School and COVID-19 Q & A with pediatrician, Dr. Di Enno

 

2020 as a year has been a doozy. There are now meme challenges demonstrating the crazy levels.

Add to it, this fall, parents have the impossible task of deciding school options for their children – virtual, in person (public or private).  All while balancing the need to work, self care, take care of home, there are now the additional worries and concerns about the little known respiratory illness that is changing the landscape of school. Parents need a resource of information to turn to, to decide how to approach these impossible questions. We are all feeling the weight of these questions. I took your questions and shared them with a pediatrician.

Enter Dr. Lisa Di Enno, MD. Dr. Di Enno is a board certified pediatrician who spent time in the Navy caring for military children who are used to a lot of unknowns. She is now working as the Chief Medical Officer for XpertCare, a telemedicine company providing pediatric care across the state of California. She took some time to answer your questions. We, as parents, need tangible information to make decisions with. Furthermore, Dr. Di Enno was joined by fellow XpertCare physician Dr. Patel, MD and Child and Adolescent Psychiatrist Dr. Falkowitz, DO to discuss the impact of COVID-19 on schooling in and the video from that previously LIVE event is here.

Your questions are in bold. Answers by Pediatrician Dr. Di Enno are in Italics below.

School and COVID-19 - A Q & A with a Pediatrician, MilMomAdventures and XpertCare

General Questions

What is a resource parents can turn to for current information about COVID by state?

I would recommend searching their state’s department of public health for that data.

Example web search: State + Public Health + COVID-19; in searching California’s Public Health Data, the daily list of cases is listed here.

What are safe community guidelines/statistics to return to in person activities?

This is the million dollar question.  The White House, working with experts in the field, have published a series of criteria that say when we’ll be ready to gradually return to life as we knew it (https://www.whitehouse.gov/openingamerica/).  These criteria include consistently downtrending influenza-like illnesses (ILI), COVID-like illnesses and documented cases of COVID.  They also include hospitals being able to function normally  (not a crisis level) with robust testing in place for at-risk personnel.  Only after these have been met, according to the experts, can we consider starting Phase 1 of reopening (which instructs vulnerable individuals to continue sheltering in place, other individuals to go in public with a mask/maintain at least 6 ft distance/limiting gatherings to 10 or fewer people, and for employers to continue telework and schools to stay closed).

What are some safe in person activities kids can join?

Dr. Di Enno recommends activities that can happen outside, involve no contact between kids, with minimal touching of common surfaces, that will allow for 6ft social distancing, that can be accomplished with masks on, and that are amenable to frequent sanitization.  Riding bikes, drawing on the sidewalk with chalk, socially distanced hanging out/watching movies, playing video games, tennis, things like that.  Small children will likely require close supervision as it’s easy for them to forget the rules.  Remember to keep the hand sanitizer and clorox wipes handy! 

What language should be used when talking to children (elementary/middle) on these new changes and how they are different from the temporary ones that existed since March?

Key message: Ask your kids what they have already heard. That gives you an opportunity at the top of the conversation to know what knowledge base you’re working with, as well as where kids are getting their information.  Gently correct any incorrect information they might have.  Give your child room to feel disappointed, nervous, or any other totally understandable “negative” emotion that we’re all feeling right now.  Let them know grown-ups are frustrated/nervous, too.  I would say that we know for a fact that kids going to school is important and good for them.  Since COVID is still around, we need to find a way to get them to school but everyone is also trying to keep them as safe as possible.  You can ask them what they think of each individual safety measure, and try to help them understand what each measure is trying to accomplish.  I would end by emphasizing we’re all in this together, and that they have (we all have!)  an important role to play in defeating this virus by following the safety precautions that have been set out.

Are there behavior red flags we should be watching for to monitor anxiety/depression in our children during this time?

Watch for changes from your child’s baseline behavior.  Are they eating more/less?  Sleeping more/less?  Not taking care of their appearance the way they usually do?  Have they lost interest in activities they usually enjoy?  Are they making negative comments more often than usual?  If you’re worried, it’s totally ok to ask them!  Give them room to feel sad.  Frequent check-ins are a good idea.  Always reach out to your pediatrician if you have additional worries/concerns.

