Pediatricians on Sending Kids to School during COVID-19

Welcome to the third edition of Facebook Live with the PedsEast Pediatricians.  Today we're joined by four different pediatricians across each location ithe Memphis area to answer your questions about kids going back to school during the COVID-19 pandemic, how to keep your kids safe from COVID-19 in school if kids should wear masks in school, and more.

Jump to a response from one of the PedsEast pediatricians:

When Should My Child Wear A Mask At School?
How Can I Help My Child Feel More Comfortable While Wearing A Mask At School?
What Are Most Schools Doing To Minimize The Spread of COVID-19?
Is My Child More At Risk if He/She Attends School?
How Can I Help My Child Be Less Nervous About the School Year?
How Can I Talk To My Child About COVID-19?
What Should I Do If My Child’s Classmate Tests Positive for COVID-19?
What Are the Pros and Cons of Children Playing Sports at School or RecreationallyThis Fall?
What is PedsEast Doing to Maintain a Safe Space for Well Visits and Sick Visits

Dr. Jennifer Lum, Dr. Bubba Edwards, Dr. Melissa Adams, and Dr. Andrew Irwin have been on the frontlines of this pandemic, serving families who may be affected by COVID-19 and offering guidance to a concerned community.

We hope these answers give you more clarity as you weigh the difficult decision of how your children will attend school this season.

When Should My Child Wear A Mask At School?

Dr. Adams:  If they are going to school or pretty much anywhere in public.  They should be wearing a mask.  I think they should be wearing their mask, getting comfortable with their mask.  We know that masks protect us from COVID-19.  It has been shown to decrease the spread.  Right now, that's the main thing we need to do is to keep these kids safe.  I think wearing a mask all of the time is the best policy.

How Can I Help My Child Feel More Comfortable While Wearing A Mask At School?

Dr. Lum:  This question comes in two parts.  The first part is being emotionally comfortable.  There might be some anxiety with wearing a mask and what that means and it is important to talk to kids about why we wear masks.  Not only to protect themselves but also to help protect others.  As a community that's really important.  We teach kids every day to be kind to other people, and this is part of that kindness.

In terms of it being physically comfortable, masks are not comfortable.  We don't enjoy wearing them, they're difficult to talk in, and it can take some time to get used to.  The first thing I'd say is to make sure that it fits well.  Make sure that it's fully covering their nose and mouth to make sure that droplets don't get spread, and that it stretches from ear to ear.  Make sure that the fabric itself is comfortable, that they can breathe through it easily.  Sometimes masks have nose bridge pieces that help the mask fit better so the kids don't have to hold it up and adjust it.  That helps it fit.

And then make it fun for kids!  There are different ways you can personalize it.  Put their name on it, let them pick their fabric, put a character on it.  That's something you can do to make it not so scary.  Also, model the behavior that you're wanting them to imitate.  The more they see you wear the mask and that you're comfortable with it, that will help the kids realize that this is okay, this is something we're going to do.

Finally, find time to practice with it.  Again, it takes time to get used to, so if you can practice for a little bit at home before they have to go out, that will help them get used to wearing it and feeling more comfortable.

What Are Most Schools Doing To Minimize The Spread of COVID-19?

Dr. Irwin:  We obviously have some schools like Shelby County Schools that have gone virtual.  They're doing what they determined to be the best decision to minimize spread.  We want our families to know we're behind you 110% if you choose to teach your kids at home.

However, we know that many of the other schools are going in person.  Some high schools are going two days a week in person, then three days at home (a hybrid model).  Some of the elementary schools and some of the private schools are going five days a week.

Over the course of the summer, I think everybody on this panel and all most of our other doctors will tell you that we see a lot of families that go to a lot of different schools and a lot of our moms and dads are teachers.  I've been curious to see what a lot of people have done and I've actually met with local principals and people from private, elementary, middle, and high schools and one thing you can rest assured over:  They've all done some extensive training.  It's not just one week of in-service where they've come in and gotten ready for school.  They've kind of put them through some boot camps.  They've been adhering to the information that the Shelby County Health Department and the CDC are putting out about the masks.  It seems that most schools are at least recommending masks at the very least, and some are going to require them.

