August 25, 2020
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CHOP doctors advise parents to ask a number of questions as they grapple with whether to send their children back to school during the coronavirus pandemic. Among them: Is the child or someone in the house at high risk of severe illness?
The school year is quickly approaching and many parents still have concerns over the best way to protect their children while ensuring they get the best education possible during the ongoing COVID-19 pandemic.
Parents have an abundance of questions.
Is in-person, hybrid or virtual instruction best for their kids? What's the best way to differentiate COVID-19 symptoms from the common cold? Is it safe to start scheduling well visits to the pediatrician again?
There is no one-size fits all solution for families, but Dr. Susan Coffin, an infectious diseases physician at the Children's Hospital of Philadelphia, and Dr. Katie Lockwood, a CHOP pediatrician, offered some tips to help parents make the best decisions for their particular situations.
How much should parents worry about their child contracting the coronavirus? In the early days of the COVID-19 pandemic, data suggested that children were less likely to contract the SARS-CoV-2 virus. More recent reports are showing an increasing infection rates in children.
There is some good news though, Coffin said.
"We are learning that children have mild disease and less likely to need to visit an outpatient provider or be admitted to the hospital," Coffin said.
Though there have been some reported cases of multi-system inflammation syndrome, or MIS-C, in children with COVID-19, Coffin said it is still very unusual and shouldn't factor into parents' school decisions.
MIS-C causes severe inflammation in multiple organ systems weeks after a coronavirus infection. Common symptoms are gastrointestinal problems, rash, low blood pressure and high fever.
"It is a very rare complication of the coronavirus and we have learned how to quickly solve it with traditional anti-inflammatory medicines," she said.
But it's still not clear how likely kids are to get infected in the first place, Coffin said. There has been an uptick of COVID-19 diagnoses in children and teenagers, but she said that likely can be attributed to greater socialization during the summer months.
As a parent, Lockwood said she understands how personal the back-to-school decision is for each family. She suggested parents ask themselves the followings questions to help guide their decision:
• Does the school safety plan follow all recommended guidelines? Do you trust school officials to reliably implement the plan?
• Is your child or someone in the house at higher risk for severe disease?
• Is virtual learning a realistic option for child and family? Do both parents work outside of the home? If so, is a caretaker available to be at home with your children, especially if they are young and need help with school work?
• Does your child have social or emotional needs that are better met in one setting versus another?
• Does your child need special services at schools?
• Are you and your child willing to follow all safety guidelines the school has implemented?
Lockwood encouraged parents to look for "a flexible attendance policy, focus on sanitation and hygiene, symptoms screening and masking for all staff and students as well as opportunities for outdoor activity."
She advised them to find out whether their child's school is adopting a cohort model that keeps students in smaller learning pods for the whole day. In those cohorts, there isn't as much intermingling between students and staff.
Once parents have made their decisions, they need to prepare their children for the changes they will encounter.
For children who are heading back to school, whether full-time or as part of a hybrid model, parents should reinforce the same strategies that they have been using at home and in the public to keep the family healthy.
Parents should remind children about the importance of wearing a mask, practicing social distance and washing their hands thoroughly on a regular basis, Coffin said. They also should make sure they understand not to run up to a friend or teacher and hug them, no matter how much they may have missed them.
"Let your child choose his or her own mask," Lockwood added. "They will be more likely to wear it if they are excited about it. Have them practice wearing it at home and be a good role model. Try not to complain about wearing one in front of them. Kids are resilient and will quickly adapt."
The type of mask children wear also makes a difference, Coffin said.
She recommended cloth masks with a minimum of 2 layers of cloth to catch respiratory droplets and a reasonable type of weave. It needs to fit securely across the child's face, minimizing gaps around the mouth. She advised parents to avoid masks made up fleece, bandanas and neck gaiters.
The school year often is accompanied by a spike in influenza and the common cold, as respiratory viruses generally begin circulating more widely in the fall. This year, COVID-19 is another worry.
Because there is an intense overlap in symptoms for all three illnesses, it can be difficult to differentiate the differences.
"Context is everything. Has anyone around the child been sick? Has anyone been diagnosed with COVID-19? How about around the community?" Coffin said. "It is a lot of responsibility for the parent."
Coffin encouraged parents to consult with their child's pediatrician when they have questions or concerns.
If the child isn't having any symptoms that need immediate medical attention, reach out by phone instead of going into the office, she said. The pediatrician can talk through symptoms and possible exposure to determine whether an office visit is needed and, if so, how to do it safely.
What if a teacher has a student come in with cold-like symptoms? Lockwood emphasized that it is not the childcare provider's responsibility to decide whether the illness is just a cold, seasonal allergies or the coronavirus. If they are concerned, they should have the parent reach out to the child's pediatrician.
The safest thing, even without a confirmed COVID-19 diagnosis, is to self-quarantine to combat possible spread, Lockwood said.
"We won't be testing every child with cold symptoms so we need to live with some measure of uncertainty," she said.
In general, patients who test positive for the coronavirus must quarantine for 10 days from the test if they have no symptoms. If they do have symptoms, then they should quarantine 10 days from symptom onset. They should continue doing so until they have been without fever for at least 24 hours and show signs of improved symptoms.
It isn't practical to expect a school year free of COVID-19 cases with any learning model, Coffin and Lockwood emphasized. Parents and schools need to be flexible and ready to adapt if an outbreak occurs among students or staff.
Alternating periods of in-person and remote learning might be necessary. That is why communication is so important, Lockwood said. Parents need to know how the school year may change and how they will be notified of those changes.
The goal, Coffin said, is to continue education with as few bumps in the road as possible while keeping everyone as safe as possible.
Many families delayed going to the doctors for well visits during the first few months of the pandemic. But that has doctors concerned because preventive care, immunizations and health screenings are necessary to help kids stay healthy.
Lockwood emphasized the importance of the flu shot. With many hospitals already at or close to capacity with COVID-19 patients, a surge of flu cases could replete their resources even more. Co-infection of both the flu and the coronavirus also remains a concern.
"We are taking precautions to keep everyone safe," she said. "It is a great time to bring your child into the office for a well visit."
