Stress, covid, other school-year worries: Experts give parents tips
As the new school year approaches, parents and children hope the return to the classroom feels as normal as possible. Public health officials and pediatricians, many also with children and grandchildren, hope so, too. What is different this year is that vaccines for the coronavirus are now available for all children 6 months and older - and more than 13.8 million children have had the virus since the start of the pandemic, according to the American Academy of Pediatrics (AAP).
But whether all of this may confer some immunity for them as another highly transmissible variant of covid-19, B.5, spreads rapidly is an open question.
With the onset of cooler weather this fall and more activity indoors, concerns exist about the new school year. The Washington Post asked public health experts and pediatricians about advice they have for parents as their children reenter classrooms - and also how those of them with children or grandchildren are thinking about schools. They all agreed that vaccinating children was the most important thing to do. Or as William Schaffner, professor of preventive medicine at Vanderbilt University Medical Center put it: "My first five recommendations are to vaccinate your children, vaccinate your children, vaccinate your children, vaccinate your children, vaccinate your children."
Responses have been edited for clarity and space.
Q: So, vaccinate?
A: Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and President Biden's chief medical adviser: Absolutely. Vaccinate your children. We vaccinate kids for a lot of diseases that have less morbidity and mortality than covid, and we keep those diseases down with vaccinations. Why wouldn't you want to protect your children against something with a rate of [sickness and death] greater than the diseases you already routinely vaccinate your children for?
Joanna Dolgoff, a pediatrician and spokesperson for AAP and mother of two teenagers: If you want schools to remain open and you want your child safe in the classroom, getting him or her vaccinated is the most important action you can take.
Katie Lockwood, a pediatrician with the Children's Hospital of Philadelphia and mother of an 11-year-old boy and an 8-year-old girl: Some families may be delaying because they expect the vaccines to change. There is no reason to wait. It's better for children to be immunized with the vaccine we currently have than wait for a hypothetical vaccine we don't have.
Tiffany Grace-Chung Munzer, a developmental/behavioral pediatrician at C.S. Mott Children's Hospital in Ann Arbor, Mich., and mother of a 5-year-old and a 9-month-old: During the last two years of the pandemic, we asked kids to sacrifice so much: in-person learning, playdates with their friends and travel. The best way to make sure things aren't more disrupted is to get them vaccinated.
Donna Tyungum, interim chief of pediatric infectious diseases at the Oklahoma Children's Hospital in Oklahoma City and mother of a 3-year-old: Covid-19 is now more transmissible with increased immune escape, which means that our children have a good chance of encountering [it] at school. Fortunately, we are in a much better place this year. Vaccines are available for every school-aged child, and layering protection with masking can help keep our kids healthy. Also, handwashing remains essential, and attaching a little sanitizer to your child's backpack won't hurt. Finally, keep an eye out for symptoms and use policies like test-to-stay to help keep more of our kids in the classroom.
My little boy is only 3, so not school-aged yet, but he is very recently fully vaccinated, which he handled like a champ, and he wears a mask around people outside of our household. Anyone around him indoors without a mask has a covid test first. If he were attending school this year, I would send him in a well-fitted mask, likely a child-sized KN95 at least for the first few weeks, hand sanitizer attached to his backpack, and I would talk to him about the importance of not sharing drinks and what symptoms to watch out for - and try to steer clear of - while at school.
Q: In light of the current mental health crisis among young people, how should parents handle kids' continuing fears or stresses about covid-19? What can parents say or do to ease their anxiety? What are you doing with your own kids?
A: Rochelle Walensky, director of the Centers for Disease Control and Prevention: I think we have to model the good behavior that can best keep us safe, including vaccination and wearing a mask. This also includes taking care of one another and not going out if you are sick. We can demonstrate that, if you do that, you are generally protected, which can be very reassuring to children. Also, listen to their fears, and ask them what they are scared of. Get into the weeds with them. Ask them to talk about their fears. Ask them for specifics. Take the time. Sit on the floor with them. Don't just say, 'It's going to be all right.' That's dismissive and doesn't address their concerns.
Schaffner: You need to emphasize how effective vaccination is, and that we are all working on this together. Explain that the school has good procedures in place to minimize risk. Emphasizing this in a positive way will provide reassurance and confidence in your children. Hugging them also is a part of that.
