AAP issues guidance to ensure continued care for children during pandemic

Editor's note: These guidance documents have been updated. For guidance on well-child care visit https://bit.ly/3eetRim. For guidance on telehealth visit https://bit.ly/3rTGck1. For guidance on newborn screening visit https://bit.ly/3nhjZJc. For guidance on childcare visit https://bit.ly/38gw4u0. For the latest news on coronavirus disease 2019, visit https://www.aappublications.org/news/2020/01/28/coronavirus.

The AAP has issued new guidance to ensure children continue to receive ambulatory services during the coronavirus disease 2019 (COVID-19) pandemic.

To underscore the importance of access to pediatric care, Guidance on Providing Pediatric Ambulatory Services via Telehealth During COVID-19 emphasizes the need for pediatric ambulatory services to continue. These include in-person visits where community circumstances allow. New guidance addresses the provision of telehealth for health supervision visits and acute and chronic care visits through telehealth, delivered by general pediatricians, pediatric subspecialists and pediatric surgeons. It stresses that care should not be delayed during the pandemic, without delay inclusive of and with appropriate referrals. The guidance also urges full payment for telehealth visits at parity with in-person visits.

Other guidance released provides guidance to support the continued provision and follow up of essential newborn screenings and safety, infection control, and wellness in guidance related to child care settings that remain open, mainly aimed at helping those serving essential workers and their children during the COVID-19 pandemic.

Pediatricians have observed a significant decrease in in-person child health visits during the COVID-19 pandemic, which not only puts children’s health at risk but also places practices in jeopardy as they balance business financing and care delivery.

“It is imperative that we preserve the medical home and pediatric workforce during this crisis, and to do so, there must be payment at parity with in-person visits for other forms of care like telehealth,” said AAP President Sara “Sally” H. Goza, M.D., FAAP. “As the U.S continues to follow guidelines from our nation's infectious disease experts during this pandemic, pediatricians are here to take care of our children and adolescents in multiple ways — in person, via telemedicine or by phone consultation.”

Well-child care should be consistent with Bright Futures Guidelines for Health Supervision of Infants, Children and Adolescents(4th Edition) and the corresponding Bright Futures/AAP Recommendations for Preventive Pediatric Health Care (Periodicity Schedule).

If community circumstances require limiting in-person visits, the guidance urges pediatricians to:

• Prioritize in-person newborn care, newborn well visits and immunization of infants and young children through 24 months of age whenever possible.
• Continue well visits for children through telehealth, with the acknowledgement that some elements of the well exam will need to be completed in clinic once community circumstances allow.
• Complete in-person elements when circumstances permit. These elements include, at a minimum, the comprehensive physical exam; office testing, including laboratory testing; hearing, vision and oral health screening; fluoride varnish; and immunizations.
• Conduct acute or chronic care via telehealth and complete some elements of the acute or chronic care visit in clinic as indicated and when circumstances permit.

Full payment for recommended codes should occur at the time of the initial visit with the appropriate modifier and should be eligible for full payment if billed by the pediatrician no matter the child’s age.

Guidance on Newborn Screening During COVID-19 calls for continued bloodspot screening, early hearing detection and intervention, and critical congenital heart disease screening. The guidance recommends that pediatricians continue to follow federal and state guidelines on newborn screening and the uniform screening panel, and specific state guidance to procure results.

Follow-up on abnormal results often requires rapid intervention, making it especially important for parents to continue with newborn visits, Dr. Goza said. “As you all know, newborn screening saves lives, and we must be diligent in making sure all children are screened according to the guidelines from the state they live in.”

Guidance Related to Childcare During COVID-19 is consistent with Centers for Disease Control and Prevention guidance. Although much of the document is intended for those serving essential workers, pediatricians who work as child health safety consultants in their communities and those who might anticipate phone calls from families can consult the guidance for information specific to fever, personal protective equipment and other safety recommendations specific to COVID-19.

Pediatricians who have questions or concerns can email COVID-19@aap.org.