How to Keep Children Safe from COVID-19

With the new school year started and autumn approaching, Colleen Nash, MD, MPH, Rush University Medical Center, pediatric infectious disease specialist, answers questions parents may have about keeping children safe from COVID, social distancing in the classroom and celebrating Halloween while COVID-19 is still a threat.

With some children back in the classroom or starting sports or other activities, what are the keys to preventing the spread of COVID-19?

The recommendations set forth for months by city and state health departments as well as the Centers for Disease Control (CDC) remain the most important. It’s imperative everyone (including children older than 2 years) continue to wear face coverings, socially distance and wash their hands often. Avoiding large groups also is crucial. Ideally, at school, children should be in contained groups, what many schools call “cohorts.” Each cohort would, ideally, interact only with individuals within that group, avoiding exposure to other groups as much as possible. That way, if a member of one cohort develops COVID-19, that entire cohort could quarantine, without necessarily affecting others within the same school. This may help prevent the need to close an entire school.

If the students are appropriately masked and distanced from one another, there should be minimal opportunity for what is deemed true exposure: being within 6 feet of another person for more than 15 minutes without protective equipment or without your mask. Those true exposures should be few and far between if we’re doing what we’re supposed to be doing inside and outside of school.

Where are children most likely to spread or contract COVID-19?

Children can contract COVID-19 with any type of exposure in any setting. Anyone who is in the school setting unmasked and near another person is at risk of getting or spreading COVID. That circumstance really should not happen. The most likely place exposure may occur at school, without it being some kind of flaw in the system, would be lunchtime or snack time, when children have to remove their masks to eat. Appropriate distancing measures and hand washing help reduce this risk.

What can parents do to help prevent their child from catching COVID-19 or spreading it?

Parents can and should lead by example. Children can handle only so much information and take on only so much responsibility. Younger children, especially, can have a hard time understanding abstract concepts. That’s where parents, as well as other adults who are with the children, need to take on that responsibility. That means repeatedly reminding children to keep their masks on and over their nose, not touch the outside of their mask if possible, keep their fingers out of their mouths, nose and eyes, wash their hands, and keep their hands off other kids and others’ personal items. These concepts hold true not only for the prevention of COVID-19, but for all other viruses such as the flu.

If your child wears a mask, washes hands and socially distances, but someone with them doesn’t, what should they do?

If a child is with someone who is not following the rules or is doing something that isn’t safe, sometimes the child can ask or remind the other person, in a nice way, to put on a mask or stay further away. That may be easier said than done, for children as well as adults. While we may not want to encourage “tattling,” we should encourage children to identify and speak up (if they’re comfortable) for what is safe and appropriate behavior. Children should always feel comfortable going to an adult if they need help negotiating a difficult interaction.

An adult certainly should be told immediately if an unsafe behavior continues or someone is clearly contaminating personal items or space, such as drinking from someone else’s water bottle, putting fingers in another person’s food or spitting. It’s especially hard when they are little. I tell my children, who are ages 5 and younger, “If you are around someone who is not doing what you know is right, you need to come tell me right away.”

If the behavior continues and isn’t corrected by the parent or caregiver, then we don’t engage with them. That part is very difficult, and why this pandemic can strain relationships. It’s really tough to say, “I’m sorry, but I don’t agree with what you’re doing, and my family can’t be around you.” No one wants to hear that.

There’s a lot of back-and-forth about whether schools should be open and how and when they should be closed. Should schools be open?

There’s no one right answer to whether all schools should be open or closed. Each school and each student are different. There are many factors at play, including how the disease is spreading in your area, the individual student or family, and the resources and capabilities of the school. Not all schools and school systems are the same. No family is the same.

When it comes to the space of the school, some are better able to physically accommodate a return of students. Even within one school district, especially in a very large district, the buildings and classrooms may vary significantly in condition and, size and extra available space. Some buildings may have better airflow and more room to spread out. It can vary significantly.

Additionally, families may decide it’s best to keep their children at home and do remote learning. They may have a family member living with them who is at higher risk for severe COVID-19, or the parents just may not feel comfortable having their children in a school setting. A one-size-fits-all approach doesn’t work given these differences.

What do schools need to do to protect kids from COVID?

Schoolteachers and staff need to make sure the infection control strategies of their school are put in place effectively, including ensuring students and staff wear masks and maintain distancing and that the facilities are clean. But the responsibility isn’t theirs alone. What we do as families outside of the school setting is just as important. It will directly affect what we see – and don’t see – in schools.

Each family’s commitment to those infection prevention practices – social distancing, wearing masks, handwashing, not gathering in large groups – is intensely important when they aren’t at home, whether that’s going to the store or riding a scooter. The teaching and positive reinforcement that caregivers provide children is also very important. Setting the example and helping children learn these practices may protect them just as much as keeping the school’s doorknobs clean.

What type of mask works?

Any covering is better than none, but a multi-layered mask that is the right size or is adjustable is best. It’s very important that the mask cover the nose, mouth and chin well enough that if the mask slips or moves, the nose and mouth remain covered. It should not have large gaps between the mask and face.

The Centers for Disease Control (CDC) has directions on how to make a mask.

Should parents be spooked by trick-or-treating this year?

Many of us will need to prepare our kids for a different Halloween celebration this year. Trick-or-treating is a cherished tradition, but having families roam the streets in large groups, knocking on doors and exchanging items is the opposite of social distancing. And, can you trust everyone on the street or handing out candy is properly masked and has clean hands? Just as they did for summer holidays, some families will decide to have a party, but that can be just as risky.

Do children spread COVID as much as adults?

We have some data about transmission, but it isn’t entirely clear if and how much children spread disease. Age may be a factor. Some studies have shown that children, especially young children, do not transmit the virus as effectively as adults or older children. Other studies have shown that a large amount of virus can been found within the nose and mouth of young children, however, we don’t yet know what the significance of that is. This topic is being studied in various research settings, but we don’t have the information we need to definitively say one way or the other at this time.

Do children with COVID get as sick as adults?

In general, children and adolescents have a milder disease compared to adults, and particularly compared to older adults. However, there are children who have experienced severe COVID-19 and other severe complications such as Multisystem Inflammatory Syndrome in Children (MIS-C).

We’ve heard how adults with certain health conditions, such as diabetes, are more likely to become very ill from COVID. Is that true for children?

While we know adults with certain conditions appear to have more severe COVID, we don’t have consistent data that indicates this is true in children. COVID-19 guidelines for pediatric care support that certain conditions, such as chronic lung disease or sickle cell disease, may predispose a child to a more serious infection, however this has not been seen consistently. Even though we see less severe COVID in children, it is important to err on the side of caution and watch for the development of severe symptoms in all children both with and without underlying conditions.

Colleen Nash, MD, MPH, is assistant professor in the Department of Pediatrics, Rush Medical College; associate program director of Pediatrics and medical director of the Pediatric Antimicrobial Stewardship Program.

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