One of the less scary aspects of the coronavirus pandemic is its effect on children. According to the Mayo Clinic, children of all ages can become ill with COVID-19, but most who are infected typically don’t become as sick as adults. Some might not show any symptoms at all. During a recent Black Health Matters Facebook Live, Pamela Huffman-DeVaughn, M.D., a pediatrician at the Pediatric & Adolescent Medicine Centers of Philadelphia, talked about signs to look for in your children and how to best keep children safe. This is a condensed version of that event.
Black Health Matters: How has your medical practice changed or adapted in the past 3 months in light of COVID-19?
Pamela Huffman-DeVaughn, M.D.: The volume has decreased, mainly because parents are afraid to come to the office. They’re afraid their child may get COVID-19. So, we’ve had to strategize and change our office with safety protocols in place so parents will feel safe in the office. Also, we’re seeing a lot of newborns, 6 days old or 9 days old. We did not want to expose them to sick children, so we rearranged our schedules [so that] we would see well visits and immunizations in the morning, and we handled sick visits by telehealth. If their child needed to come into the office, we would schedule them near the end of the day so as not to have patient-patient contact.
BHM: What precautions are you advising parents to take when they do come into the office?
Huffman-DeVaughn: We ask [parents] to call the office first and there will be screening questions asked, and we can decide if that child is sick, [whether or not] we can handle it in the office or if we can handle it by telehealth. Then, we need to schedule them and bring them into the office. We also ask that they wear a mask if their child is over two years of age, [and that] the parent wears a mask. The staff [are] wearing masks to protect the children as well as the staff. We want the children to come in because we found immunization rates dropping. The CDC has advised us we need to advise parents to come in to have their child updated on immunizations. We started this earlier, before the CDC recommended it. But, if the immunization rates drop, then we will have a re-emergence of these vaccine-preventable illnesses, such as whooping cough, measles, bacterial meningitis and, leading into the fall, influenza and COVID-19. We do not want that to happen. If that should happen, that would be disastrous to the children as well as the country. So, we’re encouraging parents to take their child to the doctor to get a well visit, update the immunizations and any chronic medical illnesses.
BHM: How can a parent protect a newborn during doctor’s visits?
Huffman-DeVaughn: Please, don’t put a mask on a newborn. You can protect the newborn if the mother has on a mask or the father has on a mask and the staff has on a mask. You’ve protected them. And we clean surfaces and wash our hands. Don’t put a mask on a kid under two years of age because they may have breathing problems.
BHM: What are the symptoms of a child developing COVID-19? Also, do you have any information on the COVID-19-related disease that is now affecting children?
Huffman-DeVaughn: There has been misinformation, but understand this is a new virus. It’s only five months old. It was discovered in December 2019 so this virus is evolving. We may find six months from now we will find some other symptoms. Basically, children do get sick but the cases are mild. So, they may just have the common symptoms of fever, cough and maybe some shortness of breath. If they have shortness of breath, they have to come in or go to the emergency room. They may also have other associated symptoms—sore throat, headache, vomiting, diarrhea, muscle aches.
What is evolving recently is this new illness that is severe and is thought to be associated with COVID-19. It’s similar to a disease which is a rare disease that I’ve treated in the past called Kawasaki’s Disease. We don’t know what causes Kawasaki’s Disease. The CDC seems to think this new illness—called multi-system inflammatory syndrome—is associated with COVID-19. Why is it multi-system? Because, it affects many systems of the body and it’s inflammatory because it’s a severe inflammatory reaction thought to be due to COVID-19. This is where you want the parents to listen and watch their child, particularly if they’ve had a COVID-19 infection because this is a post-infection syndrome. Some of the things you want to look for are a fever that lasts more than four to five days, red eyes but they don’t have discharge like you see with pink eye, cracked lips, a strawberry tongue—when they stick their tongue out there are red bumps. Sometimes they may have a red rash, swollen lymph nodes in the neck, and swollen hands and feet. If your child has any or all of these symptoms, call your doctor immediately. If you don’t have a doctor, take that child to the emergency room. If we get those children in early, they do very well. Unfortunately, because it effects the heart and blood vessels, these kids may have low blood pressure, go into shock and die. We have lost some of those kids.
Just another point: Lately we found it’s affecting Afro-American and Afro-Caribbean kids more than other kids. So, I just want the parents to be on the lookout for those signs and symptoms. I don’t want you to worry, because it is a rare illness.
BHM: Does multi-system inflammatory syndrome mostly affect infants, toddlers or adolescents?
Huffman-DeVaughn: It’s affecting children of all ages. Recently we had this young lady who is a preteen have it. The older kids may not present with all the symptoms like the younger kids. But what we’re seeing from the reported cases is it is affecting all the age groups in pediatrics.
BHM: If a parent becomes infected with COVID-19, how can they protect children living in the same household?
