Anne Steptoe, a doctor in Charlotte, North Carolina, sat in her cramped office between packages of diaper and onesies as she waited for 5- to 11-year-olds to get a coronaviruses shot last month.
One teenage girl was suicidal and the other was anemic. Several young boys gained weight. A 10-year-old had been having asthma attacks and was using her inhalers wrong. A child of the same age needed a mental health consultation after an angry eruption at school.
Many families were relieved when the shot was made available for young children. Many parents who were eager to get their children vaccine have already done so. The Omicron variant's arrival made the campaign even more urgent, and the next phase is reaching the hesitant and undecided.
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The National Health Service Corps brought Dr. Steptoe to the Charlotte Community Health Clinic.
Many of Dr. Steptoe's patients at Charlotte Community Health Clinic have chronic medical conditions, crowded housing arrangements and vulnerable family members, which make them the most in need of the shot. Most parents who have brought their children to the clinic have declined it. They are wary of the vaccine because they want to get treatment for mental and physical problems that went undetected during the P.H.
Dr. Steptoe said that her patients and their families were taking a cautious approach, seeing how that shot was used among friends and neighbors, and asking for follow-up conversations with the clinic. She said that the vaccine campaign for adolescents had a similar situation in which it led to steadier take up months into the shot's deployment in that age group.
The numbers are small. The event was advertised locally, but only six children showed up. Only 43 of the 900 doses the clinic received have been used as of Tuesday, and only 18 percent of 5- to 11-year-olds have received an initial dose.
The Biden administration has paid special attention to getting the vaccine to pediatricians in private practice, but it has also helped steer hundreds of thousands of doses to community health clinics.
70 percent of children were uninsured in the year 2020. It is one of the few local access points for health care in the city.
Dr. Steptoe has seen the effects of the Pandemic on children and their mental health.
Dr. Steptoe decided after examining him that the 15-year-old from Honduras probably had undiagnosed cystic fibrosis.
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Dr. Steptoe was talking to his brother and sister.
She reviewed with his sister and brother-in-law a list of specialists he would need to see. He was uninsured and faced a hospital bill of over $2,500 and prescription drug costs, which Dr. Steptoe said a federal program could help cover.
He was hospitalized before he was eligible for a second dose of the coronaviruses and had delayed his shot. The simple act of sitting in a doctor's office for the first time since the Pandemic began forced a reckoning with vaccine hesitancy for many patients.
Carolyn Allison, the clinic's chief executive, said that it was building a plane in flight. It may not be anti-vaccine, but what is practical in my universe?
Dr. Steptoe acknowledges a family's fears about the Covid-19 vaccine without challenging them.
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The medical assistant prepared the vaccine at the clinic. Attempts to promote the vaccine have often been wedged into anguished discussions about how a child's life had been disrupted by the virus.
She said that she has learned to keep having conversations and listen to people. She said that counseling families on the vaccine would be a long-term game.
Five million of the 28 million children in the 5-to-11 age group have received at least one dose of the Pfizer-BioNTech vaccine since it became available to them more than a month ago, a figure that suggests the campaign will require gradual progress.
The families of the few young patients who did receive the Covid-19 vaccine at the first week of eligibility made significant sacrifice to get them there. A 9-year old with attention deficit disorder who came for a physical lashed out at school. A social worker talked to a patient. His father and mother took a day off to get him there.
His mother had shown him videos of other children getting the vaccine to encourage him to get it.
A patient's view of the vaccine at any given appointment is a snapshot.
Getting to a second conversation increased her chances of a parent and child choosing the vaccine.
She said that she had no chance of getting a shot that day. It is another voice, hopefully that they trust, or are building trust with, that says that in a calm and confident way.
She said that she and her family had to travel across state lines for routine checkups because she grew up in rural West Virginia without adequate primary care. She was inspired to become a doctor after the tonsillectomy experience in elementary school, in which the surgeon did not properly close a wound.
She said that she knew from an early age that bad things happened to people in health care. The resources in our community were linked to that.
She said that many young patients had mental health problems because of conflicts within their families. She asks patients if they can count on the adults in their lives.
The practice has sought out foster care children, many of whom have experienced neglect in part because of a spiraling addiction problem in the state.
People with supportive families have gone years without seeing a doctor. A rare "yes" for vaccine was given to Andi, a 10-year-old boy, by his grandmother. An urgent dental referral was needed because Dr. Steptoe noticed a severe tooth decay. A long wait list is causing a lot of patients to visit the dental practice.
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Many of the patients at the clinic are unable to afford even basic cleanings, and Dr.Quiana Robinson has been deluged by them in recent months.
Brandon carefully watched his brother get several vaccines, including the Covid-19 shot. He decided to get the shot as well.
The mother of Eliuth, 10, and Karen, 13, refused the vaccine for their children, saying that family members had died after getting the shot. Bria Clyburn, a medical assistant, gently told them that they had long lives ahead and needed to be protected for the holidays. Their mother promised to allow them to get vaccine at their next appointment.
The vaccine was promoted in a way that made it seem like a child had been shattered by the virus. Dr. Steptoe said that her patients who needed intellectual and social stimulation had suffered from developmental problems. If she finds mental health problems during her appointment, she will call a behavioral health consultant.
The 9-year-old patient who had recently erupted at students and teachers in school was grounded after disrupting class. Ms. Pennell told his parents to let him play soccer.
She said that children had been deprived of two years of key relationships.
Dr. Steptoe said that the father of a young child she saw recently was afraid of letting his son go outside during the Pandemic because he would bring the virus home to vulnerable family members. The child gained 40 pounds.
Dylan, an 8-year-old patient, gained weight during the Pandemic but was starting to get more exercise. Dr. Steptoe suggested ways to keep junk food out of the house. Dylan's mother said she would need to talk to her husband when the discussion turned to the Covid vaccine.
Tiffany had gone months without the medication she needed to treat her mental health disorders after moving to Charlotte. She was not able to sleep. One day after she missed a lot of class, school officials showed up at her home. She was worried that she would be judged by her peers if she returned to school.
Dr. Steptoe talked to her about the possibility of taking community college classes online.
Tiffany wanted to be a school guidance counselor to help children with similar troubles.
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Families traveled from wealthier parts of the city and region to get one of the first available doses for their children, a contrast with the persuasion campaign waged by the community clinic staff nearby.
The doctor steered clear of the topic of the vaccine. Her mother said she didn't want to be a guinea pig. Tiffany was allowed to make her own decision.
Tiffany wondered why she would have to wear a mask if she got the shot. She was worried about the risk of heart-related side effects.
Dr. Steptoe wanted to get your questions answered.
She didn't want to push any further.
