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Experts weigh in on top pediatric concerns a year into pandemic

February 22, 2021













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Partnerships with schools and community groups plus more supports for children and families are needed to help youths impacted by the pandemic that has stretched on for a year. Those were among recommendations of experts who took part in a recent AAP virtual town hall panel discussion.

Addressing “What’s Happening to the Children?” the speakers shared views on the types of supports necessary to address lingering — and worsening — social drivers. Mental health, academic under-achievement, food and housing insecurity, racial discrimination and obesity were top of mind, they said.

Most children are less impacted by the infectious complications of COVID-19 but disproportionately affected by the other impacts, AAP President Lee Savio Beers, M.D., FAAP, said as she kicked off the discussion.

The panel featured Ihuoma Eneli, M.D., M.S., FAAP, professor of pediatrics at The Ohio State University and director of the Center for Healthy Weight at Nationwide Children’s Hospital; Kimberly Gayle Montez, M.D., M.P.H., FAAP, assistant professor of pediatrics and associate director of Integrating Special Populations, Maya Angelou Center for Health Equity at Wake Forest School of Medicine; and Sonja O’Leary, M.D., FAAP, assistant professor of pediatrics at University of Colorado School of Medicine and medical director of Denver Health’s School-based Health Centers. AAP chief population health officer Anne R. Edwards, M.D., FAAP, moderated the discussion. 

Food insecurity had just started to improve in her clinic before the pandemic hit, Dr. Montez said. Some surveys now show that rates during the pandemic doubled in households with children. She is, however, encouraged by recent federal investments in nutrition programs. 

Housing insecurity affects not only homeless populations but also those paying unsustainably large portions of their income on housing, Dr. Eneli said. 

Dr. O’Leary, chair-elect of the AAP Council on School Health Executive Committee, is concerned about the educational attainment of students. In one of the schools in her network of 18 school-based health centers, Dr. O’Leary said she heard that 70% of high school seniors were not on track to graduate on time because of missed schoolwork. Some older teens are responsible for helping younger siblings with class work and may be holding jobs — even full time. 

Dr. O’Leary advises older teens with school problems to meet with their counselors to discuss how to graduate on time. She suggested pediatricians develop partnerships with schools and other community agencies, and advocate for increased funding for summer school and pre-college programs that help students graduate on time.

Dr. Montez, vice chair of the AAP Council on Community Pediatrics Executive Committee, talked about screening all patients for social challenges, especially since many physical complaints can be traced to stressful environments. She is a proponent of integrating behavioral health in practices where it is feasible. 

Dr. Eneli said she was “struck by how much that’s not going right is tied to the family dynamics.” COVID has shown pediatricians the importance of improving behavioral counseling as well as communication skills. 

Childhood obesity is another ongoing issue. With shelter-in-place and remote learning, physical activity levels have fallen, said Dr. Eneli, associate director of the AAP Institute for Healthy Childhood Weight. In addition, chronic stress triggers responses in the body that can negatively impact weight regulation. Modeling studies predict at least a 3%-4% weight gain in children during the pandemic.

“In our own network, when we’ve looked at kids over a three- to six-month period, we’re seeing about one in five of them can gain up to 11 pounds …” she said. 

She recommended that pediatricians advise parents to address the “low-hanging fruit,” such as replacing sugar-sweetened beverages with alternatives. Pediatricians also can provide flyers with nutrition information such as healthy snacks. 

Dr. Montez concluded that pediatricians are “amazing advocates, and I think at this time it’s really (important to) lift up our expertise,” especially on the need to dismantle racism and for policies that lift families out of poverty.

“I think for us, that’s part of the core of being a pediatrician is that voice for children, and … with families as partners,” Dr. Edwards said. “I have optimism for what we can do together for our children and families.”

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