Posted on October 26, 2022
By Alana Vega
ACNJ Health Policy Analyst and Youth Engagement Coordinator
Well-child visits, also known as check-ups or routine pediatrician visits, are an important part of preventative healthcare for children and adolescents. The American Academy of Pediatrics (AAP) recommends a “periodicity schedule” for children beginning when they are just a few days old through 21 years of age. According to AAP, children ages three and older should receive annual check-ups with their providers, while younger children should see a doctor more frequently. These check-ups are important for a variety of reasons, including disease prevention through regularly scheduled immunizations, testing a child’s blood for traces of lead and tracking a child’s developmental milestones. Visits are also important for parents. In addition to providing a chance to ask questions and raise concerns, pediatric visits are an opportunity to screen mothers for signs of maternal depression.
In the wake of the COVID-19 pandemic, several entities, including Centers for Medicare and Medicaid Services (CMS), highlighted a national decline in routine well-child visits. Several factors may have lead to this. In 2020, Centers for Disease Control and Prevention (CDC) guidance encouraged health providers to delay non-emergency services in an effort to target resources to combat the pandemic. Additionally, parent concerns regarding exposure to COVID may have contributed to fewer visits. Although there was some evidence of an increase in pediatric care conducted via telehealth, these visits did not offset the declines.
One study indicates that missed visits were reported more for certain age groups than others--with nearly half of children ages 2-6 and 7-12 missing well-visits. Comparatively, roughly a quarter of parents of children under age 2 reported missing a routine visit. The same study indicated a higher prevalence of missed visits among Hispanic children in comparison to other racial groups; non-Hispanic Black children had the lowest rate of missed visits.
CareOral Health for Kids -- Did You Know?
Children should visit the dentist twice a year – beginning at age one! Many parents are unaware their children should see a dentist so young. Preventive dental care is an essential part of good healthcare, just as important as immunizations and wellness visits. Dental disease can harm a child’s overall well‐being and has been linked to illnesses such as cardiovascular disease, diabetes and strokes. To find a dentist, parents should contact their insurance company or HMO. NJ FamilyCare, New Jersey's publicly funded health insurance program, covers oral health for children.
Lead Testing and Routine Immunizations
The decline in well-visits had a domino effect on blood lead tests and routine immunizations among children. In March 2021, the New Jersey Department of Health (NJDOH) announced a partnership with the New Jersey Chapter of American Academy of Pediatrics, in response to a decline in the number of children under age 17 screened for the presence of lead in their blood. The NJDOH annual Childhood Lead Exposure in New Jersey report, covering State Fiscal Year (SFY) 2020, showed that 78% of children turning 3 years old during SFY 2020 had at least one blood lead test in their lifetime. One year prior, 90% of children turning 3 years old had received at least one blood lead test. Early identification of lead is critical; lead is a toxic metal that can cause lifelong harm to mental and physical health. The CDC maintains that there is no safe level of lead for children.
Early reporting during the pandemic also pointed to a decrease in vaccination rates among children between March-May 2020. Subsequent CDC research showed that despite a rebound in vaccination rates from June-September 2020, rates had not recovered to sufficient levels needed to catch children up on their scheduled immunizations. In New Jersey, Annual Immunization Status Report (ASR) data show that the percentage of school aged-children in compliance with immunization requirements has decreased between the 2017-18 and 2021-22 school years (from 94.6% of students to 92.6%). All public and private schools in New Jersey are required to annually report vaccination status of students enrolled in child care, preschool, entry level grades (kindergarten or 1st grade), 6th grade and among transfer students.
Number and Percentage of Children Meeting All Immunization Requirements
What Can Be Done?
Well-visits are a core component of ensuring lifelong health for children. Missing scheduled immunizations can cause children to have vaccine preventable diseases that can lead to severe illness. And lead exposure can lead to impaired brain development that cannot be reversed--even when young children are exposed at very low levels. ACNJ supported S1507, a bill requiring blood lead testing for children before enrolling in preschool and kindergarten. This bill intends to strengthen New Jersey’s existing universal lead screening requirements by connecting blood lead testing with school enrollment.
Beyond legislative action, there are some steps we can all take to remind families of the importance of preventive healthcare for children. Parents can use this opportunity to schedule a visit with their child’s pediatrician. Tools like the CDC’s free Milestone Tracker App allow parents to track their child’s development, and to identify any concerns or questions they may have for their next pediatrician visit.
Additionally, programs like HealthySteps, which utilize a team-based approach, can be effective models to ensure that children are reaching their developmental milestones and to provide targeted support to families. Currently there are three practices in New Jersey that implement the Healthy Steps model, with plans to expand the program to eight new sites in Camden in Newark over the next few years. Parents can use this tool to see if there is a site nearby.
As the end of 2022 draws near, we owe it to Garden State children to ensure they are building a healthy foundation for future success.
Pediatricians, you play an important role too!
A JAMA Pediatrics study indicates a few different strategies for pediatricians to help families catch-up on well visits:
- Consider using sick visits (when appropriate) as an opportunity to promote vaccination and potentially utilize the time to discuss preventative health.
- Contact families directly to remind them of missed vaccines. While phone calls are helpful, text messages could be especially effective at reaching lower-income families.
- Leverage partnerships with organizations that have strong relationships with families, children and adolescents. Though physicians are parents’ most trusted source of information regarding child vaccinations, broadening outreach efforts could be critical to reaching harder to reach populations, such as disconnected youth.
- Partner with school districts as vaccination sites -- another effective way to reach families.