That's going to be a big change for kids, but as Dr. Lum mentioned, you just try to make it as normal for the kids as possible.  We told our kids, "It's kinda like a ticket to get into school.  If you didn't wear a mask, you wouldn't be able to go to school and see your friends.  When you get to school, you're going to see that everyone else is wearing masks.  One thing I've been reinvigorated by is seeing all of these teachers and talking to them.

As pediatricians, we love kids, we love their families and that's why we do what we do.  Being around all of these teachers, you realize just how passionate they are.  And they want to see their kids and students in the classroom as much as they can.  You're going to see them focusing more on hand hygiene.  More handwashing, more hand sanitizing than ever before.

Another thing that will probably adjust is some of the activities.  A lot of times in Kindergarten you do this little station and after 5 minutes, the kids rotate to the next one, so you can expect them to adjust some of those activities to minimize how much the kids are mixing objects.

I know many schools are going to limit visitors, and some may not even have the parents drop the kids off all the way at the front.  I know that some schools are going to be doing temperature checks.  Most schools are doing some type of screening so parents have to answer.  Parents may have to answer questions like:  Does anyone in your house have a fever, cough, runny nose, headaches, diarrhea?

Part of that is going to be dependent on the families.  And you hope it's not the family that gives the kid Tylenol so that when they get sent to school they don't have a fever.  But I think between the focus on the masks, the increased focus on hand hygiene, and limiting some activities (maybe they're not going to sing in the classroom and instead go outside), we're not as worried about the spread.  There's going to be an adjustment.

And finally, I think the last good thing that some schools are doing is implementing tracing protocols.  They're trying to keep kids in smaller groups, so if there were a case of COVID-19, then they can say this group or teacher may have to stay out of school for a week or two until things have been resolved, rather than having hundreds of kids mixing all at once.

It's not just one thing they're doing.  They're probably hitting on about seven or eight points that studies conducted in the U.S., Europe, and Asia have helped them stay in or get back to school or daycare as safely as possible.

Is My Child More At Risk if He/She Attends School?

Dr. Adams:  The discussion about masks is definitely the biggest thing for alleviating their risk.  As far as risk in school and out of school, it really depends on the school and the situation.  I think that the schools who have opted to go in person have already taken this risk into consideration.  They're already doing the six-feet spacing (distancing).  They're requiring masks.  Just as Dr. Irwin was discussing, they've changed the routine.  They've changed to reduce the number of children at school on one day or they've decreased the number of activities that involve them being all in one room together (made the classrooms smaller).

Therefore, all of this is decreasing the risk as much as possible, yet keeping them socially at school.

They are at risk when they go out of the house.  Everyone is taking that certain risk but by decreasing the risks with physical distancing and masks, I do think it's appropriate for most kids to go to school.  We have to look at each individual family as far as specific risks are concerned.  You have to weigh the benefits and risks individually.

I don't think we can say there's a 100% in the clear at every school.  But, they're doing a lot to help prevent the spread of COVID-19.

Dr. Edwards:  I'd like to add to that.  As far as what I've seen, most of the kids that we've seen with COVID-19 (which haven't been many) have gotten the infection from their parents or from an adult.  So one thing parents can do to keep their kids safe (whether the kids are in school in person or at home) is to be just as careful about their own hygiene.  Parents should wear masks and limit their social engagements.  And that's a hard thing to do, but if you want to protect your kids keep yourself safe – if one parent goes home with COVID-19, the whole family ends up getting it, basically.  I think that's important to look at. That’s just as important as having all of the kids wear masks in schools.

Dr. Adams:  The other thing we need to look at beyond the risks of COVID-19 is that some kids just aren't going to do well with online learning.  Disabled children or families that have two parents working – they can't put them in an unsafe situation of learning at home, or demand that they have a babysitter 5 days a week for them to get this education.  We also have situations of abuse that are not being caught at home, and certain kids need to go to school.  There are many other risks of a child staying at home that we also need to consider.

