With the advent of the COVID-19 pandemic, healthcare providers everywhere are changing how they care for their patients. I asked a few members of the ACEs in Pediatrics community what they’re doing differently. 

Dr. R.J Gillespie, pediatrician at The Children’s Clinic in Portland, OR.

Gillespie says that, as much as possible, they’re switching to virtual visits, which allows them “to comfort and reassure our patients face-to-face as much as possible without risking their exposure by being in the clinic.”

Maintaining the wellbeing of the clinic staff is also a great concern. “Not only are they dealing with their own stresses and concerns about the pandemic,” he says, “— how to keep their family safe, having to take on homeschooling as our schools shut down, worries about finances, hoarding toilet paper (who knew that would be a thing!) — but they’re also having to cope with the anxiety of our patients and families,” which, he says, sometimes comes out “as anger, impatience and frustration.”

To weather the particular problems that come from restrictions to stay home, Gillespie says that we all should be thinking about connection. “A lot of the behaviors that we’re seeing (including toilet paper hoarding) has to do with a sense of individualism, when what we need is a better sense of social cohesion,” he says. “Connection is the strongest factor in resilience. Are we checking in with family members, neighbors, friends to be sure that they are safe, cared for, and provided for? I’ve loved the stories of quarantined people singing to each other between buildings in China and in Italy, reminding each other that we’re really not in this alone, that this is a shared experience that affects us all.”

Dr. Andria Ruth, pediatrician at Santa Barbara Neighborhood Clinics, Santa Barbara, CA.

Ruth has seen a lot of anxiety in her young patients. “It’s a novel experience to have numerous school-age children say, ‘I am afraid,’” she says. She’s found that her ACEs-informed approach is particularly helpful in dealing with them and their parents. “[It’s important to] understand that this current pandemic and its effects on the structure of life for children are essentially an additional potential adverse childhood experience (ACE). As pediatric providers, we have an important role to play in educating and reassuring parents and children. We spend time asking families how they are doing, eliciting children’s concerns and finding out how they are managing being at home.” To help their patients manage stress, Ruth and her colleagues talk with them about the importance of good nutrition, sleep, exercise and play, and they encourage them to meet with friends online to nurture supportive relationships. They also suggest that people spend time in nature and learn to practice mindfulness whatever they’re doing.

And while children might have a hard time getting on board with staying at home for so long, Ruth says she’s been appealing to their sense of responsibility. “It’s important to communicate to a child that their task is to stay healthy by avoiding exposures, and that by staying away from others, they can help protect those who are vulnerable. This makes the difficulty of staying at home more acceptable,” she says.

One abiding thought through all of this for Ruth is to express gratitude for all of those who are making sacrifices to care for the health of their communities. “I am comforted by the oft-remembered words of Fred Rogers,” she says: ‘When I was a boy and I would see scary things in the news, my mother would say to me, ‘Look for the helpers. You will always find people who are helping.’”

 Dr. Suzanne Frank, supervising pediatrician at School Health Clinics of Santa Clara County, San Jose, CA.

Frank is taking a more targeted approach to her patients’ anxiety. She says the staff are focused on managing whatever chronic conditions their patients have. The idea is that if a person does get COVID-19, being in better shape to begin with might decrease the severity of the illness. (Those at higher risk for severe infection include people 65 or older, especially those with underlying conditions, and younger people with chronic lung diseases, moderate to severe asthma, uncontrolled diabetes and obesity, according to the Centers for Disease Control and Prevention.)

Frank also points out that many of the clinics’ patients are dealing with more than just physical and emotional issues. “Our families are losing work and health insurance,” she says, and in some cases, they’re actually running low on food. As a result, staff are helping patients apply for Medicaid, food assistance and other support in the community. 

Dr. Amy Shriver, a pediatrician with Blank Children’s Pediatric Clinic in Des Moines, IA

Shriver is mobilizing a messaging campaign for providers and patients. “As an ACEs expert, I'm working with our state's mental health experts and organizations like Reach Out and Read and the AAP [American Academy of Pediatrics] to disseminate information on how to talk with children about COVID-19, and the importance of self-care for children and grown-ups during the pandemic.” (Here is a link, another link, and a third link to handouts Shriver has been giving to parents.)

Shriver says it’s important for everyone to be reflective about the overall effect of the pandemic. “Pay attention to the fact that this isn't business as usual, and there’s an accumulation of stress that affects our abilities to do what we normally do. We need to give ourselves, and others, grace during this challenging time,” she says..

Dr. Ariane Marie-Mitchell, a pediatrician with Loma Linda University, Loma Linda, CA

Marie-Mitchell has noticed that, in her own family, the most restrictive aspects of the pandemic are actually helping to provide some of this much-needed “grace.” She feels badly for “the young students, artists and athletes who have had their special moments taken away,” with all the cancellations of events and performances. Yet, she says, her family is getting more sleep since they don’t have to rush to get the kids off to school, and they’re doing all sorts of activities together, like gardening, going for walks, and playing games. “These are all good things which don’t negate the losses,” she notes, “but do help us live through the sorrow and uncertainty.”

She also sees a potential silver lining in the switch from in-office to virtual doctor visits. “Could we learn to be more environmentally friendly and patient-centered by conducting more patient encounters by phone or video conference? Could we reduce stress on our staff by reducing their commute times and allowing more remote work? Perhaps this crisis will help propel our healthcare system toward people-friendly innovation,” she muses.