Getting Back to School With the Help of Pediatric Nurse Practitioner Care
Prepare your younger patients for the school year and beyond with these insights from a pediatric nurse practitioner and Co-Chair of the AANP Pediatrics Community.
The onset of a new school year is always rife with activity — as parents work overtime to ensure their children have everything they need to learn and succeed, and children desperately soak up the last days of summer fun before returning to class. For nurse practitioners (NPs) seeing children and teens for their annual well-child visits, not only is this time of year busy, it's vitally important.
“These visits are an important touchpoint at critical times of child and adolescent development,” states Laura Searcy, MN, RN, APRN, PPCNP-BC, FAANP, co-chair of the American Association of Nurse Practitioners® (AANP) Pediatrics Community. Speaking to AANP about back-to-school visits, Searcy continued, “We need to check in with the child and the family about how things are going at school and home; perform recommended screenings; provide injury prevention and anticipatory guidance; administer recommended immunizations, as well as perform a thorough head-to-toe physical examination. It’s a tall order for a visit.” Read on to learn how NPs can tackle this tall order to make the most of well-child visits — and advocate for their younger patients all year round.
Comprehensive Care for a Bright Future
Although parents and patients may come in expecting a quick visit, well-child exams offer a crucial opportunity to take a closer look at a child’s health. “This is an opportunity to really take a comprehensive look at the whole child,” states Searcy. “What's happening at home and in school? What kind of challenges are they facing? What are the things that parents need to be talking to their kids about, and what do they need to be looking out for as far as risk factors? How can they help encourage the best physical, social, emotional and mental wellness in kids?”
However intimidating this all might seem, Searcy reassures NPs that, “Luckily, there are tools to assist busy providers. I recommend that all providers who see children utilize the American Academy of Pediatrics’ “Bright Futures” guidelines. The Bright Futures/AAP Periodicity Schedule is a one-page graphic summary of guidance from the prenatal period through age 21 and includes recommendations for developmental, social, behavioral and mental health milestones, as well as for screenings and immunizations. Other Bright Futures resources include the expanded Bright Futures Guidelines, 4th edition, and the Bright Futures and Preventive Medicine Coding Fact Sheet to assist in reimbursement for these important preventive services.
Conversations on Vaccinations
Vaccinations are a routine part of a well-child visit, yet they’ve become a controversial health issue in recent years. “Routine vaccination rates for kindergartners declined during the pandemic nationwide,” states the National Conference of State Legislatures. “Kindergarten vaccine coverage decreased during both the 2020-21 and 2021-22 school years after holding steady for a decade. The vaccination rate did not return to pre-pandemic levels during the 2022-23 school year.”
For Searcy and many NPs, the conversation around vaccine hesitancy is unavoidable. “Vaccine hesitancy is real, and it's been fueled by a lot of factors, including the very public controversies about COVID-19 vaccines and the tremendous amount of medical misinformation that’s circulating on social media,” Searcy explains. “Once something gets 500,000 likes, it stays there forever, and parents don't know what to believe. So, they often have questions and concerns about what they’re seeing and hearing from others.”
How can NPs broach the subject of vaccinations and encourage vaccine uptake among their patients? “It is vitally important to listen to patients’ and caregivers’ very real concerns, provide accurate information and confident provider recommendations for age-appropriate vaccines — always leaving the decision to the parents and leaving the door open for future conversations,” states Searcy. “Research shows that health care professionals play the most important role in addressing parents’ questions and concerns, and a strong recommendation from a provider is the main reason patients and parents decide to vaccinate.”
As an example, Searcy demonstrates, “’Okay, your child is 11 years old coming in for their checkup. Here's what we're going to be doing today,’ and include the vaccines recommended for that age group and any catch-up vaccines needed in that list. Discuss the risks and benefits of both vaccinating and not vaccinating and utilize motivational interviewing techniques to address any vaccine hesitancy.” The key, she suggests, is confidence. “Leading off with that very confident positive recommendation from a trusted provider is a very powerful strategy in overcoming vaccine hesitancy.”
