Amid Push to Vaccinate Children, Other Challenges Deluge Pediatricians

Olivia Pelayes, MD, a medical assistant at Charlotte Community Health Clinic, prepares doses of the pediatric coronavirus vaccine from Pfizer-BioN Tech on November 11, 2021 (Travis Dove/The New York Times)

CHARLOTTE, NC — Towards the end of one of the first days when kids ages 5 to 11 could get an injection of the coronavirus last month, Dr. Ann Steptoe, a pediatrician, sat crouched in her cramped desk between diaper packs and nappies. And children’s books, cataloging patients of the week on her laptop.

One teenage girl was sleepless and suicidal; Another was anemia. Many young boys gained weight during the pandemic. A 10-year-old girl had asthma attacks and was using her inhalers incorrectly. Another child of the same age needed mental health counseling after his tantrums at school.

The release of the syringe for young children has brought relief to many families eager for enhanced protection amid a wave of new cases of the virus. But much of the request made has already been met; Many parents who were eager to vaccinate their children did so. The success of the campaign, made even more compelling with the arrival of the omicron variant, depends on the next stage: reaching the undecided and the undecided, including those who didn’t think or managed to get to the shot.

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Steptoe patients at Charlotte Community Health Clinic, many of whom have chronic medical conditions, crowded housing arrangements and vulnerable family members, are among the children who need the injection most. However, most parents who have brought their children to the clinic within the past month have refused. They are wary of a vaccine, and focused on getting treatment for mental and physical problems that have remained unchecked for most of the pandemic.

More broadly, Steptoe said, her patients and families have been taking a cautious and “gradual” approach, watching how the shot was spread among friends and neighbors, and asking to follow up on conversations with the clinic. This was also the case in the adolescent vaccination campaign, she said, which has led to more stable uptake after the shot was rolled out in that age group.

At the moment, the numbers are scanty. The clinic’s pediatric vaccine launch event attracted only six children despite it being advertised locally. Only 43 of the 900 doses the clinic received as of Tuesday were used, and only 18% of children ages 5 to 11 in Mecklenburg County, including Charlotte, had received an initial dose as of November 29, Dr. Raynard Washington, deputy county public health director.

While the Biden administration has paid particular attention to getting the vaccine to pediatricians in the private clinic, it has also helped direct hundreds of thousands of doses to community health clinics like Steptoe.

In 2020, 80% of Steptoe Clinic’s 5,000 patients were uninsured, including 70% of children. For them, it is one of the few local access points for healthcare in a rapidly growing city.

Steptoe has already seen the pandemic’s extreme effects on children’s well-being, including their mental health – the subject of a report published Tuesday by Dr. Vivek Murthy, US surgeon general.

Stepto determined that Josue, a 15-year-old from Honduras who recently spent about six weeks in a hospital for malnutrition and blood count abnormalities, likely has undiagnosed cystic fibrosis.

Josue and his sister reviewed the list of specialists he would need to see: pulmonologist, geneticist, gastroenterologist, nephrologist, endocrinologist and infectious disease expert. He was not insured and was already facing what his sister said was a $2,800 hospital bill, plus significant prescription drug costs, which Steptoe said the federal program could help cover.

Josue got his first dose of coronavirus in early September, but was hospitalized before he was eligible for a second dose and delayed it. For many of the patients seen in the clinic on the opening days of the children’s vaccine rollout — and their parents — just sitting in the doctor’s office for at least the first time since the pandemic began has forced the reckoning to vaccinate.

“She builds an airplane on the fly,” said Carolyn Allison, the clinic’s executive director, of its efforts to vaccinate children. It might not be anti-vaccine, but ‘what’s practical about being me? “”

Steptoe said she is eager to acknowledge the family’s concerns about the COVID-19 vaccine without challenging them.

“What I’ve learned from the pandemic is just to keep talking and listening to people, because I hear different things over time,” she said. She said advising families about the vaccine would be a “long game”.

Nationwide, 5 million of the 28 million children age 5-11, or roughly 18%, have received at least one dose of the Pfizer vaccine since it became available to them more than a month ago, a number that suggests the campaign will require progress. gradually.

