Advice on playdates, social distancing, and healthy behaviors to help prevent infection
Children's lives have been turned upside down by this pandemic. Between schools being closed and playdates being cancelled, children's routines are anything but routine. Kids also have questions about coronavirus, and benefit from age-appropriate answers that don't fuel the flame of anxiety. It also helps to discuss — and role model — things they can control, like hand washing, social distancing, and other health-promoting behaviors.
How does COVID-19 affect children?
Children, including very young children, can develop COVID-19. Many of them have no symptoms. Those that do get sick tend to experience milder symptoms such as low-grade fever, fatigue, and cough. Some children have had severe complications, but this has been less common. Children with underlying health conditions may be at increased risk for severe illness.
A complication that has more recently been observed in children can be severe and dangerous. Called multisystem inflammatory syndrome in children (MIS-C), it can lead to life-threatening problems with the heart and other organs in the body. Early reports compare it to Kawasaki disease, an inflammatory illness that can lead to heart problems. But while some cases look very much like Kawasaki's, others have been different.
Symptoms of MIS-C can include
- fever lasting more than a couple of days
- conjunctivitis (redness of the white part of the eye)
- vomiting and/or diarrhea
- a large, swollen lymph node in the neck
- red, cracked lips
- a tongue that is redder than usual and looks like a strawberry
- swollen hands and/or feet
- irritability and/or unusual sleepiness or weakness.
Many conditions can cause these symptoms. Doctors make the diagnosis of MIS-C based on these symptoms, along with a physical examination and medical tests that check for inflammation and how organs are functioning. Call the doctor if your child develops symptoms, particularly if their fever lasts for more than a couple of days. If the symptoms get any worse or just don't improve, call again or bring your child to an emergency room.
Doctors have had success using various treatments for inflammation, as well as treatments to support organ systems that are having trouble. While there have been some deaths, most children who have developed MIS-C have recovered.
Should parents take babies for initial vaccines right now? What about toddlers and up who are due for vaccines?
The answer depends on many factors, including what your doctor's office is offering. As with all health care decisions, it comes down to weighing risks and benefits.
Getting early immunizations in for babies and toddlers — especially babies 6 months and younger — has important benefits. It helps to protect them from infections such as pneumococcus and pertussis that can be deadly, at a time when their immune system is vulnerable. At the same time, they could be vulnerable to complications of COVID-19 should their trip to the doctor expose them to the virus.
For children older than 2 years, waiting is probably fine — in most cases. For some children with special conditions, or those who are behind on immunizations, waiting may not be a good idea.
The best thing to do is call your doctor's office. Find out what precautions they are taking to keep children safe, and discuss your particular situation, including not only your child's health situation, but also the prevalence of the virus in your community and whether you have been or might have been exposed. Together, you can make the best decision for your child.
When do you need to bring your child to the doctor during this pandemic?
Anything that isn't urgent should be postponed until a safer time. This would include checkups for healthy children over 2 years (many practices are postponing checkups even for younger children if they are generally healthy). It would also include follow up appointments for anything that can wait, like a follow-up for ADHD in a child that is doing well socially and academically. Your doctor's office can give you guidance about what can wait — and when to reschedule. Many practices are offering phone or telemedicine visits, and it's remarkable how many things can be addressed that way.
Some things, though, do require an in-person appointment, including:
- Illness or injury that could be serious, such as a child with trouble breathing, significant pain, unusual sleepiness, a high fever that won't come down, or a cut that may need stitches or a bone that may be broken. Call your doctor for guidance as to whether you should bring your child to the office or a local emergency room.
- Children who are receiving ongoing treatments for a serious medical condition such as cancer, kidney disease, or a rheumatologic disease. These might include chemotherapy, infusions of other medications, dialysis, or transfusions. Your doctor will advise you about any changes in treatments or how they are to be given during the pandemic. Do not skip any appointments unless your doctor tells you to do so.