Dolgoff: Open communication is the key. Let your children know they can talk to you about their fears. Validate their feelings. Tell them: "I can understand how you feel. This can be scary. However, there are lots of things we can do to keep ourselves safe." I see it in my patients all the time of all ages, ranging from mild anxiety to refusal to go to school. We work with mental health professionals to try to ease them back into school or continue with remote learning if they won't go back. It's much better now than it was earlier, but it's still an issue. My own daughter, who is 16, expressed some anxiety about returning to school after remote learning. We talked about her feelings and discussed strategies to mitigate the risk, such as wearing a mask and social distancing. A lot of the fear is the unknown and lack of control. Giving them things they can do helps them regain control. She's doing great now, thriving. My son, who is 19, had a healthy respect for covid, but didn't have the same anxiety as my daughter.
Lockwood: My own children are asking when covid will be over. We have all shifted our mind-set to this being an endemic issue, so instead of framing this as something to get through, I am trying to normalize it. It's not a mysterious 'other' in our lives, but a normal thing we live with because we are taking all the safely precautions. When you empower kids to realize they got their immunizations and are protected, they will be less scared. My son told me there was another child who didn't want to be closer than six feet, and that's okay. I think the schools have done a great job in having kids respect other kids' choices.
Chioma Torres, a specialist in developmental and behavioral pediatrics at Michigan State University, and mother of three children, ages 11, 3 and nearly 2: The covid pandemic has challenged me as a parent. I was hesitant to take my children to in-person day care and school, but eventually and cautiously I took them - out of necessity. Over this last year, I saw how important in-person learning was for all of them: My 11-year-old son struggled with virtual schooling and my now 3-year-old needed several months to adjust when finally returning to day care with social emotional delays that weren't obvious until that transition.
My [youngest] was born during the pandemic and is used to the masks and well adjusted to day care. School and young childhood programs are important for academics and physiologic development, such as social and emotional development and peer relationships.
Children can detect fear. I decided to arm my children with knowledge and tools to stay safe. I explained and modeled desired behavior. I also have modeled wearing a mask in indoor settings and all my children wear masks at school, even my almost 2-year-old - but not unsupervised. They are among the few in their classes today who wear masks, and there are times they protest, and I explain "mommy wears a mask at work" or "let's wear our masks to keep you and your friends safe."
Children need honest and genuine answers without too many details and to know they are safe. Let them know you are protecting them the best way possible by keeping them in in-person learning, vaccinating, wearing masks and testing, while reminding them they are loved and supported.
Gabrielle Virgo, a Silver Spring, Md., pediatrician: [Mental health] is almost a separate pandemic onto itself. It's not just the illness, but the isolation. I include a good mental health assessment with all of my patients, even for the pre-verbal crowd. A lot of them have been affected because they haven't seen faces, except for their parents'. The only faces they've seen are masked. I've had parents say their kids become frightened at the sight of other people outside. One parent told me they went to the grocery store and the toddler panicked because it was a shocking experience. I just talk to the kids. I say: How are you feeling? Happy? Anxious? They have been very, very honest. I hear about their fears and anxieties, not always for themselves but for a loved grandparent or beloved aunt. They are all excited to get the shots, which is first time I've ever seen that.
I try to tell parents to try to not let their anxiety affect the children. Turn off the news and social media. Play music. Talk to the kids honestly and listen to them as well. If a child is expressing extreme anxiety, we need to get them help, which sometimes is easier said than done. If there is a wait for a mental health professional, I do counseling sessions with some of the kids myself. I have to do something.
Munzer: I think asking kids what they are most worried about and listening opens the door to discussion. Sometimes the child expresses worry about covid, but it might be deeper than that, like losing someone. The most important thing is to provide an opportunity for open conversation and acknowledge their feelings. Talking about the emotion and putting it into words can often make kids feel at ease and reassured. Too often, we as parents try to lead with solutions, but that doesn't acknowledge kids' feelings and stresses. Your attitude should be: "My job as a parent is to keep you safe. Your job is to be a kid and enjoy life. Let me take the burden off of you."
With my daughter, a lot of her anxiety has come through in play. At the beginning, she was 3 and everything shut down. She would pretend to fly to Arizona where her grandparents live. It was, "Oh, I'm going to fly to where 'Mombo' and 'Bob-Bob' are. Oh, their house is closed." She flew to all these places, and all of them were closed. At the end, she flew home - and home was open. Kids should be able to express themselves through play, and adults should listen to the clues that come out in play - and provide a safe space for them to "fly" home - and that home is open for them.
Q: Under what conditions should kids wear masks in school? Do you mask your kids?