It goes back to the individual families for weighing benefits and risks.

Dr. Irwin:  I think one of the things that everybody on this panel and within the Pediatrics East group feels is that as pediatricians we're dealing with more than just COVID-19.  What most of the studies have shown is kind of usual, because kids don't spread it as much.  Teenagers are a little different.  Again, I think one of the things we have to keep in mind is that even kids who aren't going to school in person are still hanging out together.  The fortunate part is that we haven't seen huge outbreaks with COVID-19.

None of us envy the school administrators and the leaders trying to determine who is going back to school and who is not.  But as pediatricians, we're just trying to do right in every aspect.  Not just focusing on one elephant in the room, but trying to make sure we're addressing all of the issues at our feet.

How Can I Help My Child Be Less Nervous About the School Year?

Dr. Lum: It's important to talk to them.  Talk to them about how they're feeling and acknowledge that those feelings are valid.  Even as adults we have anxiety over the situation.  The kids feel that and pick up on that and they have their own worries and walk to talk about it.  I think it's important to set up expectations for them about how their classroom might look:  What's going to be different, how things are going to look for them in the classroom with social distancing, wearing masks, what's going to be expected of them, and how they're not going to be able to play with their friends like they used to, or share objects.

I think it's also important to talk to them about that, as the school year progresses, things might change and it's important to be flexible.  It may not look like it does when we first start and that's going to depend on getting back in the classroom and how our cases are doing and how different counties are doing and what that looks like.

I tell parents all of the time when they ask me questions about COVID-19 that what I'm telling them right at that moment might change next week based on the data that we see.  That's probably been one of the most frustrating parts of all of this.  Things have been changing so quickly that we have to learn to adapt and be flexible with it.

And also, just reassuring them that, as everyone has touched on, that the school system is putting measures in place to help keep them safe.  They're doing everything that they need to do to make sure these children are as safe as they possibly can be in this situation.

What Should I Do If My Child’s Classmate Tests Positive for COVID-19?

Dr. Adams:  The first step is an investigation.  Trying to figure out two things.  The first is the distance from that positive person, and the second is the time around that person.  If the school has been appropriately distancing and the child is wearing a mask, then you're really limiting your risk of needing to quarantine a whole cohort of students.

Right now the marker is an exposure of longer than 15 minutes.  So exposure of passing in the hall or passing someone in the bathroom or just brushing past a person is not an increasing risk for COVID-19.

Things get risky when you're exposed for more than 15 minutes, are within 6 feet, and aren't wearing a mask.  If any of those conditions are met then we would recommend a 14-day quarantine.  That would start either 2 days before the patient became symptomatic.  If the patient is asymptomatic, then it would start 2 days from the time of the positive test.  That's when the timeline would start.

For students who may have been in contact with someone with COVID-19, but have a negative test, you'd want to quarantine for 7 days from the last contact with the carrier.  It's really up to the school and the child to keep 6-feet of distance between themselves and others.  That will keep schools from having to quarantine whole classes.

How Can I Talk To My Child About COVID-19?

Dr. Irwin:  I think a big part of this question has to do with the age of the child.  I have a two, a five, and an eight-year-old.  My two-year-old is going to have to wear a mask when he goes to pre-school.  And his understanding of Coronavirus is that he prays every night for Coronavirus to go away.

For my five-year-old, I occasionally ask if he has any questions about it.  His understanding is that there's a virus he has to wear a mask, and school is going to look a little bit different.  And for my eight-year-old, we discuss it a little more in-depth.

For a high school kid...I don't think you need to start flooding your children with information and statistics.  That may just actually worry them more than if you'd not done it.

