'Parents were scared': Amid COVID-19, Kansas City area kids not going to the doctor

May 26--Dr. Corey Iqbal rarely operates on a child whose appendix has gotten so bad that it has ruptured.

But he is seeing more than usual lately -- four acute appendectomies within about a week recently. And, "there is definitely a common theme among the parents," he said:

They didn't want to take their kids "to the hospital where there could potentially be people with coronavirus," said Iqbal, medical director of pediatric surgery at Overland Park Regional Medical Center.

While the coronavirus is not considered a direct threat to children, pediatricians in the Kansas City area and nationwide report that it is taking a toll in other ways.

Parents have avoided the doctor's office and ER, they say, a situation similar to adults ignoring signs of heart attacks and strokes because they fear going to the hospital during a pandemic.

Children are missing vaccinations and well visits. In some instances, parents are not taking kids in quickly enough for emergency attention.

The American Academy of Pediatrics noticed parents stopped coming in not long after the pandemic began, with some private practices reporting office visits had dropped off as much as 80%. Parents canceled appointments and didn't set up new ones.

So the academy rolled out a "Call Your Pediatrician" campaign. The social media effort kicked off last week, employing a healthy dose of humor. Said one tweet: "Dear parents: We'll take 'em off your hands for 20 minutes. Love, Your pediatrician. #CallYourPediatrician"

Pediatricians want to see your child now.

"People were told to stay at home, not to go unless they had to, so what we immediately started seeing was a sharp decline in patients coming to the office for their well visits or their sick visits or anything," said the group's president, Dr. Sally Goza, who is based in Georgia.

"People were really scared about what should we do? They were hearing how busy doctors were so they were like, 'I don't want to bother the doctor if they're that busy.'

"We also had instances where parents were scared to take their children to the emergency room and they would delay care on it. I actually had a patient who fell off a trampoline, had a broken arm. Obviously ... it was painful. ... Mom didn't want to go to the emergency room the night before, and she came in to see us the next day."

The arm was fractured.

What Iqbal is seeing with appendectomies worries him. When he removes an appendix and it's not ruptured, those children are usually home in less than 24 hours. But a perforated appendix could land a child in the hospital for more than a week, or longer, and increase their risk of infection.

"Even pre-coronavirus, parents are usually pretty remorseful. But it just seems to have intensified, because these are very good parents. Their intentions were in the right place," said Iqbal.

"They didn't want to bring the child to the hospital because they were concerned about their safety, and the rest of the family's safety. It wasn't because they wanted to ignore their child. So it seems they're almost at a loss for words. 'I give up. I don't know what the right thing to do is.'"

A message of safety

Kansas City issued stay-at-home orders in March, right around the time Morgan Freed was scheduled to take her 7-month-old baby, Juliana, for a round of vaccinations. The new mom wasn't quite sure what to do.

Should she venture out of her home and take the baby to see her pediatrician, Dr. Angela Linz? Was it even safe to be at a busy doctor's office during a pandemic?

"I called the doctor's office and asked if I should reschedule and just kind of try to wait it out," said Freed, 27, a kindergarten teacher at Trailwoods Elementary in Kansas City.

The phone call set her mind at ease when she heard that Pediatric Associates had changed the way it was doing business to help mitigate the spread of COVID-19. "The way they are taking everything very seriously, the way they process check-in and separating different patients made me feel very confident," said Freed.

So she took Juliana in for her shots.

"We have absolutely been open the whole time," said Linz, who gave the Freed baby, now 9 months old, a checkup on Friday.

New safety measures at the three Pediatric Associates locations on the Country Club Plaza, Lee's Summit and Overland Park include car-side visits where patients are seen in the parking lot.

"For general symptoms where you need to check out a set of ears or a rash, and if they don't necessarily need to come up, we can sometimes go down to the car side, which we've been doing a little bit less frequently here recently as people are more comfortable coming into the office or have seen what we've been doing," said Linz.

Waiting rooms aren't used anymore, and sick patients are seen in an area separate from well children. They use separate exits, too. Other pediatric offices are seeing sick children at different times than well kids, and most have been using telemedicine to screen sick ones before they come into the office.