How do we talk to our children about the unknown of holidays (likely no trick or treating, Santa visiting everyone’s house, etc)?

This depends on how you celebrate holidays. I think decorating the house/yard and driving around to see christmas lights is still fine.  I feel like trick-or-treating could be done safely (I was thinking of wearing a mask, insisting on the person holding the candy bag wearing a mask, then ladling candy into the child’s bag).  I don’t think pictures with Santa or flying to a big family gathering would be safe right now.  I would emphasize that this isn’t going to be forever, and that we’re all working together to defeat this virus.  Think about ways you could still incorporate your usual traditions (can you do a zoom call with distant family?  Can you do a socially-distant Halloween parade in your neighborhood?).

Suggestions on how to build a small community that we can socialize within in a healthy way.

Quaran-teaming is definitely a thing.  If you have one or two families that you’re close with and you’re confident are taking quarantine as seriously as you are (staying home, wearing masks consistently, frequent handwashing, etc), it’s possible to spend time with that family.  The idea is that the other families are taking quarantine as seriously as your family, so interacting with them should be like interacting with other members of your own family.  I would say that, if you trust the other families, you could forget about social distancing.  However, every contact with another person is a possibility for transmission from an asymptomatic carrier.  Just be careful.

What language should we be using to discuss the current concerns right now with children without creating fear? How much should we be discussing this with our children?

You know your child best.  It depends on their age, maturity level, sensitivity, etc.  I would recommend not having the news playing in common areas.  I wouldn’t leave the paper or news magazines lying around where child who can read will see them.  I would try to keep adult conversations about stressful events out of range of little ears.  I typically advocate not bringing up the topic if the stress caused by the topic out weighs the value of the child hearing about it.   

If you feel it’s important to address the topic with your child, I would start out by saying, “You might have heard people talking about (stressful news event).”  Again, this gives you an opportunity to find out what your child knows and where they’re getting their info from.  I would ask if they have any quesitons about it.  If no, I would express to the child what you think they should know.  I would follow that up with another ask about any questions.  If no, let it go for the time being.  I would recommend checking in periodically to see if you r child has any new questions.  

Learn more from Dr. Di Enno’s Facebook talk about children and anxiety and depression.

Questions about Returning to School In Person

How can we help alleviate the anxiety about returning in person?

Start with a general “How do you feel about returning to school this year?” or something similar.  Allow the child room to express their concerns.  If the child states they don’t have any particular feelings about it, you could follow up with, “Some kids feel nervous about going back to school with COVID still around.  Are you nervous at all?”  Allow the child to express their feelings.  Normalize their anxiety.  Review all the ways you and the school are working to keep them safe.  Solicit any additional questions.  Check back in periodically.

How can teachers help students safely socialize/run small groups in school?

I’ve seen group tables with plexiglass dividers, that looks like a safe option.  Teachers could additionally consider using chalk to mark out socially distanced spots for talking or circle time.  Would strongly recommend continued mask wearing during these groups and frequent hand-washing after.

How often should children and teachers be washing/sanitizing their hands? (most teachers do not have a sink in the classroom so it would mostly be sanitizer).

I would recommend any time they change tasks, in addition to all the usual recommendations (before eating, after playing, after using the toilet, after sneezing/coughing).

What precautions should be done for eating meals in the classroom since the cafeteria will be closed?

I would recommend desks distanced 6ft apart, washing hands before and after eating.  Holding trash at desk until children are individually called up to throw out (to avoiding crowding at trash can).

Should there be concerns about spread if handing out paper worksheets to students?

An understandable fear, but I think risk is relatively minimal.  I would recommend the teacher use hand sanitizer before passing out papers, then use it again once she’s finished.

How do we talk to young children about wearing masks for extended periods of time?

Gauge their attitude about it, why they think we’re doing it, and what they’re comfort level is with wearing the mask.  I would answer any questions they have regarding why it’s necessary.

