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American Academy of Pediatrics Coronavirus Guidelines, Explained

The AAP, the governing body for pediatricians in America, has guidance for doctors and parents.

The one silver lining in this pandemic is that the novel coronavirus isn’t especially virulent for children. The first look at under 18 population in the U.S. shows that, as they found in China, hospitalization rates of kids and severe symptoms are far below that of adults. The one exception may be infants, for which there is porous data. Still, a pandemic doesn’t just impact health, it shakes the foundation of the healthcare system, putting kids and parents at greater risk of kids with ailments big and small not getting the care they need. This is why organizations like the American Academy of Pediatrics (AAP), the governing body of pediatricians in the United States, are so crucial. Their guidelines can save lives — if implemented uniformly. So what is the AAP telling pediatricians right now? A lot.  Here’s what parents need to know.

Well Visits

The AAP guidelines for well visits are flexible to fit the number of infections in a local area. Here are the changes to everyday practice they encourage pediatric offices to consider:

  • Pediatricians may choose to only conduct well visits for newborns, and for infants and younger children who require immunizations and to reschedule well visits for those in middle childhood and adolescence to a later date.
  • Pediatricians may choose to limit well visits to early morning while reserving the remainder of the day for sick visits.
  • Pediatricians are encouraged to dedicate specific rooms for sick visits and well visits; or for those with multiple practice sites to consider using one office location to see all well visits (staffed by those in higher risk categories).
  • Pediatricians may choose to increase their capacity to deliver telehealth.

What does this mean for parents? Expect your yearly check-up to be postponed and for most routine visits to be canceled or done through telemedicine. The exceptions will be for infants and immunizations. Immunizations should also proceed on schedule, which is usually the case for children under the age of 5 and around age 11. “Anybody who needs immunizations should definitely be going in,” says Ashlesha Kaushik, a pediatric infectious disease physician and a spokesperson for the American Academy of Pediatrics.

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If you do need to go into the office, you may face extra precautions designed to protect your family. Well visits may be scheduled during the morning only, and the clinic may have separate rooms for sick and well visits. If your provider uses multiple offices, they may dedicate one solely to well visits. A provider will probably take you directly to a private room so you don’t have to linger in the waiting room. As per guidelines from the Centers of Disease Control and Prevention, you and your kid should both cover your face with a cloth mask. Wash your hands frequently and stay six teeth away from others when possible.

Sick (Non-COVID-19) Visits

The AAP doesn’t have guidelines specifically for what to do if your child is sick with an illness other than COVID-19, such as an ear infection or a stomach bug. However, they do recommend keeping your kid out of the medical system if possible. Kaushik recommends giving your pediatrician a call if you have any concerns about your child’s health.  “In the mode of social distancing, we don’t want to leave families alone,” she says. “Parents should call the pediatrician if they’re worried about anything, be it symptoms that they think are related to COVID or to any other stresses they’re feeling.” The provider can help you decide the best course of action, whether that be treatment at home, a telemedicine appointment, or coming into the office. Whatever you do, don’t show up at the clinic unannounced. Call ahead so they can prepare for your visit.

If your child does need to see a pediatrician for an illness, the provider may schedule you for an afternoon appointment. Follow the same personal safety guidelines as you would for a well visit. Encourage your child to cough into their elbow or a tissue. If your child has a specialist for any underlying conditions, make sure you’re in contact with them as well as a pediatrician.

Suspected COVID-19

If your child has symptoms of COVID-19, the AAP doesn’t want you to jump in a car and drive to the nearest testing facility. Call ahead. “If a parent is really suspicious, then they should call their provider and ask for guidance,” Kaushik says. Even if the child have the telltale fever and cough, they may not qualify for testing. The AAP advises that each clinician use their own reasoning to determine whether to test a child:

Use clinical judgment in determining if diagnostic testing is necessary and rule out other potential causes of respiratory illness (eg. Influenza). Considering the following:

  • Local epidemiology of COVID-19
  • Clinical course of illness, including presence of symptoms (fever, cough, shortness of breath)
  • History of travel to an affected geographic area within 14 days of symptom onset
  • Close contact with a laboratory confirmed COVID-19 patient within 14 days of symptom onset.

Symptoms of COVID-19 include fever, dry cough, and shortness of breath. Kids may also have a sore throat, runny nose, and stomach issues. These symptoms may appear in any combination, so it can be difficult to tell if it’s COVID-19. If you have any concerns, give your doctor a call. They may or may not decide that your child should get tested depending on availability in your area and other factors, such as whether your child has underlying conditions like asthma or if they’re immunocompromised.  If you suspect your child has COVID-19, make sure they are getting plenty of rest, eating well, and hydrating. In most cases, that’s all it will take to recover, so testing often isn’t necessary. If you do, the AAP recommends using a drive-through testing site. If you have to go into an office, expect to wear a medical mask and be placed in a room with a closed door as soon as you get there.

“No age is immune to the virus,” Kaushik says. Some children do get severely sick, and you need to be vigilant about watching for severe symptoms such as shortness of breath, fast breathing or difficulty breathing, excessive sleepiness in small children, and not eating, Kaushik says. These are signs that they should see immediate medical care.

Kids Wearing Masks

In a set of guidelines released on April 9, the American Academy of Pediatrics deferred to the CDC on the rules that all children over two-years-old should wear masks right now when going outside, with  a few caveats: You can skip masks when kids are at home, should take special precautions with kids who have severe cognitive or respiratory impairments (including monitoring them with a pulse oximeter) and also, a bit confusingly, not worrying so much if people aren’t around and kids can keep their hands off oft-touched surfaces:

If children can be kept at least 6 feet away from others, and not be in contact with surfaces that could harbor the virus, then they do not need a mask for the protection of themselves or others.

For example, during a walk outdoors, as long as children can maintain social distancing of more than 6 feet and do not touch tables, water fountains, playground equipment or other things that infected people might have touched, then they will not acquire the infection and would not need masks.

Other experts have pointed out that the purpose of wearing a mask isn’t to keep your kid safe so much as to prevent your little germ incubator from spreading disease. As many as 25 percent of cases of COVID-19 are asymptomatic and many of those who are infected without symptoms are probably kids. For more mask guidelines, see our reporting here.

Mental Health

Failing health due to COVID-19 isn’t the only problem your child can develop during the pandemic. The world is experiencing varying degrees of generalized anxiety and kids — whether they know what’s going on or not — absorb the national mood. Kids with mental health issues are especially susceptible and may need additional support right now. The AAP parenting website HealthyChildren.org advises that both parents and children find ways to manage their stress during one of the most stressful times of your kid’s life, such as keeping some type of routine or schedule, ignoring bad behavior that isn’t dangerous, and taking breaks from being together. If children or adolescents are fearful, reinforce that your family is taking positive actions such as social distancing to keep yourselves and other safe.

If your child already has some mental health issues or some type of mental or intellectual disability, be in touch with your specialist. Make sure you have enough of medications you may need. If they have a condition such as ADHD, they should continue to take their medicine even if they are not in school.

Make sure you manage your own stress as well. Kids can be a lot. Develop coping mechanisms and check in with yourself about what battles are worth fighting. Because we’re going to be here for a while.