#childsafety | COVID-19: What Parents Need to Know

Q&A with Anita Juvvadi, MD, Stanford Children’s Health pediatrician with Juvvadi Pediatrics

Original article updated on May 20, 2020 to accurately represent the evolving situation.

Ongoing news about the current outbreak of novel coronavirus (COVID-19), has parents wondering what they should do to keep their families protected. We sat down with Stanford Children’s Health pediatrician Anita Juvvadi, MD, with Juvvadi Pediatrics, to address the most common questions she is receiving from patients and their families.

Q: As a pediatrician, what are some of the most common questions you are hearing from patients and their families right now?

Dr. Juvvadi: The most common thing we are continuing to hear
from parents is that their child has a fever and a cough, and they are
wondering how worried they should be. Others are asking about exposure,
concerned about one parent leaving the house to go to the grocery store and
whether this could put the rest of the family at risk. The CDC is reporting
that symptoms of COVID-19 are generally presenting as mild in children, but
parents are asking if they would get a more severe version if they contracted

As the status of COVID-19 continues to evolve and we are hearing of more positive cases in the community, I am reminding families of the importance of staying at home according to the recommendations of their counties.

Q: In general, how susceptible are children to COVID-19?

Dr. Juvvadi: I want to reassure all families with young children that of the data from hundreds of thousands of cases, the pediatric age group is the least affected. So there is a very good chance that your child will not be severely affected even if exposed.

That said, with the general exposure to COVID-19 through mucus membranes, any human being could be susceptible to the disease. Because we know that the virus seems to cause a pneumonia, for children with severe asthma or a congenital heart problem, we are recommending parents take extra precautions right now.

Q: If a child exhibits flu-like symptoms, how do parents know whether the child has COVID-19 versus flu or a seasonal cold?

Dr. Juvvadi: If your child has a fever, cough, congestion, goopy eyes, stomach pain, nausea and vomiting, please contact your pediatrician for further evaluation. These visits can be conducted over the phone, or in some cases, virtually, using telehealth. If your doctor feels that the symptoms may be indicative of COVID-19, they can help arrange for your child to be tested at a designated facility. In accordance with recommendations from the CDC, before heading to urgent care or the ER directly, speak with your pediatrician to discuss if testing is warranted and find out if there is a local facility that does drive through testing.

Q: I’ve been reading news reports about pediatric multi-system inflammatory syndrome as a complication of COVID-19. What is this, and should I be worried that my child may develop it?

Dr. Juvvadi: On May 14, The Centers for Disease Control and Prevention (CDC) issued a health advisory providing background on a few recently reported cases on a condition they are calling multisystem inflammatory syndrome in children (MIS-C) among children who tested positive for COVID-19. The syndrome resembles other inflammatory diseases and has certain characteristics in common with Kawasaki disease, which is rare and typically affects children age 5 and younger, though it can occur in older kids. Physicians in New York, London and other places where MIS-C has been reported have described the symptoms of MIS-C as a persistent fever, a rash or changes in skin color, red eyes or conjunctivitis, abdominal pain, and swollen lymph nodes.

Stanford Children’s Health infectious disease experts and other scientists around the world are working to better understand the condition, and I want to reassure families that this complication is very rare. If parents do notice any of these symptoms, they should call their pediatrician for advice on next steps.

Q: As the CDC is now recommending that everyone wear cloth face coverings to help slow the spread of COVID-19, should I be covering my child’s face as well?

Dr. Juvvadi: The CDC is not recommending face coverings
for children under age two, which is likely related to the ability of young
toddlers to both keep on and remove coverings from their faces. With newborns
and babies, in general, it is advised to never cover their faces.

The best protection for children and families at this
time is to maintain social distancing and practice good hand hygiene. If that
is not possible, in accordance with CDC recommendations, a cloth face covering
should be worn whenever people are in a community setting, especially where you
may be near people, such as at a grocery store or pharmacy. For older children,
you can make homemade masks with fun prints that they will enjoy wearing if
they have to go out for an essential need.

Q: Should I cancel my child’s upcoming well-child visit if he or she is otherwise healthy?

Dr. Juvvadi: If your child is due for a vaccination, it
is a good idea to keep your appointment, especially if he or she is under the
age of two. The last thing we want to see right now is an outbreak of another
disease, and we highly recommend that children get the required immunizations
to protect their immune systems from other serious illnesses.

However, you should check with your pediatrician to determine whether they have adjusted schedules or designated times for well-child exams. In my office, I am conducting only well-child exams in the morning hours, and reserving the remainder of the day for sick visits. In addition, we are postponing all older children’s well exams that do not include vaccines that are due urgently.

At this time, we are recommending that patient families explore telehealth options for doctor visits whenever possible.

Q: What should parents be doing at home to protect against the virus?

