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Well child visits may be associated with higher risk for influenza-like illness

Harold Mandel's picture
A sick child

Well child visits may sometimes put a child's health at risk. It is a paradox to think that taking your child to be checked up at a clinic could actually undermine your child's well being, but according to new research this may be the case. In consideration of the fact that waiting areas in clinics are often overcrowded and sometimes filled up with sneezing and coughing kids, this does however become understandable.

Questions have arisen as to whether or not well child visits are a risk factor for subsequent influenza-like illness visits, reported thre journal Infection Control and Hospital Epidemiology. Researchers set out to determine whether well-child visits are a risk factor for subsequent influenza-like illness visits within the child’s family.

The researchers used data from the Medical Expenditure Panel Survey from the years 1996–2008, and they identified 84,595 families. For each family the researchers determined those weeks in which a well-child visit or an influenza-like illness visit occurred. They identified 23,776 well-child-visit weeks and 97,250 influenza-like illness visit weeks. They observed that an influenza-like illness visit by a family member was positively associated with a well-child visit in the same or one of the past 2 weeks.

This increased risk translates into potentially 778,974 excess cases of influenza-like illness a year in the United States, with a cost of $500 million per year. These results should encourage ambulatory clinics to enforce infection control recommendations more aggressively. Furthermore, it has been suggested clinics could consider time-shifting of well-child visits so they will not coincide with the peak of the influenza season.

Well child visits have been found to be associated with greater than 700,000 subsequent flu-like illnesses a year, reports the Society for Healthcare Epidemiology of America on Feb. 12, 2014. It has been shown in new research that well-child doctor appointments for annual exams and vaccinations are associated with an increased risk of flu-like illnesses in children and family members within two weeks of the visit.

It has been estimated that this risk translates into greater than 700,000 potentially avoidable illnesses each year, with a cost of more than $490 million annually. Phil Polgreen, MD, MPH, lead author of the study, has said, "Well child visits are critically important. However, our results demonstrate that healthcare professionals should devote more attention to reducing the risk of spreading infections in waiting rooms and clinics." There are presently infection control guidelines which exist. In order to increase patient safety in outpatient settings, more attention must be paid to these guidelines by healthcare professionals, patients, and their families.

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Researchers from the University of Iowa did this study. They found that well-child visits for kids younger than six years old increased the chances of a flu-like illness in these kids or their families during the subsequent two weeks by 3.2 percentage points. Lisa Saiman, MD, has noted, "The true cost of flu-like illnesses are much higher since only a fraction result in ambulatory visits and many more cases are likely to result in missed work or school days." It has also been noted that these flu-like illness visits are associated with inappropriate antimicrobial use.

The research authors have stressed the importance of infection prevention and control in ambulatory settings. They have suggested that pediatric clinics follow recommended guidelines which include:

1: Improving environmental cleaning

2: Cough etiquette

3: Hand hygiene compliance

However, Dr. Polgreen says that even with interventions that include restricted use of communal toys or separate sick and well-child waiting areas, if hand-hygiene compliance is not good, and potentially infectious patients are not wearing masks, many preventable infections will continue to occur.

It appears in the haste to adhere to well child visits parents often do not give careful consideration to the risks which may be associated with taking their children to crowded clinics. Interestingly, I have often noticed it is the kids themselves who complain about having to wait for long periods of time in overcrowded clinic waiting rooms with other kids often sneezing and coughing.

Although more and more clinics are making it mandatory for anyone waiting who is sneezing or coughing to wear face masks, it appears measures aimed at preventing the spread of infectious illnesses are not aggressive enough. More aggressive hygiene of toys in the waiting area and more
aggressive suggestions for hand hygiene are needed. The suggestion to schedule well child visits to times outside of the flu season is also worth noting.



Not just kids. Anyone can get sick just sitting in the waiting areas !