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Every conversation I have now with parents comes back to questions about COVID-19. Everyone is looking for answers. Dr. Elissa Rottenberg is my go-to answer doc. She earned her undergraduate degree from Princeton University in 1994 and her medical degree from Harvard Medical School in 1999. She was a chief resident in the Children's Hospital Boston and Boston Medical Center's residency program, is a fellow of the American Academy of Pediatrics, and holds a teaching appointment at Harvard Medical School. She now practices primary care pediatrics in Newton, Massachusetts.
She's also my sister-in-law. And in every tricky medical situation for the last twenty years, I've picked up the telephone and called her. I was delighted she agreed to respond to my questions publicly this time. So here, exclusively on The Nonlinear Life, are her answers to the six most common questions parents have about children and COVID-19.
1. Let's begin with the current moment. What are you seeing in your practice with Omicron right now that feels different than the past?
We're seeing significantly higher rates of infection with Omicron than we did with previous COVID variants. Around my office, we’ve been using the phrase ‘spreading like wildfire.’ I've seen it move rapidly through entire sports teams, carpools, and teenage parties. One encouraging note: I haven’t seen Omicron spread rapidly through classrooms—so our masking policies are working!
Another piece of good news: Most of the Omicron infections we’re seeing in children and adolescents are mild. I work in a highly vaccinated, reasonably healthy population, and that’s made a difference. I would caution, though, that because children display mild symptoms, families are more likely to go about their normal routines, thinking, This can’t be COVID. If a child shows even mild symptoms, it’s important to check with your doctor to make sure they don’t spread the disease unknowingly.
Also, one more cautionary note: Some people who get Omicron will get seriously ill—and people who are unvaccinated or have immunocompromising medical conditions are at especially higher risk. And hospitals are full right now, so we need to continue to be vigilant.
2. What advice do you have for parents about how to tell the difference between the sniffles, a cold, the regular flu, or COVID-19?
None of us can tell the difference, so you're not alone! The symptoms of COVID have varied with each new strain. With Omicron, we're seeing a lot of nasal congestion, coughs, and sore throats. For children who do get a fever, it’s usually low-grade. So, yes, there is a lot of overlap among regular colds, the flu, and COVID. If in doubt, keep your child home from school—and sports practice—and call your doctor for testing.
Also, a plug: Be nice to your doctor! In the first week of January, my office was the busiest we have been in 20 years. There were days I just didn’t know if I would be able to get everything done–see patients, send off COVID tests, follow up on results, complete patient charts, and return phone calls to parents who understandably had many questions. On top of that, hospitals were backed up getting us test results, and I had multiple patients with pressing non-COVID issues. I know that parents can sometimes get frustrated with delays—and we share those frustrations—but please be patient. We’re trying our hardest!
3. What about school? Under what circumstances should parents keep their children home from school? And if children are otherwise healthy, what are the risks of going vs. not going to school?
For the most part, unless your child has COVID, was directly exposed to someone who has tested positive, or has COVID-compatible symptoms, parents should be sending their children to school. From the last two years, we know that staying home from school can lead a child to fall behind academically and experience social isolation. Last year, a report from McKinsey & Company found that kindergarten through high school students fell behind on average five months in math and four months in reading by the end of the 2020-21 academic year. We can’t let that happen again.
Also, while transmission can occur in school, preventive strategies can be effective, including vaccination, masking, social distancing, improved ventilation, and staggered lunchtimes. Even in daycare centers, where children are too young to wear masks, preventative measures have been helpful, including cohorting infants and toddlers into smaller groups and insisting adults wear masks.
Naturally, there are situations in which parents may want to consider keeping higher-risk children home for brief periods of time. In the Northeast, we saw this in early January when certain communities experienced surges in cases. But these situations should not be the norm. When they do happen, parents should work with their child’s school to make sure students keep up with their coursework.
4. What should families do if one member of the family tests positive, whether it's a parent or a child?
First, don't freak out. Second, try to make rational decisions. Third, if members of your family are vaccinated, the chances are very good that you’ll all get through this without serious problems.
Now, what should you do? With Omicron, I've seen a lot of spread within families, but you can reduce the risk. Do what you can to isolate the infected family member while also being careful not to over-isolate and contribute to mental health problems. Some families with older children can have a child stay in their own room, use their own bathroom, and eat separately from other family members. Other families can’t do this. If your child either can’t isolate or needs supervision, then have everyone at home wear a mask if they are able to do so. And choose well-fitting masks, like KF94, KN95, or N95, if possible. If those aren’t available, any mask is better than no mask.
Also, make sure you keep up with federal and local regulations regarding isolation and quarantine, as these are changing all the time. If you’re not sure what to do, reach out to your child’s school, pediatrician, or local health department.
5. What tricks do you have for parents who are having trouble keeping masks on their children? And should they be worried about children not learning how to read facial expressions or other nonverbal communication?
This is one area where the news is wonderful. I’ve been blown away by how natural it has become for young children to wear masks. Kids are adaptable—and they want to do what everyone else is doing—so if they see everyone around them wearing masks, they are usually happy to wear them.
Also, unlike at the start of the pandemic, when children were stuck wearing adult-sized masks, manufacturers have been great about creating masks to fit smaller faces. And masks have become a way for children and teens to express their personalities. I've seen princess, dinosaur, and superhero masks for young children. For adolescents, I’ve seen masks used to make fashion statements, political statements, or to show support for their favorite sports teams.
As for reading facial expressions, I remember seeing a six-month-old baby early in the pandemic. I smiled behind my mask, and to my amazement, the baby smiled back at me. How could the baby know I was smiling? I quickly realized that the baby was reading my facial expression from the crinkles in my eyes. I’ve been thrilled to see data that supports this. In a November 2021 article published in the journal JAMA Pediatrics, 300 children aged 3-6 were able to identify an actor’s emotion—joy, anger, or sadness—equally well whether or not the actor was wearing a mask.
6. Finally, children and mental health. What have you seen? What are the warning signs? And what should parents do if they are worried, but don't know how to respond?
We are experiencing a true mental health crisis in children of all ages. (And many adults, too.) Anxiety is high; levels of depression are elevated; social isolation is real. I receive phone calls every day asking for referrals to therapists and psychiatrists but finding appropriate resources has become challenging. At times, our local pediatric emergency rooms have been more than half-filled with patients waiting for placement in mental health programs.
My advice to parents is to look for warning signs. These signs can be nonspecific–mood swings, emotional volatility, an adolescent wanting to spend more time in their room, a teen not wanting to see friends, a child not wanting to participate in a beloved activity. If you’re worried at all, please seek out an expert.
As for some positive things you can do—eat a family meal together every day; if you can’t do dinner, try breakfast or a late-night snack. These family gatherings are a wonderful time to gauge your child’s emotions. Also, try to make time for family activities your children enjoy—from playing games, to doing puzzles, to movie nights, to spending time outside. One of the biggest side effects of COVID has been social isolation; anything you can do to preserve family togetherness will help all of you get through this time.
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