AAP Voices Blog

When I walk through our nearly empty outpatient center, which is dedicated to the care of children with neurologic and neurodevelopmental conditions, I feel a distinct sense of loss. I miss the kids. Gone are the smiling children interacting with their doctors. Gone are the faces of loving family members searching for information and hope.

The pandemic has made our most vulnerable patients and their caregivers fearful of coming to our clinic, which is in Baltimore, because of the risk of contracting COVID-19. And while we have switched our care primarily to telehealth, key aspects of preventive health care are at risk. This includes vital annual influenza vaccines.

Children with disabilities are at higher risk for severe influenza disease, although many pediatricians, families and caregivers are not aware of that. According to a 2013 study from the CDC, only half of all children with neurologic or neurodevelopmental conditions were vaccinated against the flu annually.  Also, physicians often failed to recognize both epilepsy and intellectual disability as high-risk conditions for severe influenza disease. It is vital that these children receive their annual flu vaccine to help decrease the risk of poor outcomes.

“Maintain a list of high-risk patients, including those with neurodevelopmental disabilities, to track and follow up with on flu vaccine status.”

For some, leaving the safety of the home feels too risky during the pandemic. Confusion about potential COVID-19 vaccines may make parents and families even more reluctant to get a flu shot. Conspiracy theories abound.

Others may feel that influenza is less of a risk due to the COVID-19 spread in their communities. How can anyone get the flu this year? Won’t everyone just get COVID-19?

What can we as pediatricians and pediatric specialists do to protect these vulnerable patients? Here are some ideas:

Inquire: 

• Have staff members ask about the influenza vaccination status at each visit, both in person and during telehealth appointments. Offer a flu shot if the patient has not been vaccinated.
• Maintain a list of high-risk patients, including those with neurodevelopmental disabilities, to track and follow up with on flu vaccine status. Caregivers will appreciate the thoughtfulness and concern for their families.

Educate: 

• Take time to discuss the risks of influenza and the benefits of flu shots at all care opportunities.
• Emphasize the need for immunizations for those at higher risk, including patients with neurologic or neurodevelopmental disabilities.
• Encourage all family members to get immunized. Not only will they protect themselves, but they also will protect their entire family.
• Take time to discuss the COVID-19 pandemic, possible COVID-19 vaccines, and the continuing risk from influenza disease. Actively work to clear up misconceptions in a proactive manner.

Offer: 

• Provide immunizations at all visits regardless of the reason for the visit. Flexible office hours with open-door access for flu shots can increase rates of vaccination. Remove barriers to administration through a nurse-driven order set, which may expedite vaccine delivery.
• Organize innovative strategies to increase flu shot compliance. Sponsor drive-thru flu shot clinics. Meet a child with impaired mobility in their car to administer the flu vaccine. Innovative strategies may decrease the fear of contracting COVID-19 through visits in a health care facility and improve compliance for those at high risk for severe flu.

As pediatricians, we must continue to help our most at-risk patients and their families access all the care they need, especially during a pandemic. The stakes are just too high.

And I am hopeful that, one day, I can walk through the halls of our clinic and see the smiles again. Until that day, let’s make sure we maximize our potential to protect the most vulnerable under our care.