The Impact of Covid-19 on Pediatric Patients & Teams: An Interview with Dr. Jessica Peck, DNP
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“Nurses often put the needs of others above our own needs to our own detriments, but I’m certain that the test of this pandemic is going to reinforce the strengths of nursing—and we are going to come through this stronger together.”
Dr. Jessica Peck, DNP APRN CPNP-PC CNE CNL FAANP FAAN
As we begin a slow and steady recovery from the worldwide devastation of Covid-19, parents and caretakers are wondering: “How will our children be affected by this pandemic?”
After more than a year of living, working, and schooling at home in isolation, every aspect of family, personal, and professional life has dramatically shifted in ways that no one could have predicted. Now, as vaccines begin to roll out and children return to in-person school, pediatric patients and their healthcare teams feel some relief but are still searching for answers. Given all that we’ve been through, how can pediatric patients and healthcare teams support children’s health and development needs on physical, social, emotional, and educational levels?
While it’s true that most children ages 5-17 years old were spared from the worst in terms of the number of Covid-19 cases, hospitalizations, and fatalities compared to other age groups (CDC 2021), pediatric health communities remind adults that children can still get sick from or transmit Covid-19 to other household members.
As vaccination rates slowly rise worldwide, UNESCO speaks to the dangers of the “disinfodemic,” known as the process of believing or spreading information about Covid-19 that is not proven by science or recommended by medical professionals.
To provide an informative, compassionate, and comprehensive perspective on the state of pediatric health, NPSchools.com interviewed Dr. Jessica Peck, a pediatric nurse practitioner and president of the National Association of Pediatric Nurse Practitioners (NAPNAP).
Dr. Peck’s professional insights highlight the challenges experienced by the pediatric community in the wake of Covid-19 while offering practical and hopeful advice for parents, caregivers, children, and the pediatric healthcare teams who provide care for all of them.
How Has Covid-19 Impacted the Pediatric Community?
Being a specialized healthcare field, the pediatric community—including children, their immediate and extended families, and healthcare providers—feels the impacts of Covid-19 profoundly. Dr. Peck says, “You can’t open any news media, go into any social media forum, or even any grocery store line without hearing parents or caring adults in children’s lives wondering: ‘What is this pandemic going to do to this generation of children?’”
While most adults acutely understand the impacts of Covid-19, Dr. Peck emphasizes the ripple effects it’s had on children and adults: “To say the pandemic has been cataclysmic would honestly be an understatement.” To illustrate this point, Dr. Peck summarizes how the Covid-19 pandemic has impacted the pediatric community worldwide.
Upending Social Norms
“We have completely changed our social norms, which impacts development and a child’s world view and how they respond to trauma,” says Dr. Peck. “Everyone has to wear a mask for safety, making it difficult for children to interpret adult facial cues. It’s hard for children to know: are they doing the right behavior or not? So much of how children cognitively process information is based on how people’s faces look. They learn a lot by watching us smile, look at them, or even how we say yes or no.”
Rising Health Inequities
“Children of color are disproportionately impacted, and this is laid bare concerning health inequities,” says Dr. Peck. “We’ve known about health inequities for a long time, but the Covid-19 pandemic has really brought them to the surface. The pandemic has removed social safety nets of caring adults from schools, organized sports, after-school curricular activities, church clubs, and camps. Kids just aren’t interacting with as many caring adults and friend groups. This puts children at risk for mental and physical health problems because there are fewer adults around to recognize the warning signs of abuse, anxiety, or depression.”
Lack of School-Based Services
“We have food insecurity—the loss of in-person school means the loss of free or reduced lunch programs,” says Dr. Peck. “Children have lost access to critical services like healthcare, speech, physical therapy, and individualized education plans they’ve had for years to provide academic support. And while some kids can ask their parents for help, most parents are trying to find time to focus on their work and attend meetings on Zoom in the next room.”
As if getting through a work-from-home day wasn’t hard enough, parents need to think about how their children socialize online to avoid predatory people and sites. “Children around the globe are isolated with only technology for companionship. We are really worried about online exploitation because online interaction is often their only connection,” says Dr. Peck. “The National Center for Missing and Exploited Children reported an increase in reports of online exploitation from 300,000 to more than 1.1 million in the first three months of the pandemic, with more than 70 percent of those reports coming from social media messaging.”