Dr. Juvvadi: In general, we should continue with the same
habits we’ve been practicing, including proper handwashing, cleaning high touch
surfaces is your home daily, and covering your cough within your elbow. It is
not an exaggeration that most viruses are avoidable with good handwashing. How
do you think doctors and nurses stay healthy?!

While there is no need to stock up on everything, if you
have young children at home, it is a good idea to have at least two weeks’
worth of infant formula, diapers, wipes, and baby food if your baby is eating

As some counties begin modifying shelter-in-place orders, it is important to note that the CDC is continuing to recommend that we stay at home as much as possible to prevent the spread of COVID-19. Families should continue to maintain social distancing, practice recommended masking and handwashing protocols, and avoid touching their noses, eyes and mouths.

Q: What medicines should I have on hand to be prepared in case my child contracts COVID-19?

Dr. Juvvadi: We are hearing that acetaminophen may be better than ibuprofen for the treatment of most coronaviruses, so make sure you have that at home in a preparation that your child likes. I also recommend keeping over-the-counter cough and cold medications, lozenges and herbal tea handy. Most importantly, if your child has asthma, make sure you have enough refills on the medications that they need.

Q: If I have a new baby at home, are there extra precautions we should be taking right now?

Dr. Juvvadi: If you have a newborn, continue to follow your usual hand hygiene practices, breastfeed your baby if possible, and make sure baby gets plenty of sunlight and fresh air. It is a good idea to use antibacterial wipes to wipe down countertops and diaper-changing stations once a day.

Q: If a woman who is pregnant or breastfeeding becomes sick, should she be concerned that her baby could contract COVID-19?

Dr. Juvvadi: According to the CDC, “in limited case series reported to date, no
evidence of virus has been found in the breast milk of women with COVID-19. No
information is available on the transmission of the virus that causes COVID-19
through breast milk (i.e., whether infectious virus is present in the breast
milk of an infected woman).”

In most cases where mom is exposed to a virus or has any
symptoms, we recommend that the best thing she can do is continue to breastfeed
baby if possible, because through breastmilk, the baby receives the antibodies
that mom’s body is producing. Historically, we have seen that with cases of
influenza and other viruses, a baby who is breastfed tends to have the mildest
version of the illness among anyone else in the family.

We don’t have enough information right now about adverse pregnancy outcomes in pregnant women with COVID-19. If you are pregnant, you should practice the usual preventive actions to avoid infection, like frequent handwashing, and avoid spending time with people who are sick.

Q: Should I be worried that my child is not
interacting with other kids or adults while we are quarantined at home?
Particularly for younger children, will this lead to separation anxiety once
daycare and school resumes? 

Dr. Juvvadi: It is true that the interaction is reduced
while families are quarantined. To keep kids’ routines as close to their
normal, or to give them something fun to anticipate and plan for, I am
recommending that families try to schedule online play dates, tea parties,
family events, dance competitions, exercise challenges, etc. Expect that the
first week back to schools and daycares will be slightly stressful, but kids
are extremely resilient and will adapt very quickly.

Q: Do you have suggestions for activities that can keep kids busy at home during school closures and activity cancellations?

Dr. Juvvadi: Please continue to spend time outdoors, as long as you are able to maintain appropriate social distancing. The fresh air is good for kids, and for you as parents. Letting kids be active is the best thing we can do for them right now. Finger painting and sidewalk chalk are always fun—you can never have enough hopscotch! Now is also a great time to plant vegetables and herbs in the backyard that can be enjoyed this summer.

Indoors, this is a time to get creative!

  • Kids of all ages can help with cooking. Little ones can mix salads, find green vegetables in the fridge, help mix batter for baking or load the dishwasher. Older kids can research ingredients shown to boost immunity or help prevent respiratory infections (turmeric, garlic, ginger and vitamin C rich fruits and vegetables are good examples)
  • Use leftover Halloween face paint to draw a T-zone on kids’ faces and see how long they last without touching the paint; the one that holds out the longest wins
  • Set up competitions between family members to do squats one day, pushups and jump rope another
  • Establish a family book club
  • Challenge each other to invent a new card game
  • This is a great time for kids (and adults!) to clean out their closets of clothes, toys and books that they no longer need and make bags that can be donated after the shelter-in-place period ends

Information for patients with complex care needs

At Stanford Children’s Health, a significant number of our patients have complex medical conditions. At this time, the CDC is not sure if specific underlying medical conditions are associated with worsened disease in children. In older adults, certain preexisting health problems are associated with more severe cases of COVID-19. Currently, Stanford Children’s Health care teams are advising pediatric patients with existing medical conditions to follow the same guidelines that are in place for all children, including social distancing and thorough handwashing. Parents should contact their pediatrician if their child shows signs of COVID-19, and follow their doctor’s directions on obtaining testing if appropriate. Parents of patients with subspecialty needs should call their subspecialty providers if their child is diagnosed with or being tested for COVID-19, so that their care team can advise them in real time.

For the latest information about COVID-19, please visit: http://coronavirus.stanfordchildrens.org

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