Huffman-DeVaughn: It’s hard to isolate, and we’re seeing that on Native American reservations, especially if you have multiple kids in the family. But the best thing you can do is, if that child is infected or if that parent is infected, wear a mask in the house to protect the other people from being infected. Let them eat out of disposable plates, cups, utensils. Make sure you disinfect the area. And if you can allocate that person to a bedroom by themselves or bathroom by themselves, that would be great. That’s hard to do with a lot of people, but if you have the ability to do so, do that. That will help.
BHM: How can we safely visit children that are not living within our household?
Huffman-DeVaughn: Now you’re asking the million-dollar question! That’s what everybody wants to know, including me. The government is doing this testing. They are trying to test as many people as they can. Once they don’t have many new cases occurring, then I think they can make a decision. Right now, just give them air hugs. Talk to them by Zoom or FaceTime. And, certainly, grandparents, you want to show precautionary measures around them.
BHM: What are some of the things parents should consider as cities are reopening?
Huffman-DeVaughn: We look at all of this confusion going on. Some governors are opening up states, some governors are still on lockdown. What I want the parents to do is what my mother would say: Just use common sense. We know certain measures we have taken halted, or slowed down, this virus. But we have no medications for it; we have no vaccines for this virus. So, the best we can do is practice preventive measures. Make sure your kid is eating well, getting a good night’s sleep, exercising and staying hydrated. The main preventive measure you want to do is to stay home as much as possible and avoid crowds and large gatherings
Make sure they wash their hands for 20 seconds with soap and water. If you don’t have that, you can use hand sanitizer. Parents can teach their kids to wash their hands [by] singing the ABC song. At least they can learn their ABCs! Regardless of what you hear from government officials, wear a mask. The Korean population did that and they really slowed this virus down. Wear a mask. If you wear a mask, that protects me; if I wear a mask, that protects you. If they go outside, wear a mask. We also want them to practice social distancing by standing six feet away from people. That helps because this virus is spread by droplets. If you’re close to somebody and they sneeze or cough, you could get infected.
BHM: What are your thoughts on child-care centers reopening?
Huffman-DeVaughn: It depends on how many kids go to that child-care center, and if they are able to separate them about six feet. I saw some child-care centers that had a long table where a child was at one end and one was at the other end, and they had masks on. But, if you have a large child-care center, that’s going to be difficult. If you just have one person taking care of your child, that’s OK, as long as that person does not have COVID-19. If I had one person caring for my child, what I would do is have that person checked for COVID-19 before they start taking care of my child. And, you can get those tests done in a lot of places now, such as Walgreens or CVS. You don’t have to have symptoms, or you can have symptoms and they will let you self-swab. You get the test results in about two to three days.
BHM: If a child catches COVID-19, and then recovers, will they be immune to catching it again?
Huffman-DeVaughn: Now we don’t know that. The research is ongoing. When you build up antibodies, that should protect you. But we don’t know if this particular virus does that.
BHM: How should parents be talking to their children about the pandemic?
Huffman-DeVaughn: Make sure you’re calm when you are talking to the kids. You also want to be hopeful. You want to speak to them on their developmental level. You could ask, ‘What do you know about this new sickness that we have?’ For younger teenagers, ‘Tell me what you know about COVID-19’ and that can start the conversation. Don’t assume they don’t know. With teenagers, you can start with, ‘Tell me what you know,’ and if there’s any misinformation you can correct them.
When you talk about this, get to the point. Mention what we can do to fight the virus, such as ‘wear a mask when you go outside,’ ‘wash your hands to the ABC song for 20 seconds’ and ‘we’re going to try to stay away from some of those other people so we can decrease the spread of the virus.’ Speak to them on their developmental level and you don’t have to go into a lot of details.
BHM: What do parents or caregivers do for their children if they live in a shelter?
Huffman-DeVaughn: I would do the same thing as if you were living in an apartment or a home. Just make sure the child washes their hands if they touch different surfaces. Make sure when they go outside they wear masks. If their child is sick, that’s different and that child has to wear a mask for the protection of others. Just try to make sure the child gets enough sleep and stays hydrated. If you can use some disposable ware, like plates, cups, utensils, let that child eat out of those.
BHM: Is there any other information we have not covered that parents may want to know?
Huffman-DeVaughn: We’ve had a decrease in illness because school is out. We actually see increase in illnesses in children when school resumes. That’s when influenza spreads so that’s going to be a controversial decision. If there’s a way they can set up the schools where these kids won’t have so much contact, it would be optimal. I just saw on the news this morning where in Korea each child has a plexiglass around their desk and they have masks and they wear gloves. I think that’s neat; we’ll see how it works. I would suggest, if it were my child, try an alternative activity for them this summer where they’re not in groups. They can take music lessons or take dance lessons or something where they’re not in a large group, unless those camps have ways they can make people feel safe. With children together, they’re not going to keep their masks on and they’re not going to wash their hands as often as they should so. That’s going to be a challenge.