“We have families experiencing economic distress and job loss and all the things that come with that, such as moving and changing schools. We see limited access to broadband in more rural areas, which means virtual working, attending online school, and socializing becomes more limited,” says Dr. Peck.
Increased Risk of Abuse and Family Violence
With the pressure of pandemic lockdowns, job losses, school closures, and hospitalized family members, Dr. Peck points out that, “There’s an increased risk of stress and family violence and child abuse.”
Decreased Pediatric Preventative Care
“Parents are not taking their children in for preventative healthcare because they’re trying to take care of things at home,” says Dr. Peck. “Immunization rates are down by as much as 30 percent, and pediatric waiting rooms are closed. If children and their families do come in, they’re met by pediatric healthcare teams all garbed up in scary-looking personal protective clothing.”
She continues, “Advanced practice pediatric nurses (APRNs) share a love for preventive care. We don’t want any kids to get sick. We don’t want any kids to get hurt. We work really hard to provide preventive care to children, and because of the pandemic, our ability to do our jobs has almost disappeared.”
“These are all things that are just extremely concerning to pediatrics and pediatric care providers and children,” says Dr. Peck.
How Has Covid-19 Affected Young Children?
Children under two years old have been exempt from public health requirements to wear masks and stay socially distant. These social expectations and lower infection rates in young children have led some people to believe that children can’t get Covid-19, which Dr. Peck says is not true.
“Even though their symptoms are usually mild, some kids have gotten really sick with Covid-19. We see kids with chronic diseases and risk factors like asthma, being overweight, and type 2 diabetes, which are endemic in the United States, at increased risk for Covid-19 complications,” Dr. Peck says.
It can’t be stated strongly enough: adults and children who are asymptomatic (i.e., not showing symptoms of Covid-19) can still spread the virus to others, which is why wearing masks over your mouth and nose, physical distancing, and frequent handwashing are necessary to prevent the spread of Covid-19.
Health inequities in children and people of color were brought to the surface by Covid-19, and data shows that communities of color have been disproportionately affected. In December 2020, the CDC reported that more people of color died from Covid-19 in higher percentages over all age groups than non-Hispanic white Americans.
Dr. Peck confirms this: “The first report that came out last year talked about more than 75 percent of the child deaths reported from Covid-19 are Hispanic, Black, and American Indian children, even though they only represent 41 percent of the population.”
Numbers like these are unjustly heart-breaking and powerful tools of persuasion for politicians. “These kinds of disparities have always been unacceptable to all pediatric providers, and they will continue to be so,” says Dr. Peck. “These numbers highlight economic disparities and help advocates push to prioritize health equity issues.”
How Has Covid-19 Impacted Pediatric Healthcare Providers?
Photos of healthcare providers wearing layers of personal protective equipment (PPE) and donning photos of their unmasked and smiling faces to comfort patients were part of the new normal in 2020. But despite their superhuman presence, beneath their extra layers of scrubs, gowns, and plastic face shields, pediatric nurses have experienced their share of pandemic-related stress.
Dr. Peck is president of the National Association of Pediatric Nurse Practitioners (NAPNAP). A survey of NAPNAP members, known in the nursing world as advanced practice registered nurses or APRNs, reveals preliminary unpublished raw data still being analyzed that show the impacts of Covid-19 on pediatric-focused advanced practice registered nurses:
- 19 percent of APRNs lost a friend or family members to Covid-19
- 25 percent of APRNs experienced financial insecurity or job loss
- 55 percent of APRNs reported concern over patient misinformation
- 70 percent of APRNs saw mental and behavioral health concerns in children
- 24 percent of APRNs felt they were not prepared for Covid-19 in terms of supplies and knowledge
- 60 percent of APRNs said there’s a significant drop in vaccination rates
- 80 percent of APRNs voiced concern for their mental health
The bright spot in the NAPNAP survey is the rate of Covid-19 vaccination amongst APRNs surveyed. “Of the APRNs we surveyed, 73 percent reported that they had received two doses of a vaccine, and only 4 percent plan not to vaccinate,” says Dr. Peck. “This is higher compared to reports of other populations of nurses. So I think there’s a real opportunity for pediatric nurses, in particular, to lead efforts and help to encourage adoption of the Covid-19 vaccine.”
