1. My child has asthma. Should they go back to in-person school?

            Having a child with asthma in a respiratory virus pandemic has raised many concerns, and unfortunately the research has not been completed yet to see how asthmatic children are doing during this time. However, many pediatricians who provide care for children with asthma indicate that asthma control has overall improved during the pandemic, and this is likely due to a combination of the fact that fewer respiratory illnesses are occurring because of safer-at-home orders and more virtual clinic visits are happening.

            Just having asthma should not stop your child returning to school, the same way that the flu season should not cause your child to remain at home. Your child should be encouraged to follow all hand-washing, mask-wearing, and physical distancing practices to ensure their safety. Also, communicate with them to report any early symptoms and make prompt virtual appointments with their healthcare provider if they are having any difficulties. If your child requires nebulizer treatments at school during the day, these treatments should be changed to a metered dose inhaler to prevent aerosolization of respiratory droplets (which protects others in the room). If your child continues to have symptoms despite being on a controller medication, you should consult with your pediatrician about other therapeutic options.

Papadopoulos NG, Custovic A, Deschildre A, et al. Impact of COVID-19 on Pediatric Asthma: Practice Adjustments and Disease Burden [published online ahead of print, 2020 Jun 17]. J Allergy Clin Immunol Pract. 2020;S2213-2198(20)30599-7. doi:10.1016/j.jaip.2020.06.001

2. My child is immunocompromised. Should they go back to in-person school?

            Having a child with a compromised immune system is (understandably) frightening during this time, and recommendations regarding returning to school should be discussed with your primary care provider and subspecialists. Research to date shows that most children who are immunocompromised and are infected with COVID-19 do well, but it depends on the degree of immunosuppression and other underlying conditions your child has (such as obesity, diabetes or a heart condition).

            Being immunocompromised should not stop your child returning to school, and you should discuss this with your pediatrician or pediatric specialist. Your child should be encouraged to follow all hand-washing, mask-wearing, and physical distancing practices to ensure their safety. Also, communicate with your child to report any early symptoms and make prompt virtual appointments with their healthcare provider if necessary.

https://www.myast.org/sites/default/files/covid-19-return-to-school-for-sot-faqs-for-families-20200727.pdf

3. Grandma or Grandpa lives with us. Should my child go back to in-person school?

Transmission of SARS-CoV-2 to an at-risk adult is a valid concern. Data to date suggest that children are infected with the virus less frequently than adults and, when infected, typically experience less severe disease. Although children have generally not been the source of disease outbreaks, it is possible that children could infect other family members after contracting SARS-CoV-2, similar to influenza virus. Because prolonged, close contact with an infected person is the main driver of transmission, the amount of contact and the specific living arrangements (separate rooms, eating spaces, etc) will likely influence risk of infection and transmission from the child to others in the household.

The answer to this question depends on multiple factors, including whether seniors in the home have chronic medical conditions and how much risk the family is able to tolerate if a student returns to in-person education. Although we know enough about how to keep people safe from COVID-19 (universal masking, social distancing, hand hygiene and sanitization), return to in-person education is not entirely risk-free. Each family will need to balance their own risks and anxiety about COVID-19 with the benefits of in-person education for children.

4. My child cannot tolerate a mask. Will you write me an exemption?

Los Angeles County Department of Public Health does not require or recommend pediatricians to write exemptions for masks. Masks are an incredibly important way for children to protect themselves from getting the virus or giving it to other children if they are already infected, and masks are absolutely safe to wear for long periods of time.

Talking openly with your child about what they don’t like about the mask can be a helpful strategy for getting them to wear it. Allowing your child to decorate their mask or use it as a part of dress-up/costume play can help them better tolerate wearing it. This is often a successful approach to children with long arm casts for example.

Early care and education settings have developed curricula for younger children on wearing masks. Some parents are reporting that their child became more tolerant to wearing masks after attending preschool and seeing other children wearing them. Children can be told that all of their friends and teachers at school will be wearing masks also.