What should parents be asking about the cleaning supplies? Is there an ingredient that parents should be concerned about exposure in the long-term?

Schools should be frequently disinfecting high-touch surfaces (e.g. door knobs, railings, faucets, etc).  The CDC has a list of disinfectants that are acceptable, including Lysol, Caviwipes, OxyClean, and household bleach.  70% alcohol is also acceptable.  My main concern at this time would be kids possibly have mild asthma flares if exposed to cleaning chemicals (think entering a bathroom immediately after cleaning with dilute bleach).  At this time, I’m not concerned about other long-term consequences of being exposed to cleaning products.

 

Questions about Virtual School 

Do the benefits of extended hours above the AAP recommendations for screen time outweigh the drawbacks?

The AAP recommendations for screen time are for *passive* screen time.  Think– watching non-educational movies, watching non-educational YouTube videos, playing non-educational video games, etc.  Screentime that is associated with schoolwork is not counted in the screentime recommendations.   That being said, I know all of our kids (mine included!) are definitely getting way more non-educational screen time right now.  In times like this, I think we all need to be a little easier on ourselves.  Try to break up screentime throughout the day with chore breaks, walk breaks, reading breaks.  We’re all doing the best we can right now. 

How can we combat depression in our kids when under social isolation?

The first step is being aware.  I’ve talked earlier about being alert to changes in your child’s attitude/habits and checking in frequently to see what they’re thinking and how they’re doing.  After that, you could consider scheduling socially-distanced social activities (e.g. playing video games seated 6 ft apart outside and masked, watching movies outside seated 6 ft apart and masked, riding bikes around the neighborhood masked, Zoom hang-outs, etc).  If you’re concerned about depression/anxiety, you can always reach out to your child’s pediatrician to discuss his/her symptoms.  The AAP’s website also has some really amazing COVID resources, including for mental health concerns. HealthyChildren.org also has some terrific advice for families.

How do military children who have moved during the summer connect socially if there isn’t school or activities happening?  

I would recommend trying to set up Zoom hangouts with their friends from their previous duty station.  See what the school is doing about classes.  If your child is one of the ones heading back, there will still be a chance to meet new people (and potentially have Zoom hangouts).  If your child is doing virtual school only, it might be harder.  I might check in with the Armed Forces YMCA and USO in your area and see if they’re hosting any welcome events for families who have recently PCS’d (I know Blue Star Families is holding virtual welcome events in September).

Are there associated developmental concerns when doing virtual learning/social isolating? If so, how do we, as parents, combat that?

Lots of parents are worried about their kids’ development, socialization, and schooling right now.  The main concerns I have are for the special needs children who need more intense structure and scheduled services to maximize their learning/development.  Fortunately, the people who work in that community are absolute superstars, and they’re doing their very best to make sure ABA, OT, etc are still being provided to the kids who need it.  While it’s not a developmental concern, peds and parents are worried about depression in kids resulting from prolonged isolation, a topic we’ve addressed above.  For questions about making the most of learning from home and stimulating younger childrens’ development during quarantine, I’ve frequently recommended checking out AAP.com and HealthyChildren.org.  Both have pages and pages of high-quality information.

A note about Self-Care

This one is a personal note from Mil Mom Adventures. Parents – I see you. I understand the pressure. It can feel overwhelming. It feels physically heavy. Making the decision on school is personal – it is best to make the best decision for your family using the best real information you can gather. You also need to take care of yourself. Self-care is not showering or eating daily, although we often group them into self-care – these are daily habits we should do for ourselves. Self-care is doing something to fill your cup beyond what you need to survive. We need to take care of ourselves so we can thrive, and continue to pour into the little people we are taking care of and raising. Please put self-care into your daily plan.

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This post is sponsored by XpertCare. The goal of XpertCare and MilMomAdventures is to provide accurate information for parents. In addition to providing pediatric telemedicine care in California, XpertCare’s team is a resource for families across the globe. Currently, XpertCare provides weekly talks on various topics on their Facebook page for free!

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