In ordinary times, a baby’s first year is full of checkups, adorable weigh-ins on the scale at the doctor’s office, and a pretty packed vaccine schedule, with shots administered every few months. During the coronavirus pandemic, however, venturing into any healthcare setting with your little one can feel very risky—we’ve been told to stay home as much as possible. But delaying the normal vaccine schedule (or not vaccinating your baby at all) also carries huge risks, and doctors are worried that parents are cancelling regular checkups and important immunizations out of fear.
"Parents are definitely nervous—especially first-time parents," says family doctor Tali Bogler, Chair of Family Medicine Obstetrics at St. Michael's Hospital in Toronto. “It’s completely understandable to be nervous about visiting the doctor’s office at this time, but we need parents to know that healthcare providers are doing everything they can to prevent the spread of infection.”
Dr. Dina Kulik, a paediatrician in Toronto, confirms that some parents are delaying their child's vaccines indefinitely because their doctors’ offices are closed. "I'm very worried about this," she says. "When the distancing restrictions are lifted, we simply cannot allow hundreds of kids to rush into our offices to get vaccines—then you have tons of under-vaccinated kids all in one space. This increases the risk of second or third waves of COVID-19, plus the vaccine-preventable illnesses we know we can prevent.”
A good first step is to call your regular doctor or local health clinic for their specific advice, and to find out if they're still seeing healthy kids in-person. If your doctor's office has closed, you may have to call around to find a walk-in clinic still accepting patients and offering vaccinations.
"As doctors, we need to figure out creative ways to make sure that the regular vaccine schedule continues," says Bogler. "At our clinic, we've protected time for well-child visits, prenatal appointments and our most vulnerable patients."
Some physicians are only seeing asymptomatic children in-office for regular checkups and vaccines—no sick kids are allowed at all. Many doctors have switched to “virtual care” or telemedicine, scheduling video conference appointments and using apps and services like Zoom and Doxy instead. Other doctors, like Bogler, are dividing, staggering or alternating their workdays, so that sick kids and healthy kids are not in the office at the same time, with rigorous cleaning and sanitizing of the offices in between. Some have patients go straight into exam rooms upon arrival. And at least one paediatric office in Toronto is trying out drive-up vaccinations, with doctors administering the shots outside their clinic, where they have set up plastic chairs and a mini-fridge to store the doses safely.
To help parents and doctors prioritize which well-baby visits and checkups are most important, Bogler recently published an interim well-child and vaccine schedule in the Canadian Family Physician journal.
The newborn and two-week visit should definitely still be in-person, to check for jaundice and assess hydration and weight gain, as well as troubleshoot any feeding challenges.
The one-month checkup could be in person or virtual, depending on whether there are any weight issues, or the parent has specific concerns. If you're unsure whether your baby has gained any weight, you can weigh yourself, then step on the scale again while holding the baby, and do the math. (Going up a size in diapers or outgrowing sleepers are also reassuring signs.)
But, says Bogler, the two-, four- and six-month visits should all be in person, as those vaccinations include the DTaP-IPV-Hib shot (which protects your baby from diphtheria, tetanus, pertussis, polio, and haemophilus influenza type b), the rotavirus vaccine, and the pneumococcal conjugate vaccine (which protects against pneumonia and meningitis—an infection of the brain). There are additional crucial vaccinations given at the 12- and 15-month visits, including the varicella vaccine (against chickenpox) and the MMR vaccine, which builds immunity against measles, mumps and rubella. Another dose of the DTaP-IPV-Hib shot is typically given at 18 months. (The specific vaccine schedule may vary in your province.)
However, the 9-month well-baby visit can be virtual, as that appointment does not normally include any shots.
Officially, according to the Canadian Paediatric Society, routine immunizations for children should be maintained as usual. "Any delay or omission in scheduled vaccines puts children at risk for common and serious childhood infections such as pneumococcal disease, measles, and pertussis,” wrote Dr. Raphael Sharon, an associate clinical professor in the Department of Paediatrics at the University of Alberta, in an article written for doctors trying to determine the best way to provide care for kids during a pandemic. Sharon says that newborns and babies under three months of age (as well as babies older than three months old who may still be at risk of failure to thrive), should be first priority.
“In our office we have only healthy newborns and well babies coming in for vaccines,” says Kulik. “No sick kids.” Even children with everyday concerns—a mysterious rash, or a suspected ear infection—are being treated via virtual appointments, because Kulik worries that any symptom could be a coronavirus symptom.
“We space out the well-baby visits all day, so there is no one in the waiting room, and all staff wear masks. We sanitize each room after every single patient, and we sanitize the waiting room, doors, chairs and washrooms at least once an hour,” she says. “Doctors’ offices and waiting rooms don’t have to be germy at all—you can eat off the floor.”
Nancy Ahmad, a mom of two young kids in Toronto, took her daughter for her six-month shots on her doctor’s advice earlier this month. While she was a little nervous at first, Ahmad says she felt very safe during the checkup. “We drove there, and I saw no one in the elevator. We were the only in-person appointment of the day.”
Like Ahmad, you can minimize exposure risk by walking or driving to the appointment instead of using public transit, babywearing while in the office as much as possible, and not letting your baby or toddler crawl or cruise around on furniture.
In addition, only one asymptomatic parent should bring your baby to the appointment. Bogler also recommends wearing a non-medical mask (if that makes you feel more comfortable); avoiding door handles; using your elbow to hit elevator buttons; making sure that the waiting room has chairs spaced two metres apart; and asking your doctor if both the baby scale and stethoscope have been wiped down prior to your visit. At her practice, only one care provider is coming into each exam room to limit exposure (instead of both a nurse and a doctor).
"You can also ask to wait outside, instead of inside a waiting room," says Bogler. "And keep the visit as short as possible—discuss any health or development questions over email or the phone first." That way, the in-person portion of the appointment is brief, and solely dedicated to the vaccines and the physical exam.