Advocating for Younger Patients
But how can one make an impact on these young lives once their annual visits are complete? To this end, Searcy encourages providers to become advocates for improving child health policy and wellbeing. “To be an advocate for children in health care means you provide evidence-based recommendations on children’s health and wellness issues to policymakers at the local, state and federal levels — and the documentation to back them up. This can help to diffuse some of the partisan political discussions and give policymakers perspectives they may not have been aware of,” she explains. “Child health issues aren't Democratic issues or Republican issues. When you're an advocate, you have to be able to say, ‘This is what the evidence says helps kids be healthier. This is what's happening in our society now that's harming kids. These are important issues we must address.’”
One area where Searcy is fiercely passionate in her advocacy is substance use. “Addiction and substance use disorder (SUD) is the most prevalent chronic illness in America. It outpaces heart disease, cancer, diabetes and all the other chronic illnesses. While it’s important to address this epidemic from treatment, recovery support and harm reduction perspectives, there needs to be a greater focus on primary prevention. Research shows that earlier use of substances — including alcohol, tobacco/nicotine and cannabis — is strongly associated with the risk of heavy substance use and the development of SUD because of the extreme vulnerability of the developing brain between the age of 10 and the early 20s.
“One of the biggest barriers to addressing this issue are persistent mistaken beliefs and community norms that substance use experimentation is inevitable and harmless as long as it’s just ‘a little vaping, a little weed, a little alcohol’ and they avoid the hard stuff, like opioids and meth and heroin. But that could not be further from the truth.” Studies show that 9 out of 10 people who abuse substances like nicotine, alcohol or other drugs began using them before they were 18, which gives pediatric providers a powerful opportunity to help curb substance use before it takes hold. “Well child checks in the pre-teen and teen years provide powerful opportunities to discuss substance use screening and prevention with both youth and caregiver and empower caregivers to have effective conversations with their children about youth experimentation. Prevention works.”
Getting Involved and Speaking Up
When asked how NPs can improve health outcomes for young patients in their community, Searcy replied, “NPs are uniquely positioned in a variety of practice and community settings to positively impact the health and wellbeing of our nation’s children by being expert voices for our practice settings, families, communities and policymakers.” Additionally, Searcy reassures providers they are not alone, recommending that they “be aware of the community resources out there to help, especially for behavioral and mental health issues. We are embedding more pediatric mental health practitioners in practices, but that's far from universal. So, if you have a young person that has a positive screening for substance use, mental health or a suicide issue, who in the community can you send them to for an immediate evaluation? Find out who you can partner with and put a safety plan in place to manage and monitor that child until they can get an appointment with a mental health provider.”
Whether discussing child and adolescent injury prevention, substance use prevention, tobacco prevention or suicide prevention, Searcy urges that no subject is too sensitive to broach when it comes to the health of a child patient. “All conversations with parents or guardians about their children are delicate. Whether you're talking about an infant that doesn't sleep well, a toddler whose diet is insufficient for their need, the school-age child who may be gaining weight faster than they ought to, vaccinations or firearm safety, we as pediatric health care providers have an obligation to address these issues with families to ensure the safety and well-being of their children.” Most importantly, Searcy urges providers, parents and our communities to speak up and have honest conversations on the issues impacting our nation’s youth. “When we shy away from talking about things that are in the vital interest of children, then I think we do our patients and their families a disservice.”
Continue Your Pediatric Journey With AANP
If you’re interested in children’s physical, mental and social health, the Pediatrics AANP Community offers a unique opportunity to interactively collaborate with colleagues who share interest or clinical expertise in pediatrics. As an AANP Community member, you’ll have access to a cutting-edge, online forum where you can engage in discussions, document sharing and knowledge exchange with your fellow NPs.
If you want to hear Searcy discuss youth mental health, consider registering for the 2024 AANP Fall Conference in Reno, Nevada, Sept. 19-22! Attend this event to see Searcy’s session entitled, “Youth Suicide Prevention and Clinical Management of Suicidal Ideation,” alongside more than 90 sessions in five unique topical areas.