To answer this question, we have used data from our CrescNet database, a representative database of more than 430 pediatric practices in Germany. The CrescNet network was established in Germany in 1998 (4). More than 130 pediatric practices and 21 pediatric endocrinology departments currently actively participate in data collection and networking (5). Pediatricians record heights, weights, and growth velocities of all children in their care systematically and feed the data into the database at our center. Data are then continuously analyzed at the center regarding individual patients' growth (height and weight). Feedback to participating physicians is ensured via phone or E-mail. By October 2020, the data of more than 940 000 children and adolescents have been included, and more than 5 million data sets have been generated. The data source has already been used to answer important public health questions related to child health (5).
Using the data entry of the pediatric practices into the CrescNet system during the year 2020, we have asked whether or not the number of pediatric practice visits would decline or alternatively increase during the COVID-19 pandemic. Therefore, we compared the number of visits in March and April in 2020 to the number of visits in 2019, reflecting the changing patients´/families´ attitudes regarding pediatric healthcare utilization in Germany.
Comparing the visit numbers in 2019 and 2020, a paired t-test revealed no significant change during the first ten weeks of 2020 (diff=35, p=0.7). But afterward, starting in mid-March 2020 (week 10), two weeks before the lockdown was announced in Germany, documented visits to pediatric practices participating in the CrescNet system have been steadily decreasing with a then striking dip in numbers in April 2020 during the first wave of COVID-19 infections in Germany. The mean number of visits per week was significantly lower than during the same period the year before (diff=-1050, p=0.005, i.e., >35%). Interestingly, there is also a continuously (non-significant) lower data entry during May and the first half of June, after the end of the lockdown, when very active communication and indeed public discussions on the dangers of the pandemic have steadily increased in Germany. With increasing numbers of adults being reported to carry COVID-19 and increasing numbers of COVID-19 patients in hospitals and even intensive care units, the number of visits to pediatric practices remained slightly lower than in 2019 (Figure 1). In contrast to the 2020 numbers, in previous years (5) exemplified for 2019, data entry numbers show only small undulations and fluctuations as are expected in relation to holiday seasons.
In conclusion, the COVID-19 pandemic seems to relate to families´ utilization of well-child clinics and pediatric practice attendance in Germany. Whether or not this is due to families´ fears of their child or themselves becoming infected in medical facilities, or physicians being too busy to report and send in their data from their clinic to our study center remains uncertain. Alternatively, the hypothesis that people being simply overstressed or too busy to use routine services, such as well-child clinics, should be investigated. Of note is that an Austrian study shows that delays in accessing acute pediatric health care may outweigh the risks of COVID-19 because diagnostics and treatments of severe diseases might be delayed during the pandemic (1, 2). Since we have also seen lower utilization of our emergency department of the Hospital for Children and Adolescents during the peak seasons of the COVID-19 pandemic, we hypothesize that people´s utilization of medical services change during a pandemic and this might lead to fundamental changes in health behaviors.
Our data do not contain information about the reasons for visits to pediatric practices (preventive medical checkup or visits because of acute or chronic diseases). Therefore, we cannot estimate the share in the decline caused by a decrease in infectious diseases also caused by measures against COVID-19. Moreover, whether or not other factors such as general societal factors, the distance between homes and the practices, and health issues might influence the attendance at child clinics cannot be examined.