A: Fauci: It depends on the community level of transmission. CDC has guidelines and recommendations on masks depending on how high the level of transmission is in a specific county.
Walensky: We should be open to having people wear a mask anytime they want and create an environment in schools where people don't feel judged or have to deal with personal questions. They shouldn't have to explain they wear a mask because "my mom is getting chemo." They shouldn't have to explain personal things. Generally, we recommend masks when community levels are high or medium - orange or yellow - although I've been seen wearing one when the levels are green, or low, because I am married to a pediatric oncologist and don't want to get him sick, or his patients.
Lockwood: I think in areas where the rates are not high, it's more of a personal decision. I try to let my kids have a little control over the decision-making. One - the 8-year-old - chose to constantly wear a mask. My 11-year-old chose not to. It's important that they feel comfortable in whatever they are doing in school.
Virgo: I strongly believe in masking. We have to be realistic. We will see another new variant. This won't be the end of it. We're not at the point where it's acceptable for everybody to be taking off their masks. I tell parents: Be prepared.
Q: What about other childhood vaccinations? Are we finally catching up?
A: Walensky: We have fallen behind. Between the 2020-2021 school year, coverage of kindergartners dropped from 95 percent to 94 percent. That may seem small, but it means 35,000 entering kindergarten were uncovered. I worry about what this overall general trend could mean and the impact it will have. It could leave children vulnerable to preventable diseases. As parents head back to the pediatrician, make sure their children are up to date on their vaccines - and it's a great opportunity to get them their covid vaccine. You can get them together.
Schaffner: There has been a substantial gap, particularly among preschoolers, but pediatricians and family doctors are trying to rectify this as they see children.
Dolgoff: Parents are now resuming all the routine vaccinations. Rates in my practice have gone way up.
Q: How worried are you about the new variant and a potential fall/winter surge?
A: Fauci: We need to take it seriously. It is spreading more rapidly than earlier recent variants. We know that vaccinations are effective in preventing severe disease more than in preventing infections, so, again, it's important to get vaccinated. For the most part, people who wind up in the hospital with severe disease are overwhelmingly more likely to be unvaccinated. Among children who have been hospitalized and died, the overwhelming majority have been unvaccinated.
Dolgoff: I am concerned the wave is only going to get worse because this variant is so transmissible. If the rates get higher, we may have to have more restrictions in the classroom. We are in a much better position than we were a year or two ago, but I don't want us to backslide. I don't see us going back to solely remote learning, but I worry that if the levels rise, we may have to impose some restrictions such as mandatory masking or hybrid learning.
Q: What do you say to remind kids to practice good hygiene without turning them into germaphobes?
A: Schaffner: I think the risk of turning kids into germaphobes is pretty small. Most kids tend to move in the opposite direction.
Dolgoff: They need to wash their hands as frequently as possible and be conscientious about social distancing. If we didn't turn them into germaphobes two years ago, it's unlikely to happen now.
Lockwood: Normalize it. We keep hand sanitizer in the car and in the house. Washing our hands has become routine, like brushing your teeth. With most things, they will learn by watching you.
Q: What questions should parents ask about school cleaning processes? What about ventilation?
A: Fauci: Proper ventilation is very important when dealing with a comprehensive approach to respiratory-borne illnesses. We should encourage schools to work toward getting proper ventilation.
Dolgoff: I don't really get questions about surfaces anymore, but ventilation is important. What are they doing to improve ventilation in the school building? I would encourage portable HEPA units and clean outdoor air. Properly placed fans also can help improve indoor air quality.
Lockwood: Ask schools to use HEPA units and open the windows.
Q: Should things be "back to normal" in schools this fall, barring the emergence of new variants or other surprises?
A: Fauci: I don't know what will happen in the fall. It's possible we will get a resurgence. If there is a brand-new variant, we will have to address it by modifying the vaccines. This virus has surprised us repeatedly in the past. It has been evading us time and again. And it has been a formidable foe.
Dolgoff: I think schools are probably going to be closer to normal than they should be. People have gotten very lax. They are just tired of it. People need to pay attention to CDC recommendations and follow the guidelines - even if they are tired.
Lockwood: We have recognized how important it is for kids to be learning in person. Children entering second grade this fall have only known school during the pandemic [remote learning], so I am hoping the school year will feel more normal for everyone this year.
Walensky: We've learned a lot over the last two years. I think our kids can have a really fantastic school year ahead if we model the right behaviors, barring anything unforeseen. Our highest priority is that kids have a safe and successful school year.
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