Ask a Pediatrician: COVID-19
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Ask a Pediatrician: COVID-19

COVID-19 is at the forefront of every parents’ mind. That’s why the doctors at Pediatrics East have taken to social media to help answer some of the most frequently asked questions surrounding coronavirus and childcare. Dr. Robert Higginbotham, Dr. Daniel Chatham, Dr. Melanie Smith, and Dr. Jessica Wilson share their thoughts on best techniques for keeping your family happy, healthy and safe both physically and emotionally while navigating the pandemic.

Q: What are the most common signs of the COVID-19 virus in children?

Dr. Chatham: So a couple of things. Thankfully this remains a virus that's not severe for our kids. It can be particularly nasty for older relatives and neighbors and the sad fact is that the more people who catch the virus, even in kids, the greater chance there is of being a bad outcome. We've seen that just a handful of times across the globe. The biggest takeaway for all of us is just to stay home as much as you can, particularly if you're sick. When you're talking about kids with COVID-19, for the most part, you're looking at some combination of fever, cough, running nose, congestion, maybe with a sore throat, maybe with some GI symptoms (like vomiting or diarrhea), which pretty much sounds like every viral illness your kids have had the last several years. Just to complicate things for us, we're entering allergy season and my truck is coated with yellow dust and all the flowers are waving at us. So anybody with allergy symptoms, when you sneeze, your family is gonna give you a dirty look for the next couple of weeks. Even though this is a virus that's going to be mild for our kids, they can still transmit that to folks that may not do well with it if they're older or anybody with an underlying medical condition, so think about COVID-19 like a fire, and we're all logs. If you keep the logs apart, you starve the fire and that's what we're trying to do.

Q: If my child seems sick during this time, what should be the first step we take?

Dr. Smith: So, that's a great question. The first thing is if you have a runny nose or something that you would just typically watch anyway then the best thing, additionally, is going to be just to watch it. If there are concerns like Dr. Chatham mentioned in terms of fever or other symptoms, cough, etc., the first step should be to call us. So we're fielding questions all day and after-hours about children whose parents are concerned about their symptoms, which is very valid, and that's what we want to do. We want to know about it. So the best thing to do is to call us. From there we can kind of make a group decision: Do we need to see the child? Can we talk about it on the phone? Is there a way that we could do telemedicine and be able to visually see the child and not bring them in and expose them to everyone else? The first thing that should pop into a parent's mind is to call your pediatrician.

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Q: If it’s nice outside, should we go for a walk on the trails or at the park? Or, does that put the family at too much risk?

Dr. Wilson: Well unfortunately right now is not the time to go out to the park. The more people that are gathering in these public places, the more we risk the possibility of exposure to this highly infectious virus. So don't risk it! But it doesn't mean that you can't go outside because we can all benefit from a little bit of sunshine. The best thing to do at this point is to plan these activities for play and exercise in your own yard. You can take a family walk or bike ride, but do it in your own neighborhood and make sure to practice safe social distancing, staying at least 6 feet apart from others who are out and about as well. The nice thing about being in your own neighborhood is that it is a little easier to keep your distance from others. Don't go to the parks, but don't be afraid to get outside and get some sun in your own yard.

Q: If someone in the house contracts the COVID-19 virus, what should other members of the family do?

Dr. Chatham: Unfortunately as it spreads, the likelihood that it's going to be in our houses starts to go up. It really depends on who has the virus. If it's a parent or an older teen (somebody with a little more independence who can watch after themselves a little bit), then you really want to think about setting aside a bedroom and preferably a bathroom that can just be the "sick area" where they can hang out away from everybody else. They may want to think about wearing a mask, a scarf, or bandana over their face when they're around other family members just in case they cough, so they can limit the spit droplets coming (of their mouths) that could get on other folks and put them at risk of catching it.

