May 13, 2020

Like most ambulatory providers in the state and across the country, I have quickly transitioned many visits over to telemedicine visits, either telephone-only or preferably video visits. As a med/peds physician, I have been doing these telemedicine visits across the age spectrum, including well child checks in kids.

Tracking growth in kids is a critical part of what we do as pediatricians, so not being able to get growth measurements on all of our kids has been less than ideal. But other critical parts of what we do involves talking about healthy lifestyles and reviewing diet and nutrition, encouraging active play and physical activity, discussing how school is going and identifying any behavioral issues. Of course, this also includes performing anticipatory guidance where we can discuss upcoming growth and developmental changes and review age-appropriate safety issues. All of these aspects of pediatric well care are addressed by video nearly as well as in-person, as it is mostly a conversation with a child and his or her caregiver.

I have found these video visits, during this COVID-19 pandemic, to be invaluable in connecting with kids and their families. Nothing is normal these days, and even young kids feel and understand this on some level, and older kids can articulate this. Parents and caregivers are universally stressed about jobs, safety, trying to help facilitate remote learning, and all the aspects of life that have changed since the stay at home order.

Even though less ideal than a full in-person exam, these telemedicine visits give us the opportunity to talk through some of the struggles that kids and their families are going through in this current crisis. At best, there is an intact family where one or both parents are still working either remotely or out of the home for an ‘essential service’ and the while the situation remains difficult, there are no financial concerns, food insecurity, or domestic abuse issues. At worst, single parents who were barely getting by before COVID are now out of work and worried about how they are going to get adequate food for themselves and their children, and in some cases even continue to maintain stable housing, or the stressors of the current situation are overwhelming caregivers and leading to abuse and neglect.

Talking with these children and their caregivers allows us to address their fears and anxiety, and while we don’t always have all the answers for them, it has been clear to me that families appreciate and respond positively to just some reassurance and letting people know that so many others are feeling the way they are feeling, or experiencing the worries and anxieties they are experiencing, and that they are not alone.  In situations where children and families are actually at risk due to food insecurity, housing instability, and other issues, there are resources to which we can facilitate connections, like 211 NH, in order to help make sure our kids are getting what they need. Many of these resources, both public and private, have been bolstered and expanded in this time of crisis. But we won’t know unless we set up those video or telephonic connections, and then ask the questions.

A report came out last week from the Brookings Institute estimating that one in five households in the United States, and two in five households with mothers with children under five, were food insecure, as of the end of April. This is a staggering number and up significantly from historical estimates, with sharp increases over the past few months attributable to the COVID pandemic.

The Granite State is not immune and this is not a phenomenon happening ‘somewhere else.’ Like the COVID pandemic itself, food insecurity is present in the Granite State in the best of times, and now will clearly be exacerbated. Let’s keep reaching out to patients via telemedicine, especially our most vulnerable, and make sure they are at least secure in the basic essentials such as food and housing, and if they are not, we can help connect them with community services that can help.

In health,

John Klunk, MD
NHMS President

Please send comments or questions to john.klunk@nhms.org