Are Covid-19 Vaccines Safe for Children?
As of June 2021, the CDC reports everyone 12 years of age and older is eligible for a Covid-19 vaccine in the United States. Some parents and caregivers want to know: are Covid-19 vaccines safe for children?
“Studies are currently ongoing to ensure the safety and effectiveness of COVID vaccines in children,” says Dr. Peck. “Right now, the Pfizer vaccine is approved for ages 16 and up, and Pfizer has asked the Food and Drug Administration for emergency use authorization to immunize children ages 12 to 15 years, which they have been doing in clinical trials for several months now in the United States. The Moderna and Pfizer vaccines are 93 and 94 percent effective respectively, which is phenomenal—these rates are higher than annual flu vaccines.” (In the time since the interview with Dr. Peck, the vaccine has been approved for children 12 and up.)
“Generally vaccine side effects are mild, especially for younger people,” says Dr. Peck. “We’re seeing younger people report fewer and milder side effects with the vaccine compared to older adults. They might have a sore arm; they might be tired or have a fever, but it’s essential for children to be vaccinated. If they have mild symptoms or no symptoms of Covid-19, they can transmit it to older members of their household without knowing, and household exposure carries the highest risk of infection.”
“On a personal note, my two oldest children, 18 and 16 years old, have both gotten the Covid-19 vaccine,” shares Dr. Peck. “They are both girls, and I would love it if they choose to have children someday. I did not have any hesitation about taking them to get their vaccines. Both of them had a little fever and felt achy and tired, but it only lasted about 24 hours, and they were fine. One of the exciting things we’re seeing is that we may have the Pfizer and Moderna vaccine available for children by the end of summer 2021,” says Dr. Peck.
“The bottom line is that Covid-19 has caused the deaths of nearly 595,000 Americans. It’s incredibly serious and incredibly contagious. Vaccination is the safest and fastest way back to our pre-pandemic norms,” says Dr. Peck.
What recommendations do you have for families of young children to cope with challenges brought on by Covid-19?
Parenting doesn’t come with a how-to manual, and parents and caregivers worldwide were indeed not prepared for how to guide themselves and their children through a global pandemic.
How to Help Children Cope with the Pandemic
Dr. Peck recommends five ways for families of young children to cope with Covid-19 challenges.
Give Yourself Grace and Space
“The first thing I would say, and I think it’s the most important thing of all, is to say to parents is give yourself some grace,” says Dr. Peck. “Realize that we’re in a pandemic, and we’re all doing the best we can. In this age, we so want to plan every moment of our kids’ lives and make everything perfect and have them not experience any hardship. We beat ourselves up for so many things, so it’s important to give yourself some grace and space to be okay.”
Realize What Kids Want Most: Our Time
“I think it’s really important to remember that kids want our time more than anything,” says Dr. Peck. “This pandemic has brought a really rare luxury of giving more time to our children.”
Develop Stress Resilience
“Parents are fretting about their children not playing sports if they are on a trajectory to get a scholarship,” says Dr. Peck. “They worry that if kids are not in school, they are missing out on academic and extracurricular activities. Those things are not on the front burner right now.”
“The most important thing that we need to teach them right now is how to respond to stress, how to respond to adversity, and show them how to manage our emotions,” says Dr. Peck. “Stress resilience is one of the important things we can teach right now. What they learn as children starts to hard-wire in their brains to respond in that way. So if children learn stress resilience now, they’ll respond better to stress in their adult lives.”
Talk It Out
“If children don’t learn stress resilience, stress builds up, and it becomes what we call ‘toxic stress.’ That can impact kids for the rest of their lives. Toxic stress can cause things like high blood pressure, heart disease, and even increased risk for cancer,” says Dr. Peck.
“So when you’re thinking, ‘Oh my gosh, I don’t know how to do this new common core math,’ just recognizing and speaking out your stress around it creates an opportunity to talk it out and demonstrate how to avoid toxic stress,” says Dr. Peck.