- Checkups for very young children who need vaccines and to have their growth checked. Check with your doctor regarding their current policies and practices.
- Checkups and visits for children with certain health conditions. This might include children with breathing problems whose lungs need to be listened to, children who need vaccinations to protect their immune system, children whose blood pressure is too high, children who aren't gaining weight, children who need stitches out or a cast off, or children with abnormal blood tests that need rechecking. If your child is being followed for a medical problem, call your doctor for advice. Together you can figure out when and how your child should be seen.
Bottom line: Talk to your doctor. The decision will depend on a combination of factors including your child's condition, how prevalent the virus is in your community, whether you have had any exposures or possible exposures, what safeguards your doctor has put into place, and how you would get to the doctor.
With schools closing in many parts of the country, is it okay to have babysitters or child care people in the house given no know exposures or illness in their homes?
The truth is that the fewer people you and your children are exposed to, the better. However, the reality is that not every family will be able to have a parent at home at all times.
All people can do is try to minimize the risk by doing things like:
- choosing a babysitter who has minimal exposures to other people besides your family
- limiting the number of babysitters. If you can keep it to one, that's ideal, but if not keep the number as low as possible
- making sure that the babysitter understands that he or she needs to practice social distancing, and needs to let you know (and not come to your house!) if he or she feels at all sick or has a known exposure to COVID-19
- having the babysitter limit physical interactions and closeness with your children, to the extent that this is possible
- making sure that everyone washes their hands frequently throughout the day, especially before eating.
With social distancing rules in place, libraries, recreational sports and bigger sports events, and other venues parents often take kids to are closing down. Are there any rules of thumb regarding play dates? I don't want my kids parked in front of screens all day.
Ideally, to make social distancing truly effective, there shouldn't be play dates. If you can be reasonably sure that the friend is healthy and has had no contact with anyone who might be sick, then playing with a single friend might be okay, but we can't really be sure if anyone has had contact.
Outdoor play dates, where you can create more physical distance, might be a compromise. Something like going for a bike ride, or a hike, allows you to be together while sharing fewer germs (bringing and using hand sanitizer is still a good idea). You need to have ground rules, though, about distance and touching, and if you don't think it's realistic that your children will follow those rules, then don't do the play date even if it is outdoors.
You can still go for family hikes or bike rides where you're around to enforce social distancing rules. Family soccer games, cornhole, or badminton in the backyard are also fun ways to get outside.
You can also do virtual play dates, using a platform like FaceTime or Skype so children can interact and play without being in the same room.
I live with my children and grandchildren. What can I do to reduce the risk of getting sick when caring for my grandchildren?
In a situation where there is no choice — such as if the grandparent lives with the grandchildren — then the family should do everything they can to try to limit the risk of COVID-19. The grandchildren should be isolated as much as possible, as should the parents, so that the overall family risk is as low as possible. Everyone should wash their hands very frequently throughout the day, and surfaces should be wiped clean frequently. Physical contact should be limited to the absolutely necessary; as wonderful as it can be to snuggle with Grandma or Grandpa, now is not the time.
More about kids and coronavirus
- New warning on coronavirus symptoms in children — what parents need to know
- 7 tips for going outside safely with your children during the COVID-19 pandemic
- Strategies to support teens and young adults with autism spectrum disorder during COVID-19
- Keeping teens home and away from friends during COVID-19
- Not a staycation: Isolating at home affects our mental health (and what to do)
- Kids fighting nonstop? How to manage during school closures
- What one study from China tells us about COVID-19 and children
- Grandparenting in the time of COVID-19
- School closed due to the coronavirus? Tips to help parents cope
- Pregnant and worried about the new coronavirus?
- How to talk to teens about the new coronavirus
- How to talk to children about the coronavirus
- Coronavirus: What parents should know and do
For more information on coronavirus and COVID-19, see the Harvard Health Publishing Coronavirus Resource Center.
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