Consider Kids
OK, team! I’ve been rollicking around in my recent optimism-meets-realism pandemic posture, but today I’m taking a break and delivering you a guest post.
(Though if you want to meet the academic guru of public health, vaccine optimism, and nuanced messaging around complex health issues, I do hope you watch my uncut interview with brilliant and hilarious Dr. Monica Gandhi at UCSF.)
So tonight while I sip my hot chocolate (that may or may not be spiked), you’ll get a dose of wisdom from my friend and NYC pediatrician, Dr. Kelly Fradin.
Since the pandemic hit, Dr. Fradin has provided a wealth of information to a wide audience through social media, her newsletter, and (can you believe this?) the BOOK she wrote about parenting in the pandemic.
Dr. Fradin and I agree that mental health and physical health go hand-in-hand—and that we best serve our patients (and their parents) when we provide realistic, practical advice that is rooted in science.
I hope you enjoy her sage advice as much as I do!
TEXT
One of the best things social media is connecting with new people. This pandemic, I have so enjoyed connecting with Dr. Lucy McBride. Her newsletter shares exactly the sort of information and COVID analysis I’ve shared for a parenting audience on instagram, but more than this we share a deep understanding that the psychosocial fallout from this pandemic is of great importance. Helping people process this pandemic in an evidence-based, empowering and reassuring way is our way of helping to reduce systemic levels of anxiety.
So as a pediatrician, what do I think is most important to discuss now?
The US is steadily recovering from the massive holiday peak of cases. Given the inherent lag between diagnosis and severe illness, we should see more impressive improvements in hospitalizations and deaths over the weeks to come.
Unfortunately, still to come is likely another few hundred cases of MIS-C (Multisystem inflammatory syndrome in children). For every 10,000 cases of COVID-19 in children, another 1 or 2 children present with MIS-C four to six weeks later. While this hasn’t been in the news recently, slowly but surely the cases have piled up, and it’s worth remembering if a child seems very sick with fever and two body systems affected such as rash, dizziness, abdominal pain or distress, fatigue or other neurologic changes, the child may have MIS-C. MIS-C can follow even a mild or asymptomatic case of COVID-19. Thankfully despite the severe nature of this syndrome, which requires intensive unit admission, most children diagnosed with this have done well and been discharged within a week with anticipated full recovery. I feel certain that prompt recognition and treatment are important factors in the positive outcomes, so read more about this here.
Feeling back to school anxiety?
I’ve been an advocate for reopening schools responsibly since May of 2020 when we started to see data about children’s role in COVID-19. It’s fantastic news that additional school districts are reopening in DC, Atlanta, Virginia and finding ways to open to educate students while mitigating the risk. Every time a new large district opens, there is more anxiety and more headlines highlighting the risk, but from a scientific perspective we have a consensus based on data from many countries and many different areas of the US, schools can reopen safely with precautions without leading to outbreaks.
If you are a parent or a teacher trying to grapple with the change of seeing students return to in person education and not easily intimidated by data, you can review the data summary from Mass General on the subject. It’s dense but summarizes the bulk of the evidence available to support these reopening. In the coronavirus chaos it may feel like “nobody has any idea what they are doing”, but every day we learn more and districts opening now should be just as likely to succeed as the many of those that have been open since September.
Will the new variants change things?
Potentially. P.1, B.1.351 and B.1.1.7 do seem likely to become the predominant circulating variants of COVID-19 in the US and may lead us to a new surge. However it’s worth remembering, we will see warning signs if new variants begin to cause increased transmission. While we aren’t testing or sequencing as frequently as I would like, we will see increasing numbers of these strains (there is a CDC tracking dashboard) and we will see cases begin to increase. No evidence suggests that children or adults are affected in a more severe way, only that increased transmission leads to more cases which is a big problem overall.
As Dr. McBride said in her prior newsletter it’s a race between vaccination and viral ingenuity. Within the context of schools, where schools have been open for some time, we find adherence to quarantine guidelines functionally “checks” our ability to continue in person school. If a community starts to be hit hard by a surge in viral transmission, we’ll see large amounts of quarantine functionally shutting down schools.
This is partially why NYC and other school districts have relaxed their original opinions about what percent positivity is required to keep schools open. We have seen even when 5% of tests in the community are positive, only around 0.1-0.2% of students randomly tested are positive and with masking and cohorting spread is rare within schools.
What do families need to make it through this spring?
Persistence and resilience. The New York Times’ “Primal scream” gave voice to something that many working mothers have been experiencing - that pandemic stress has been at a breaking point for far too long. As we round into a year of coping with this stress, it’s no surprise that many are struggling COVID-fatigue.
When things change, even in a good way it’s very stressful. Pediatricians and parenting specialists have been championing practices to optimize resilience for years. We know that embracing these evidence-based strategies can protect children from the consequences of toxic stress. What are these magical strategies? They are simpler than you might think.
We can use challenges as opportunities to help our children develop coping strategies. These coping strategies will help with this crisis and the ones that follow.
We know that having a “a parent you can talk to” is a predictor for children’s resilience. At a time of so much isolation, finding ways to connect in a positive way with your children is more important than ever.
Will the kids be all right?
We have no evidence to guide us about this as nothing quite like this has happened before. Prior pandemics like MERS and SARS have caused epidemics of anxiety, depression and PTSD. Undoubtedly some children, particularly tweens, teens and young adults will require support to get through the fallout from this pandemic. Investing the time and energy in connecting these children with good resources doctors and therapists to help support them can be life-saving.
The children I worry about most are those who have been hardest hit. Families with children with special health or educational needs may require more support to catch up from what they have lost. Additionally children from low income communities where there has been limited access to education will require more investment to recover from this pandemic.
Some of the common concerns I hear about are overblown. Children can continue to develop communication skills and emotional literacy even if they are masked. Our children may be behind academically, as parents we aren’t running at 100% efficiency either, but children should be able to “catch up” in the years to come with appropriate support. Children learn a lot of social skills from everyday life at home with their parents and siblings, and again will have experiences in years to come to fill these gaps.
If you found this helpful I’d invite you to check out my book Parenting in a Pandemic or follow along on instagram/facebook/my newsletter to learn more about my perspective as a pediatrician and a mom reflecting on the pandemic.
I hope you enjoyed this post.
I will see you next week to talk more about double-masking, the vaccines, the new CDC guidelines on quarantine, and more! Also join me and Dr. Clay Ackerly on Monday, February 15 at 8 pm on Facebook live to answer your questions.
See you then. Until then, be well.