“You have the opportunity to share your struggles and give children the opportunity to ask questions, make decisions, and act as a family to create a sense of camaraderie and community. If your child hates wearing a mask, let them say, ‘I hate wearing a mask’ and say, ‘I understand. I hate it too. What do you hate about wearing a mask?’”
Harness the Simple Power of Routines
“One of my favorite quotes that I’ve heard in all of the interviews that I’ve done is from my colleague, Dr. Bernadette Melnyk, a pediatric nurse practitioner, and University Chief Wellness Officer & Dean at the College of Nursing at The Ohio State University. She said, ‘These things are very simple, but they are not easy.’” says Dr. Peck.
“And I thought, that’s it, these are simple, but they’re not easy things,” says Dr. Peck. “We need routines such as going to bed at around the same time each night, having the same tuck-in routine, and that kind of thing. Eating well, having family dinners together, and trying to engage in physical activity, all of these healthy routine behaviors are things that are very simple, but not easy.”
What Resources Are Available to Help Parents and Pediatric Professionals With Covid-19 Challenges?
“I invite everyone to listen to NAPNAP’s podcast, TeamPeds Talks. This podcast is for parents and pediatric care providers. Our first series focuses on child health equity. Our second series explores mental health impacts on children, adolescents, and pediatric caregivers,” says Dr. Peck. “There’s a lot of encouragement from helpful experts. Currently, we have more than 8,000 listeners in 24 countries listening, which is exciting.”
TeamPeds Talks covers topics such as:
- Attention deficit disorder (ADD)
- Electronic aggression
- Eating disorders
- Child trafficking
- Sleep Hygiene
“The TeamPeds Talks podcast provides parents with empowering knowledge and pediatric professionals with continuing education contact hours. The episodes are full of practical advice to help us raise perhaps the most resilient generation the world has ever seen,” says Dr. Peck.
How Can Pediatric Professionals Support Themselves and Their Teams With Covid-19 Challenges?
“I think the important thing to remember is that nurses are ranked annually as the most trusted profession by the American public,” says Dr. Peck.
“The reality is that the nursing profession requires grueling work. It’s very costly, physically, mentally, and emotionally. Sometimes our families struggle to understand the burdens that we bear. And we don’t want to put those burdens on them either. We make morally distressing decisions nobody would ever want to have to make. Our bodies and minds are tired. Nurses often put the needs of others above our own needs to our own detriments, but I’m certain that the test of this pandemic is going to reinforce the strengths of nursing—and we are going to come through this stronger together.”
A Challenge for Nurses: Say Yes to Self-Care
“And so I challenge each and every nurse that’s out there reading this to practice self-care. Take your vacation days. Say yes to offers of help. Eat well, sleep well, and seek mental health when you’re overwhelmed. Do all those things that are simple but not easy because it’s going to take extraordinary courage to impact the issues that are facing, especially pediatric healthcare,” advises Dr. Peck.
In closing, Dr. Peck leaves pediatric nursing teams with the reminder that, “We are the literal caretakers of the future. One of the things I’ve learned in this is that we can do more than we think we can with less than we think we need. And I’m confident that nursing will rise to meet this challenge with dignity, strength, resolve truth, and courage. And I hope that future generations will say of us that we were wise and diligent and trustworthy stewards of their future.”
To stay focused, motivated, and learn about the latest pediatric health resources for practitioners and parents, follow Dr. Jessica Peck DNP on Twitter, Facebook, and Instagram.
To learn more about the future of nurse practitioner careers, please read our 2020 interview with Dr. Peck: NAPNAP President Dr. Jessica Peck on the Year of the Nurse and the Future of NP Careers.
Rachel Drummond is a freelance writer, educator, and yogini from Oregon. She’s taught English to international university students in the United States and Japan for more than a decade and has a master’s degree in education from the University of Oregon. A dedicated Ashtanga yoga practitioner, Rachel is interested in exploring the nuanced philosophical aspects of contemplative physical practices and how they apply in daily life. She writes about this topic among others on her blog (Instagram: @racheldrummondyoga).