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How COVID-19 is affecting children

With summer here and children itching to get outside and play, we know many parents have questions about how to keep their kids safe. Dr. Summer Day, Gritman | Moscow Family Medicine physician and pediatric hospitalist, has the latest COVID-19 updates and advice.

Q: How will I know if my child has COVID-19?
A:
Many children won’t show any symptoms. However, these children would still be able to spread the virus. For others, it will look just like a mild cold, with a runny nose and cough. Some experience more moderate illness, with fever, chills, body aches or pneumonia. Some children also have diarrhea, nausea or vomiting. You should watch for fever, prolonged respiratory symptoms, a worsening cough or any significant energy drops. If you are concerned your child may have COVID-19, call your doctor or our COVID-19 Hotline at 208-883-4109.

Q: What about the inflammatory illness associated with COVID-19 that is making children ill?
A:
The illness was first called pediatric multisystem inflammatory syndrome (PIMS or PMIS) and is now being referred to as multisystem inflammatory syndrome in children (MIS-C).

Children are presenting with signs and symptoms of widespread inflammation and may have symptoms similar to a known illness called Kawasaki disease. In this disease, children have prolonged high fever, skin rash, conjunctivitis (red eyes), swollen hands or feet, red lips or tongue, and swollen lymph nodes. It can go on to cause heart problems.

For MIS-C, patients do not have all the symptoms of Kawasaki disease, but they all have fever and most have been very ill. They have also had more GI symptoms (nausea, vomiting, abdominal pain) than typically seen in Kawasaki. In severe cases, especially ones you’ve heard about in the news, it can present as shock, where patients can’t maintain their blood pressure and require intensive care.

You can find more information on the Centers for Disease Control and Prevention website.

Q: Are we sure it is caused by the novel coronavirus?
A:
Not yet, but it is suspicious. Right now it is just being described as an association without causal link. Many areas with high prevalence of COVID-19 are seeing much higher rates of this inflammatory illness than typical. Most, but not all, of the patients presenting with MIS-C have positive SARS-CoV-2 antibodies or known exposure to COVID-19. We know Kawasaki disease may be related to other viruses, so this link makes sense. Doctors suspect that coronavirus (and other viruses) can cause a delayed reaction in the body that triggers an overreaction in the immune response.

Q: Should I be worried about MIS-C?
A: Yes and no. We, as parents and physicians, will always worry about the potential for serious, critical illness or death. But this is still very rare. Currently, we are only seeing it in places with major outbreaks, where thousands of people are getting COVID-19. The good news for people on the Palouse is we have an extremely low prevalence of COVID-19, and I do not expect to see this illness until we have much higher rates in our community.

Q: If my child has not been sick, is it OK to have playdates with other children?
A: The answer to this depends on a number of factors. When this all started and we were under stay-at-home orders, it definitely wasn’t recommended. But now that things are opening up, small gatherings with people who are low risk, especially gatherings outside and for limited amounts of time, are reasonable, as long as everyone is healthy.

Q: Is it OK for my child to attend summer camps? 
A: In low prevalence areas, outdoor day camps are probably safe. Overnight or sleepaway camps, especially those with children coming from other states and by airplane, are the greatest risk and should likely still be avoided. The American Camp Association has a guide with recommendations for operating camps.

Q: Is it safe to take my child along while I go shopping?
A: I’d still recommend against it, especially for children who have problems wearing a mask and touching stuff. For some people, though, it is not a choice – in order to get food, they have to take their kids to the store with them. If this is the case, I recommend talking to them in advance about staying close, giving other people space and wearing a mask if they are able.

Q: Is it safe for my child to be in daycare?
A: Many parents have asked me if their children should return to daycare. My advice to all:

1. On the Palouse, with our low prevalence of COVID-19, it is reasonable to have children return to daycare. I would make sure your center is following CDC guidelines.

2. If your child is high risk (moderate to severe asthma, immune compromise, other chronic health condition), or if they come into contact with someone who is high risk, you should seek your medical provider’s advice as to whether continued avoidance is recommended.

3. Be prepared for continued sudden closures when staff become ill, as well as the potential to have to pay for childcare and not be able to send your child when they have even mild symptoms of illness.

Q: If my child is sick or is scheduled for a routine visit, is it safe for me to bring them into your clinics?
A: It is definitely safe at all of our clinics and at Gritman. There are protocols in place to keep infection from spreading. All patients are now screened for symptoms of respiratory illness prior to their appointments, and everyone entering our facilities is required to wear a facemask. We have also rearranged our lobbies and processes to allow for appropriate social distancing.

We are also offering telemedicine appointments. The majority of insurance plans now reimburse these the same as a regular office visit. Know that your doctors want to continue caring for you during this difficult time, and we’re doing everything we can to keep you safe and healthy.

Q: What are some of the best ways I can protect my child from the virus?
A: Wash hands, use hand sanitizer, practice social distancing and avoid people who have symptoms.

To learn more about how Gritman is working to keep you safe, go to gritman.org/coronavirus.

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