Dr. Lum mentioned this earlier.  Discussing how wearing the mask is to protect those around you.  You don't have to go into a lot of details, though you should always allow an open line of communication and periodically check in with them as they go back to school.  Kids will be talking about it.  If they do ask, reiterate that this is a virus that doesn't primarily target children.

When we talk about wearing masks and washing hands, that pertains to all aspects of life like when they're interacting with their grandparents, friends, teachers.  Telling kids that we're going to do the best we can to help control this.  In the same way that you talk to your kids about safety issues like bike helmets, pool safety, car seats, and vaccines---all of the things that we do as parents and as pediatricians to normally promote health in our kids.

You may even consider limiting how often you have the news on while your kids are around.  Many are very worried because even though they're wearing masks, some of their peers or adults in their lives aren't.  We're all in this together, and we need to be aware of how we're talking about this because our children pick up on it more than we realize.

The best thing to do is to be positive about it and see ways that we can get back a sense of normalcy.  Remember, don't overwhelm them with information, be careful of the tone we use when discussing it, and be mindful of the media you're consuming when they're around.  Talk about how it helps your friends and neighbors by doing all of the things we've mentioned, and reassure them that it doesn't always affect kids, but we want to make sure we're preventing other illnesses as well.

As pediatricians, we've actually seen a drop in other normal vaccines this year.  So how can you make sure we're not going to see a resurgence of mumps or influenza or measles.  We want to make sure we're protecting kids for those things just like we always have.  Those illnesses still pose a risk if we don't take care of that.

Dr Adams:  I'd like to mention too:  In times of anxiety for children, and especially now, I always love Mr. Rogers' "focus on the helpers."  As in focusing on who is doing stuff right.  What is your teacher doing to keep you safe?  What is the school doing?  What is the janitorial staff doing?  Focus on the helpers.

That helps spin it so that they can become a helper too.

Dr. Edwards:  This whole thing about the masks...People still have problems believing that they need to wear a mask, even though it's the law and it's universal, people still don't want to do it.

We hear stuff like "I don't think they work.  I don't think they protect me.  They may make me sick."  The city of Hong Kong China (that's 7 million people), they've had 64 COVID-19 related deaths so far.  Not 64,000.  Sixty-four.  That's because those people are culturally okay wearing a mask.  They wear masks here in Memphis when there's a flu outbreak.  Many Asian people have been accustomed to doing that.  And they're doing a great job.  So when you look at a city like Hong Kong that could have been inundated by COVID-19, they've had virtually none because they took responsibility from the front end, did what they were supposed to do, and now they're over it.

Here we have the freedom to voice our opinions in so many different ways that we hear people say "I don't want to wear a mask.  I don't have to wear a mask.  You can't make me wear a mask."  And now we're dealing with the consequences.

What Are the Pros and Cons of Children Playing Sports at School or Recreationally This Fall?

Dr. Edwards:  Kids like sports.  Sports are good for kids.  We like for them to have physical activity, exercise, community involvement,'s so important.  However, sports are for the most part contact situations.  Most sports kids are in a huddle.  Football, basketball, whatever.  They go to the sidelines.  They're right next to each other, they're doing a lot of stuff – maybe excluding a sport like cross-country, tennis, something that's a little further apart.

I think we have to be wary of watching kids and being attentive over the next few weeks as school begins as to whether or not we're seeing outbreaks in sports teams and other groups of people.  I think that's a risky situation.

Again, we've mentioned the cost and benefits of going to school, seeing your grandparents, and other activities.  There are benefits and there are risks.  We don't know what those numbers are yet, and we don't know what's going to happen.  We're going to have to have our antennas up and look carefully and be willing to make adjustments.  I tell parents that you have to make the best judgment you can with the information that you have today.  But tomorrow's information is going to be different.

We have to be flexible, and I think sports are going to be the same way.  The Grizzlies have been playing down in Orlando in a bubble, everyone has been tested, and I haven't heard of any outbreaks so far in the NBA.  But I can promise you if one team had six guys that came down with COVID-19 tomorrow, that's going to be shut down.  It'll look different next week.

