While the toll of the COVID-19 pandemic accelerates as the case and death totals continue to climb, children have fortunately been spared from the worst of the direct ravages of this virus.

But as the pandemic continues and the effects on the health and financial well-being of caregivers mount, children are being impacted in a myriad of harmful ways that could have long-lasting consequences if not addressed.

As parents and pediatricians, we recognize profound effects of the virus on children that are not obvious now, but are on the horizon. In a sense one wonders if this is the calm before the storm.

Adverse childhood experiences (ACEs) as a result of toxic stress are known to cause changes in the level of stress hormones in the developing body. Children who experience ACEs like abuse, neglect or household dysfunction are more likely to experience a variety of poor short- and long-term health outcomes, like heart disease, high blood pressure, obesity, drug abuse, depression and suicide.

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Other environmental factors like poverty, community violence and poor housing also play a role in future health and well-being of a child.

Not only is the social isolation required during the pandemic likely to cause stress, but the death of a caregiver, loss of income or a job, or the potential for child abuse may all lead to prolonged, chronic and intense ACEs during the pandemic or in its wake.

The uncertainty and loss of normalcy children are facing is not something previous generations have experienced. Children must process the abrupt termination of the school year, social isolation from friends and extended family, and the onslaught of information received daily. Stress that children are currently facing may ultimately redefine ACEs as we know them and will certainly amplify existing disparities in our society.

Solutions will need to be innovative, adaptive, wide-ranging and long-lasting.

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In an effort to keep kids safe, many pediatric practices have limited the number of in-person visits during this time. While that is prudent given the current circumstances and endorsed by the American Academy of Pediatrics (AAP), practices are still trying to maintain visits for checkups for patients 2 years of age or younger and are advised to use their judgment on well-child visits for patients of other ages.

Regardless, many practices are experiencing a severe decline of well-child visits, which could ultimately lead to delays in vaccinations, putting children at risk for acquiring many serious vaccine-preventable diseases. As evident with measles outbreaks, such diseases are as real a threat to children as COVID-19 and need to be taken equally seriously.

As we focus on the development of a vaccine for COVID-19, we must not forget routine age-appropriate immunization for all children. It will take time and effort from a fragmented health system to provide catch-up immunizations for this now even more vulnerable population.

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As with routine well-child visits, it is important for children to get medical attention for common childhood illness. Children have come to the clinic and emergency department later after the onset of symptoms than they normally would, leading to longer illnesses and often more difficult hospital courses.

While avoiding the novel coronavirus is recommended, it has to be balanced with the damage that can occur with delay in medical care for potentially life-threatening medical illnesses. Those illnesses may not be related to COVID-19 yet need urgent evaluation and treatment to avoid long-lasting and potentially catastrophic consequences which could have otherwise been avoided.

During these unprecedented times we strongly urge policy makers, health systems, communities and families to remember the unique needs of children.

Many systems are already in place and many will continue to be put in place from our combined efforts. An example of this is the telehealth service that many pediatricians have promptly adopted, which may be the first step in determining what level of care is needed for your child.

If your child is due for vaccines, it is of paramount importance to prioritize those visits while also practicing social distancing. Your child’s pediatrician should still be your point of contact. We are here for the children of our region to provide routine care and guidance when your child is ill. It is important to contact your pediatrician in a timely manner or bring your child to the emergency department if necessary.

Even though children have thus far been mostly spared from the physical impacts of COVID-19, the collateral damage that children could face from both immediate and long-term consequences of COVID-19 – from delays in seeking attention for current illnesses or abuse to chronic toxic stress and threat of communicable diseases due to delayed vaccinations – need to be addressed head on.