Now, if you're talking about a younger kid who is going to require care, it's probably a good idea for parents to go ahead and gameplan who is going to take care of that kid. If one of you are older or has a medical problem that may put you a little more at risk, you may want to focus more on picking up slack in other ways like food, dishes, laundry, taking care of the other kids, etc. and let your spouse take care of the sick one, just to try and keep yourself safe. If you have a positive in your house, everybody else in the house needs to be prepared to stay home for 14 days after the sick person starts to get better and the reason for that is that most people will develop symptoms about 4-5 days after they're exposed. Though, it can take a little bit longer than that, even 11-12 days. So 14 days right now is what we think is a safe time. You're probably also going to be contacted by the Health Department so they can map who you've been around and get in touch with people so that they can stay at home as well. Importantly, if you've got somebody who has COVID-19 in your house, you do want to watch them for signs that their illness could be worsening. Are they having trouble breathing? Are they having chest pain? Are they having bluish discoloration in their face and mouth? Do they seem confused? Anything like that should cue you up to "We need to seek medical care." So either call your doctor, or if it's an emergency call 911 or go to the emergency room. Preferably letting them know ahead of time what your diagnosis is, so they can be prepared to take care of you appropriately.

Q: If both parents become infected with the COVID-19 virus, how do you take care of your kids without infecting them?

Dr. Higginbotham: That's a tough situation. Unfortunately, I think that's going to be a situation that we're going to see. As we said, this virus may move through families, much like many of the other viruses that kids bring home from school or daycare, they tend to run through the family. And at some point everybody is sick. I think one of the first things (and we've said it a number of times), is to stay home. Do not go out with your children. If both parents are sick, then the children have almost certainly been exposed by that point. Taking the children to another family member's house or a friend's house can potentially worsen the chance for spreading the virus. The parents should obviously keep a close eye on their own personal health and if they need help, they should contact their doctor. If people are feeling sick but are able to take care of themselves, then they can still take care of their children. Just watch your children for signs of illness, then call us if that happens.

Dr. Smith: Daycares are still open. So for a lot of people who are emergency or healthcare personnel who need daycare, which is very valid, then children are going. But if parents are having symptoms, then it's a good idea to try and keep your child out because otherwise, they can get it and will spread it.

Dr. Higginbotham: Again, that 14-day window of staying home until all of the household contacts are well, that would apply to daycare as well.

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Q: Some parents are first responders or medical workers, putting them at heightened risks. How should we handle our responsibilities as workers versus our responsibilities as parents?

Dr. Smith: All of the pediatricians and the staff at Peds East are struggling with this, so we definitely understand. The first thing I will say is that every parent in that situation really has to take care of themselves first. The two most important things are taking care of themselves and taking care of others. When taking care of themselves, the best thing to do is wear PPE when they're at work, wash their hands, as much as you can do to protect yourself. That way you're not catching it or spreading it to others. The second thing, which is equally important, is when you go home, make sure that you are taking off the clothes that you wore at work, washing your hands (if you can shower, shower). Do everything you can do before you interact with your family or loved ones. That way you're not spreading it, whether you've been exposed during the day or not. It just puts you at higher risk, but we feel your struggles!

Q: If my family has been self-isolating and our friends have been self-isolating, could we have a playdate so the kids can be around other kids?

Dr. Smith: Unfortunately, it's a good time to cancel playdates (which is a hard thing to tell your 3-year-old when they ask you every morning if they can go play with their friends!). The tricky part is that even though you don't know if somebody has been exposed to COVID-19 or has the illness, people still have to go to the grocery store and interact with others. The best thing to do is to cancel playdates. Some good alternatives are Facetime (which somehow my 3-year-old understands very well these days), or other methods that you can interact with others without actually having to be together. The best thing to do is to put playdates on hold.

Q: Should I allow my kids to play in the cove or backyard? Can they play with the kids of other families?

Dr. Wilson: Unfortunately, with other kids being around, the answer to that is going to be "No." As tempting as it is to let them run around out with friends. It really opens up too many of those possibilities to exposure to Coronavirus, and really isn't worth the risk. As Dr. Smith was saying, if the kids are really wanting to chat and see their friends, you could try other things like virtual playdates and use tools like Facetime, Skype, or Zoom, whatever works best for them. But really, no playdates and no playing in common areas with other kids in the neighborhood.