So we'll have to wait and see what happens with fall sports.  If they happen, if they don't happen.  That's a controversial subject right now.  If I had the right answer for that, I wouldn't be behind this camera.

What is PedsEast Doing to Maintain a Safe Space for Well Visits and Sick Visits?

Dr. Irwin:  I'm glad I get to work with these awesome doctors.  We were discussing this even before there were national recommendations on what to do.  As we've said before, we want patients to be happy and healthy.  We love their families and we're trying to do the best we can with the recommendations that come out.

What we've been doing since March or early April is we're reserving the first part of the day just for check-ups.  Whether you have a newborn that just got discharged from the hospital or the 18-year-old that needs a check-up before they head off to college, we're dedicating the first part of our day just for well-visits.  We're not going to have anybody coming in sick.  For those who are familiar with our historical schedule, we've temporarily suspended the Morning Walk-in Clinic which was available previously.

Later in the day, we have a mixture.  Some are sick-visits, some well-visits.  Many people are still working, and can only get that check-up at 4 o'clock in the afternoon and we're more than happy to do that.

Throughout the day, from the point our employees arrive at work, we're screening them.  We're making sure no one has a fever.  If they do, we're sending them home.  We've always done an exceptional job cleaning in between patients and at the end of the day.  Now we've gone above and beyond on that.  We've taken things out of the rooms that might be touchpoints between patients.  We're also dressed head to toe for the environment.  We've got masks, face shields, gloves, we've got scrubs, gowns, etc.  It's still us behind all of that gear, and we try to make our patients feel as at ease as possible.  However, all of these things are done in the best interests of protecting our patients and families, the families of those who visit us throughout the day, and of course our staff.

We also have telemedicine options.  That's something we've been trying to implement out of necessity due to COVID-19.  Unfortunately, it doesn't work for everything. But for many of our patients that may have a severe medical problem and their sibling is sick and it's something we can take care of over the phone, we can do that.  It's similar to what we're doing right now with Zoom.  All you need is a computer or smartphone.

This is great for follow-ups for things like anxiety, ADHD, depression, visual diagnoses (things like diaper rash, insect bites).  We obviously can't look in ears over telemedicine, but for some families either out of concern or out of risk, we're able to do telemedicine.

In a situation where someone does want to get a COVID-19 test, our staff has been able to conduct these tests in the parking lot.  We gear up and swab and are able to send that to an outside lab.  In the current state of affairs, we can get a result between 1-16 days.  

One of the things we've been trying to tell families about recently is trying to acquire the 5-15 minute Coronavirus test.  All of this discussion about getting children back into school and into their cohort groups, we're inevitably going to see children with fall allergies.  It will be important to differentiate between who has allergies, a cold, the flu, strep, or COVID-19.  The ability to have between 90-97% or higher accuracy of tests and tell you the results within a few minutes will hopefully make this transition a little less stressful in figuring out who can go back to school, or who can visit with friends and family.

We're not the only group that's doing this, but we'll hopefully have them pretty soon and in every office to further help families continue to navigate this situation.  As we've said, there are many new recommendations surfacing all of the time, but they change daily.

We're doing everything we can, day-to-day.  We're keeping each other in check and keeping up to date on every piece of new information, and we'll continue to do that.

In Conclusion

Dr. Irwin:  We'd like to give a big shout out to all of the teachers out there.  And we want to remind everyone to be patient and be flexible.  It's tough.  We all want our children to have as much of a normal school year as possible.  We'd love to say that we'll make it all the way to Christmas without any hiccups, but we have to play it by ear.

Kids are resilient, but they'll see the effects.  They may get down and frustrated with it.  I know I speak for everyone on this panel when I say we're always happy to talk to kids over the phone or see them in the office.  But I know we've also had several patients who have begun to or have struggled with anxiety who may need to see a counselor or therapist, and some of those professionals have been able to provide telehealth visits.  Don't hesitate to reach out if your kids are struggling with this transition, or even yourself.

We're always glad to help.