Safety was addressed during an online town hall event Children's Mercy hosted earlier this month, along with questions from parents concerned about whether they and their children should be out in public at all, said Dr. Angela Myers, director of the Division of Infectious Diseases for the hospital.

The hospital lost so much business during the pandemic -- surgeries and outpatient visits went down more than 70% and emergency room traffic declined by 57% -- that it laid off nearly 600 employees last month.

The hospital's clinics and surgery department began rescheduling postponed appointments and scheduling new ones on May 18, beginning a phased-in approach to bring patients back. Along with that comes messaging about the hospital's new, pandemic-era safety protocols.

For instance, now there are markers on the floor in places where lines might form to remind people to stay six feet apart. Every parent and child will be screened and have temperatures taken. Patients will be scheduled in a way to minimize overlap. And crayons aren't shared anymore. A patient might get a box to take home.

"I would say when the pandemic became more prevalent nationwide, I think initially people were very nervous to come into the pediatrician's office, and rightfully so," said Linz. "And we definitely did see a huge decrease in the number of well-child visits and especially those with vaccines.

"And then as soon as we started to see that this was the case, we did try to start reaching out to some of those parents and saying, 'Hey look, we're taking these measures to keep you and us safe and we still feel very strongly that your child needs these well visits.' We need to monitor development, we need to monitor growth and we first and foremost need to keep them vaccinated to prevent other outbreaks that could occur in the community."

Vaccinations take a hit

As the anti-vaccine movement debates the merits of a possible coronavirus vaccine, pediatricians are worried about their young patients skipping regular immunizations.

Goza said vaccination rates have dropped anywhere from 40% to 50% in certain parts of the country.

The academy cited Centers for Disease Control and Prevention data published earlier this month showing that from mid-March to mid-April, doctors who participate in the federally funded Vaccines for Children program ordered 2.5 million fewer doses of vaccines compared to the same period in 2019.

State health departments can order vaccines through that program, and they are given, for free, to children through age 18 who meet certain criteria, including being uninsured or eligible for Medicaid.

In Kansas, orders are "down significantly compare to last year at this time," said Kristi Zears, communications director for the Kansas Department of Health and Environment.

"The big concern is that we could have a vaccine-preventable outbreak of disease -- chicken pox, whooping cough -- all of those things could come back if our vaccination rates drop too low," said Goza.

"And the problem is that as things are opening up, parents are going out more. Children are going outside to play with their neighbors, they're going around their family, there's talk of camps possibly this summer. And school's opening in the fall.

"If those children are not vaccinated ... that could be very devastating in this country if we are already thinking about in the fall having flu and coronavirus at the same time, then we add on measles or whooping cough or something else, we're going to really, really be in trouble with our children."

Angry toddlers

But it's not just children's physical health that worries pediatricians like Dr. Julie Brown at Shawnee Mission Pediatrics. She, like others, has been talking to parents "who were really afraid, afraid to come in," who worried that were going to be safe, she said.

"So I think our job as pediatricians has absolutely been not only care for our patients, for our little people, but to try to care for the entire family as well."

Children from toddlers to teens are picking up on their parents' anxiety, pediatricians say. "Whether we realize it or not, or whether we give them enough credit or not, our kids are keenly aware of their parents' stress and they're going to have some emotional outbursts or issues, understandably so, because of that," said Brown.

"We've had a lot of conversations in person or by telemedicine with parents who are like, 'Hey, is this normal, is my kid acting out normal?'

"Yeah, it's probably pretty normal. They feel like you do. They feel weird. They're not supposed to think that people wearing masks around ... that's not natural, that's not what they're used to."

Kids are struggling with being isolated from friends, missing out on year-end activities at school and being umoored from daily routines. Not knowing whether they'll get to participate in summer activities is weighing on them, too.

Their pediatricians say that some children are afraid they'll get the coronavirus, or that Mom and Dad will.

"We're starting to see a huge impact related to the recent stay-at-home order, and just the change in routine that kids are used to," said Linz.

"We see the school-age kids, it doesn't really present like your classic anxiety or depression. But suddenly these school-age children are just having more anger than normal. And parents are wondering 'what is this going on?'"

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