Q: With everyone being so isolated, how do you talk to your kids as parents about possible grief, stress, anxiety regarding COVID-19?

Dr. Higginbotham: That's a tough question. The stresses that we feel as parents are probably not a lot greater than the stresses our children feel when they've been taken out of their normal routines. The stresses may be different, but not significantly. We all know that parents are stressed. They're stressed because of their work situations. They're stressed because of the fear of getting ill. They're stressed because they're stuck in the house in a lot of situations. But remember, your children look to you for stability. They look to you for comfort. And they look to you for advice. I think it's really important for parents to maintain their calm when they're talking to their children about this. We have a little bit of anxiety about what's going on, but try not to reflect that too much when you're discussing it with your children because they model their behavior on yours. So if you're really anxious, they'll tend to be more anxious. If you're calm, peaceful, that will reinforce them being calm.

Another thing that's important is that when you're talking to your children, you need to answer their questions on their level. Teenagers have a lot more insight into what's going on in the world than your 3-year-old does. So answering your teenager's questions certainly should be more detailed, but still calming and reassuring as best you can. For a child that's 3-years-old, they don't need to know what all the statistics are saying. They just need to know that you're going to be there for them.

Q: If we don’t want to come into the doctor’s office during this, but my child is sick, what should we do?

Dr. Chatham: Now, as it has been since PedsEast has opened its doors, we want to hear from you. So if your kid is sick, and you're not sure what the next step is, just give us a call. We're always ready to talk and coach and guide you through what the best steps are. All of us have been on the phone for many, many hours in the last couple of weeks. Thankfully, we have Telehealth up and running. So if it's something where we're just not sure or we think maybe we could handle it through Telehealth or through laying eyes on your kid through our computer screen (or anything that will help us get a better idea of what we need to do with you), we can do that. There are some things that are easily handled through Telehealth, and there are some things that aren't. But sometimes just being able to see your child helps us better make those decisions. Right now with the current pandemic, whether you're well or sick, the safest place for you is in your home (both for you and those around you). So if at all possible, we're going to try and keep you there. But there are going to be some cases where we need to see you just to take care of your kid. The short answer is to call, and we'll go from there.

MORE INFO: Telemedicine at PedsEast

Q: What is Pediatrics East doing to help make office visits safer for families?

Dr. Higginbotham: A lot of people are taking some of these steps. We've been talking with other pediatric groups in the Shelby County area, as well as nationwide and I think a lot of pediatricians are attacking this in the same way. I think one of the biggest things we're doing initially is we started screening patients before they came into our offices. When they call for appointments we're asking them if they have certain risk factors so that we can try and keep those patients from coming in if at all possible. But if they do need to be seen, we certainly want them to call and try to schedule an appointment. We have stopped our walk-in appointments because there's no way to screen those patients before they come in the door. We ask that you please do not show up at the office. Call us first! Just like Dr. Chatham said, it's important for us to hear from you first.

We've arranged our schedules so that now we're only seeing well children for checkups in the mornings up until 11 AM. Then in the afternoon, we have appointments for sick patients when we need to get them in. One of the things we've also tried to do is keep as many patients out of our waiting rooms as possible. We've staggered our schedule so that the chances of you being in our waiting room for more time than it takes to quickly check you in are minimized. If you're uncertain about coming into the waiting room, call us from the parking lot, and we'll make sure we get you back as soon as you walk through. Particularly, with our newborn babies, we like to do that anyway. We've also increased the amount of cleaning that we're doing. We've always tried to keep our offices as clean as possible. We've also increased the cleaning of our exam rooms with a lot more materials and diligence in the office. And of course, all of the staff and doctors are using personal protective equipment (PPE). Gloves, masks, other materials that we might need when they're needed. And then the last thing that we've all discussed is Telehealth. I think that Telehealth a very important, powerful tool for us to use. Currently what we're using is Zoom, which a lot of people are using in all sorts of different ways. But it's worked well for us so far, so I would encourage any parents out there who think they may need to schedule a Telehealth appointment to go ahead and download Zoom onto their computers or their phones so that they can be ready so we can help them!