For the few young patients who received the COVID-19 vaccine at the clinic in the first week they were eligible, families often made significant sacrifices to get them there. Emiliano, a 9-year-old with ADHD who came for physical therapy, was criticized recently several times at school. The clinic social worker discussed anger management with him. His father had taken a day off from work, and his mother three hours, to get him there.

But Emiliano eagerly agreed to the vaccine — bringing tears of relief from his mother, who played him videos of other kids getting him to encourage him.

Steptoe said a patient’s view of a vaccine at any given appointment was a “snapshot in time.”

Engaging in a second conversation, or a third conversation, increases the odds that a parent and child will eventually choose the vaccine.

“Even for people I know I don’t have a chance of injuring an arm that day,” she added, “it’s another voice, which I hope they trust, or build trust with, who says it in a calm, confident and without judgment way.”

Steptoe grew up in rural West Virginia without enough primary care, she said, forcing her family to travel across state lines for routine checks. She nearly died after a botched tonsillectomy in elementary school—the surgeon didn’t close the wound properly—an experience that inspired her interest in pediatrics.

“I knew from an early age that bad things happened to people in healthcare,” she said. “It was related to the resources we had in our community.”

For many young patients, she said, the pandemic has exacerbated the conflicts within their families that have burdened them with mental health problems. As a screening question, you often ask patients if they can count on adults in their lives.

The practice has sought to foster foster children, many of whom have experienced neglect in part due to the state’s mounting addiction problem, which has been exacerbated by the pandemic.

Even those with supportive families often went years without seeing a doctor. Andy, the 10-year-old boy seen at the clinic, was a rare “yes” to a vaccination; His grandmother was keen to protect him at school. Separately, though, Steptoe noted a severe tooth-eating cavity, which required an urgent dental referral. The dental clinic of the clinic is facing a flood of patients with a long waiting list.

A few hours later, 10-year-old Brandon carefully watched his older brother, Jonathan, get several vaccinations, including the COVID-19 one. He decided to take the shot as well, to which he was met with applause.

But nearby, the mother of Elliott, 10, and Karen, 13, refused to vaccinate them, saying that family members died after receiving the vaccine. Priya Claiburn, medical assistant, was careful not to look dismissive, and kindly told them they had a long life ahead of them and they needed protection for the holidays. Their mother promised to consider letting them vaccinate at their next appointment, months later.

Vaccine promotion is often linked to painful discussions of how a child’s social life is wrecked by the virus. Away from school, her patients who were in desperate need of intellectual and social stimulation had problems developing, Steptoe said. If she discovers mental health issues during the appointment, she calls Rachel Pinnell, a behavioral health counselor.

Emiliano, the 9-year-old patient who recently broke out on students and teachers at the school, has been isolated after class was disrupted. Pinnell told his parents to allow him to continue playing football.

She said the pandemic has deprived children of “two years of key relationships.”

Steptoe said the father of a young child she saw recently was afraid to let his son go outside even during the pandemic, lest he bring the virus home to vulnerable family members. The baby gained 40 pounds in a year.

Dylan, an 8-year-old patient, gained weight during the pandemic but started taking more exercise. Steptoe suggested strategies for keeping junk food out of the home. But when the discussion turned to the COVID-19 vaccine, Dylan’s mother said she would need to consult her husband.

Late one day, Steptoe greets 16-year-old Tiffany, who, after moving to Charlotte during the pandemic, has gone months without the medication she needs to treat several mental health disorders. She was struggling to sleep. School officials showed up at her home the day after she had missed a significant amount of class. She was afraid that if she went back to school, she would face her problems there and be judged by her peers.

Steptoe spoke with her about the possibility of taking community college classes online or switching to temporary homeschooling.

Tiffany said she dreamed of becoming a school guidance counselor, helping children with similar problems.

Gently, the doctor headed toward the topic of the COVID-19 vaccine. Her mother opposed her, saying she did not want to be a guinea pig for the government. But she let Tiffany make her own decision.

Tiffany wondered why she should get the shot if she still had to wear a mask. She added that she was nervous about the risks of heart-related side effects.

“I just want to answer your questions,” Steptoe said, explaining the benefits of the shot.

I decided not to pay more than that.

© 2021 The New York Times Company

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