Adapting to Change

2020 was a year of change, and the pediatric community responded.

Even after the World Health Organization declared a COVID-19 pandemic on March 11, 2020, the threat did not seem real to many people. Despite the rapid spread of the virus, many thought it could be controlled in a few weeks or months. The notion that a pandemic would last a year or longer — and radically change the way people around the world live, work, play, and even die — was difficult to imagine.

Yet, the pandemic did last all year, and the toll it took — including lives and livelihoods — increased with each passing month.

Nurse practitioner Bryana Hinck checks a patient in Thrive Pediatrics’ sick-child tentBy the end of the year, more than 2 million U.S. children tested positive for COVID-19 — about one out of every eight cases in the United States. Half of those positive cases were reported after Nov. 12, 2020.1 At the same time, primary care physicians across the country reported growing mental health needs, increased insurance fragility among their patients, staffing shortages, exhaustion, and inadequate protection and testing supplies.2

Heroes Emerge

Amid the chaos, though, heroes emerged, from pediatricians working long hours to fight the pandemic to those who fought the virus in their own bodies to those who found innovative ways to adapt to the life-altering changes in their practices and communities.

Like many pediatricians, Dr. Steve Smith of Meridian, ID, began offering telemedicine appointmentsBeginning in March 2020 and practically overnight, telemedicine became a common and reimbursed option in many practices. Pediatricians designated separate entrances, waiting rooms, and treatment rooms for sick and well children, and they also met patients in office parking lots. Some set up tents outside their clinics, while others began making house calls. Some wrote books about the virus for children. And when fall came, many set up drive-through flu vaccination clinics.

Recognizing how much pediatricians were learning about the coronavirus and adapting their practices to accommodate the “new normal,” the ABP automatically awarded continuing certification credit.

In addition, the ABP added flexibility to MOCA-Peds, the online, non-proctored assessment platform, by allowing participating pediatricians to drop two calendar quarters in 2020 if they needed more time to focus on their patients, their own families, or their health.

Training Programs Adapt

Training programs struggled during the pandemic, too, because clinic appointments for healthy children were postponed, fewer physicians were allowed in examination rooms, and some trainees or their families contracted COVID-19. Program directors were challenged to find ways to ensure high standards for quality medical education.

Many residents and fellows at the end of their training had to postpone taking their initial certifying exams, due to test centers closing or the desire to avoid indoor spaces. In support, the ABP added flexibility with expanded registration periods and testing dates, refunds, and eligibility extensions.

Existing Challenges Magnified

When many schools and child care centers closed in the spring, children’s access to teachers, coaches, and counselors — who often are the first to notice signs of stress, anxiety, depression, hunger, neglect, abuse, and drug or alcohol use — diminished. Behavioral and mental health challenges in children were often aggravated by the pandemic or began anew.

In addition, COVID-19 disproportionately affected people of color, heightening the public’s awareness of health inequities. In May, when George Floyd died while in police custody, sadness and anger about systemic racism surged across the country, and the connection between racism and health inequities was solidified. These events spurred the ABP Board of Directors to commit to actively fight racism and eliminate health care inequities for all children.

As challenging as 2020 has been, the ABP is proud to report how the pediatric community learned, adapted, and found innovative ways to care for their patients and each other.


1American Academy of Pediatrics. Children and COVID-19: state-level data report. https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report. Accessed Dec. 31, 2020.

2The Larry A. Green Center. Quick COVID-19 primary care survey: series 24 fielded December 11–15, 2020. https://www.green-center.org/covid-survey. Accessed Jan. 31, 2021.


Top photo: Nurse practitioner Bryana Hinck checks a patient in Thrive Pediatrics’ sick-child tent.

Bottom photo: Like many pediatricians, Dr. Steve Smith of Meridian, ID, began offering telemedicine appointments.