My 10-year-old son’s sizzling, empty cough lasted for a weekend. He showed no other symptoms, and his chest barely bounced as he turned his head to point at his sleeve. It was early March and reports of an outbreak seemed distant, in Washington state and abroad. We convinced ourselves that we were safe on the east coast.
When my 7-year-old son developed a similar dry cut, it was more powerful and persistent, and was accompanied by low fever and fatigue. My sick son insisted on sleeping in my bed, hugging me and holding my hand to comfort me, making it difficult to dodge the cough overnight. In a few days it was as if the children had never been sick. But a week later, I developed that same cough, and my symptoms quickly progressed to pneumonia. A chest x-ray and other tests confirmed that he had covid-19.
I have recovered, for the most part, although I am still dealing with fatigue and some other lingering symptoms. But now, as many states have started to reopen and families are retreating back to normal, including larger camps, activities and gatherings, I am concerned that health and safety will become an afterthought. And I’m concerned about the challenges parents who care about sick children face as they try to stay healthy.
Angela Rasmussen, a virologist at Columbia’s Mailman School of Public Health, says that despite early reports that children were largely unaffected by the new coronavirus, children are at risk of contracting and spreading the virus, And while most children can recover smoothly, parents should not assume that all children will be fine if they are exposed.
“A small percentage of infected children can develop a very severe covid and, in some cases, die,” says Rasmussen, emphasizing that even if the child does not become very ill, they can transmit the virus to others. “This is especially true for close contacts with those who spend a lot of time indoors, such as members of their household.”
I did not do a good job protecting myself from my children’s illness, and I am still living with the consequences. As children re-enter social settings, it is important to teach them to protect themselves while away from home, to reduce the risk of passing the virus on to their parents, says Kristin Moffit, a pediatric infectious disease specialist at Boston Children’s Hospital . And if they do get sick, there are some simple preventative measures you can take to try to minimize the chances of another family member becoming infected.
Monica Gri from Houston recently decided to send her 7-month-old and 4-year-old children back to daycare. Her husband is immunocompromised, and she acknowledges that the virus could easily reach her home, but she doesn’t feel like she has a choice. “In a perfect world, we would all stay protected inside and safe from all germs, but we tried for two months and it just wasn’t sustainable with both of us working,” he says, adding that he is taking precautions. “I do not allow [our 4-year-old] touch anything after school. When I lift her up, she covers her hands and arms in hand sanitizer. When we get home, it’s literally straight to the bathroom. The baby follows him. Her clothes are washed immediately. “
Moffitt says parents should plan ahead for the possible illness. Stock up on essentials, including over-the-counter fever medications, a humidifier, bleach, or other CDC-recommended cleaning products, hand soap, face covers, and some extra groceries, in case someone gets sick. Parents should also consider designating a punctual person outside the home who can bring supplies in case someone in the home becomes ill and the family has to be quarantined.
Rassmussen points out that if a child tests positive or shows symptoms, the best way to prevent the spread of the virus is to separate it from the rest of the home, but this is not always practical, especially for young children.
In those cases, Moffitt says, families should be creative. Children must sleep alone in a room, even if it means rearranging the bedrooms. If the bedroom is to be shared or the room is shared, she suggests sleeping from head to toe if the children are old enough or rearranging the furniture to reduce transmission. Good ventilation is key, because droplets can remain in stagnant air. Moffitt recommends opening windows and using fans.
Designate an adult, ideally one who is not in a high-risk population, to monitor and interact with the sick child, but even that person should keep contact to a minimum. If typical child caregivers are high risk, consider asking for help from other community members. If possible, both the child and the caregiver should wear masks. Moffitt says that caregivers can continue to breastfeed if children depend on it for comfort or nutrition. In this case, the adult should wear a mask and carefully wash the skin, including the chest and nipples as well as the hands, with soap and water after each encounter. Bottles used to feed babies should be sterilized after use.
Rachel Feichter of Washington, DC had a teenager with covid-19, but managed to prevent it from spreading throughout the house. Her youngest son is receiving chemotherapy and immunosuppressants for an autoimmune disease, so his family is often on high alert during cold and flu season.
As soon as Feichter’s teenager showed symptoms, he isolated her from other household members. Her daughter screamed when she left her room to go to the bathroom and everyone moved to a different area of the house while she left her quarantined space. Every time her daughter used the bathroom, she wore a mask and gloves, then Feichter immediately decontaminated that space and other surfaces that her sick son might have touched or breathed, while wearing a mask and gloves. She also cleaned door handles and kitchen surfaces at least twice a day and kept six feet away when caring for her son.
Parents of younger children may have to explain why precautions are so important. “Show them why they are apart and use age-appropriate language to explain the disease,” says Moffitt. “Use toys or videos to show how germs are transmitted from one person to another who is too close, and show which distances are safer.” If a child is to be held, caregivers should wear personal protective equipment and wash regularly.
Moffitt also emphasizes the importance of empowering children to be part of the solutions that the family develops. “They should be told that they are sick and that they need time and space to improve,” she says. “Show them that there are other ways to stay connected by using tablets or mobile devices. Brainstorm ways you can play while keeping your distance.” Examples include reading a book or telling stories from across the room, playing a game that requires no proximity, such as Pictionary or I Spy, or watching a movie. Make sure they have their favorite blankets, stuffed animals, and pajamas, and allow them to use communication devices when they feel alone.
“Wash favorite items and change clothes if they are wet or dirty, even if they have been biting or sucking cloth, but don’t be aggressive with frequent changes,” says Moffitt, noting that sick and grumpy children may be less apt for showers, and that’s fine. Physicians should limit contact with the child’s high-use items and wash their hands after touching them.
Physical distancing and other protective measures should continue for up to 10 days after the onset of symptoms, or until the child is symptom free for three days. Moffitt says that people who test positive are more infectious two to three days before and after developing symptoms, so that’s the time frame they really should focus on.
So it’s just a matter of waiting until a normal family life appearance can be resumed. “There is no magic secret,” says Fichter. “Just do your best and stay diligent as a family for a few weeks.”
