = rough estimate of baby’s weight].
Can also be reassured by parents’ subjective report of weight gain/outgrowing diaper size and sleepers.

2, 4, 6 months visits

In-person for vaccines

Pertussis, tetanus, diphtheria, Haemophilus influenza b, polio, pneumococcal and rotavirus

9 month visit

Virtual/Telephone

12, 15 months visits

In-person for vaccines

Meningococcal, measles, mumps, rubella and varicella

18 months visit

In-person for developmental assessment and vaccines (could consider virtual/telephone)

Pertussis, tetanus, diphtheria, Haemophilus influenza b, polio
Virtual/telephone visit would be a surrogate for an in-person developmental assessment. Developmental questionnaires can be sent to parents prior to the appointment.

4-6 year visits

Consider postponing

Adapted from Interim schedule for well-child visits (CFP, March 25, 2020) and Guidance for Immunization Service Providers During COVID-19 (MOH, April 19, 2020).

Resources

For patients

For providers

These supporting materials and resources are hosted by external organizations. The accuracy and accessibility of their links are not guaranteed. CEP will make every effort to keep these links up to date.

Acknowledgement and legal

The COVID-19 Resource Centre was developed by the Centre for Effective Practice (CEP) in collaboration with the Department of Family Medicine at McMaster University, the Ontario College of Family Physicians and the Nurse Practitioners’ Association of Ontario using a rapidly modified version of the CEP’s integrated knowledge translation approach. They are some of several clinical resources developed as part of the Knowledge Translation in Primary Care Initiative. Funded by the Ministry of Health and Long-Term Care, this initiative supports primary care providers with the development of a series of clinical tools and health information resources. Learn more about the Knowledge Translation in Primary Care Initiative.

Clinical Working Group

A clinical working group was established and provides significant input and oversight into the development of this resource. Members include:

• Claudia Mariano, MSc, NP-PHC
• Darren Larsen, MD, CCFP, MPLc
• Derelie Mangin, MBChB (Otago), DPH (Otago), FRNZCGP (NZ)
• Dominik Nowak, MD MHSc, CCFP, CH
• Jennifer P. Young, MD, FCFP-EM
• Lee Donohue MD, CCFP, MHSc, MPLc
• Mira Backo-Shannon, MD, BSc, MHSc
• Paul Preston, MD, CCFP, CCPE, CHE
• Rob Annis, MD, CCFP
• Soreya Dhanji, MD, CCFP

In addition to our clinical working group the CEP also obtained feedback from others, including:

• Arun Radhakrishnan, MSC, MD, CM, CCFP
• Central Region Primary Care Leadership
• David Daien, MD, CCFP
• David Makary, MD, CCFP
• David Price, BSC, MD, CCFP, FCFP
• Jose Silveira, BSC, MD, FRCPC, DIP, ABAM
• Michael Chang MD, FRCP(C)
• Payal Agarwal, MD, CCFP
• Robert Sauls MD, CCFP(PC), FCFP
• Tara Walton, MPH

Lastly, for certain sections, the CEP also obtained feedback from others, specifically:

Readiness assessment for delivering in-person care
Operational requirements for in-person care
COVID-19 Provincial Primary Care Advisory Table
• David Price (Chair), MD
• Andrea Sereda, MD
• Annelind Wakegijig, MD
• Beth Sweeney
• Cathy Faulds, MD
• David Daien, MD
• David Kaplan, MD
• Kamila Premji, MD
• Kelly Van Camp
• Kim McIntosh, MD
• Michael Green, MD
• Rebecca Carson
• Sarah Newbery, MD
• Thuy-Nga (Tia) Pham, MD
System stakeholders
• Registered Nurses Association of Ontario
• Association of Family Health Teams of Ontario

Thank you to everyone who supported the development of this resource.

Conflict of interest

• Clinical Leads receive compensation for their role
• Clinical Working Group receive an honorarium for their participation
• Focus group and usability participants receive a small token of appreciation (e.g. gift certificate)

The Routine Child Care in the COVID-19 Context resource is a product of the Centre for Effective Practice. Permission to use, copy, and distribute this material for all non-commercial and research purposes is granted, provided the above disclaimer, this paragraph and the following paragraphs, and appropriate citations appear in all copies, modifications, and distributions. Use of the Routine Child Care in the COVID-19 Context resource for commercial purposes or any modifications of the Tool are subject to charge and use must be negotiated with the Centre for Effective Practice (Email: info@cep.health).