Schools will also release guidelines on mask breaks which will be designated times where children can take their masks off (likely at certain time intervals and when appropriately physically distanced).

The California Department of Education allows for the use of face shields with a cloth drape underneath that tucks into a shirt for students who are truly unable to tolerate wearing a face mask or for children who are hearing-impaired. The Los Angeles County Department of Public Health allows for this provision in very rare instances, generally for children with special needs with significant developmental challenges.

5. Isn’t masking bad for children because they won’t be able to breathe if they wear it all day?

Masking is generally acceptable to anyone over the age of 2 years. You may know that the AAP does not recommend masks for children <2 years; this is not because of breathing issues, but rather to avoid a potential choking hazard. Masks are perhaps the most important way for children and adults to protect themselves from getting the virus or giving it to other people if they are already infected, and masks are absolutely safe to wear for long periods of time. There is no build-up of dangerous gases behind the masks when you are breathing.

            The only negative effect of masking that may need to be addressed is minor skin irritation which can be prevented by making sure the mask is properly fitted and made of a material that does not irritate your child’s skin. If they are experiencing this irritation then a gentle lotion can be used on the face and chapstick if the lips are irritated.

6. I heard that COVID-19 damages lungs. If my child gets COVID-19, will there be long-term damage to their lungs?

To date there is not enough data on the long term effects of COVID-19 on the lungs to answer this question. Children tend to have milder disease when they are infected which hopefully means that there will not be significant long term effects on the lungs or the body. COVID-19 is a part of a family of viruses called coronaviruses, and the other known coronaviruses that infect humans do not typically cause permanent long-term effects to the lungs.

7. What will be the return-to-school note process for children previously ill from COVID-19 be?

            There is no standardized return-to-school note that healthcare providers will give to families after their child has been sick. Indeed, LAC DPH does not require a note from a healthcare provider for returning to school, but individual schools may have their own policies. The current Los Angeles County Department of Public Health guidelines on when a child is safe to return to school after having been sick with COVID-19 are improving symptoms, 24 hours without fever (without using any medicines that reduce fevers for 24 hours) and at least 10 days after the onset of initial symptoms.

8. What if a school is planning to re-open without adhering to public health guidelines?

            The Governor’s order from July 17, 2020 prohibits any school in California from returning to in-person education if the county that the school is in is on the state’s monitoring list. At this time, all seven of the counties in our AAP chapter are on the state’s monitoring list. Only preschools, which fall under difference guidance for Early Care and Education, are allowed to open at this time.

            When in-person education is allowed and if you suspect that your child’s school is not adhering to LAC DPH safety and health guidelines, then we would recommend not sending your child back to that school and also to inform LAC DPH immediately.

9. I keep hearing about people with medical conditions being at higher risk for problems from COVID-19. What are these medical conditions?

There are not enough data in children to answer this question definitively. Based on available data from adult patients with COVID, children who have medical complexity, who have neurologic, genetic, metabolic conditions, or who have congenital heart disease might be at increased risk for severe illness from COVID-19 compared to other children. For the adult population, risk factors for more severe disease that have been identified are related to older age, being overweight or obese and diabetes. Children tend to have a less severe infection overall. If your child has a chronic medical condition it is prudent to make sure the condition itself is maximized (e.g., diabetic control). As well, it is always important to focus on healthy lifestyle habits to promote mental and physical wellness. Try to remain active (while staying physically distanced) and to provide your child with nutritious and balanced food.

https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html#children-underlying-conditions

10. Because my school is doing distance learning and both of us have to work, I am considering putting my child in a pod. Are there recommendations for pods?

            Learning pods are small groups of the same children that learn together in person as a substitute for the larger in-person classroom that is traditionally known. We are aware from our patients that parents are informally arranging learning pods for their children, given that all schools will be starting with distance learning this fall. We recommend that all learning pods follow the same guidelines as schools to reduce possible transmission of SARS-CoV-2. It may be more difficult to enforce infection prevention methods in a home environment as opposed to school, so following the guidelines is particularly important: