As we write this, the city is in disarray. Riots have occurred throughout Philadelphia, triggered by real tragedies in Minneapolis, Georgia, and Kentucky. These painful events have ripped open the long-standing wounds of racism in this country. Meanwhile, unemployment claims surpassed 40 million, and COVID- 19 deaths raced passed the grim 100,000 mark. The tinderbox has erupted.
While we mourn, we also know now, more than ever, that we must move forward in productive and progressive ways. People’s livelihoods depend on it. More importantly, our mental health and the mental health of our children depends on it. In many cases, the physical health of our children also depends on it.
Phone calls to our office have overwhelmingly been about this topic: “When and how do we open up?” In the last newsletter, we outlined our plans as a practice to start seeing more age groups. Amidst all the unfortunate consequences of these last few months, we do not want to add to the COVID-19 pandemic another epidemic of vaccine preventable diseases. We also do not want to forget that monitoring our children’s overall health and development is among, if not atop, our highest priority list. Coming to the pediatrician is essential!
“Opening up” also means that we need safe and trustworthy childcare. The decision about what to do with your children while you attend to important responsibilities and needs is complex. We cannot give definitive answers of what is best for you. As we have said before with COVID-19, “low risk never means no risk.” Compounding this uncertainty is the fact that the science of this virus is nascent and quickly evolving.
Below we once again offer information on how we at Center City Pediatrics, are working to make our space as safe as possible for you and your children. We also offer tips to help you make your own difficult decision about childcare.
Eric, Grace, and the entire Center City Pediatrics Team
Keeping You Safe at Center City Peds
As reported in the last newsletter and on our website, we are now seeing children for “check-ups” for the following ages: all kids 0 to 2 years, 4 and 5 years, 11 years, and teens preparing for college. We will announce as soon as we feel that we can safely accommodate all other ages, but for now we feel compelled to focus on visits where vaccines and the most crucial developmental monitoring is needed. To assure your and our staff’s safety, the following protocols are in place:
- All our staff have been required to wear medical face masks at all times since April 1st. With the PA governor’s order on April 19th, all visitors, and patients 2 years of age and older are now also required to wear face coverings when entering our offices.
- We have a strict illness policy for our employees, and all of our staff undergo daily temperature and symptoms checks at the start of shifts.
- Minimizing crowding has been and will continue to be a priority! To this end, we intend to return to our full office hours, including evenings, in the near future.
- In an effort to keep families out of our waiting room, we are modifying our normal schedules to ensure a staggered flow of arrivals. Please help us by being on time for your appointment. Late arrivals may need to be rescheduled. Please contact the office by phone if you will be late for your appointment. Likewise, we may not be able to check you in early, depending on room availability.
- We are excited to announce the opening of our new Fishtown location in July. Adding this exam room capacity allows us to bring you back as soon as you step in the office, reducing time spent in the waiting area.
- The Fishtown office will follow the Bala Cynwyd location’s model of having no “sick visits”. Only well visits will be scheduled at these locations.
- The bulk of sick visits will continue to be managed via Telehealth.
- The Center City office will see “sick visits” only in a separate designated area, cordoned off from the other rooms. The multipurpose room remains set up as a separate waiting room for sick patients, even though we have thus far been able to immediately isolate all sick patients in the designated exam rooms as soon as they arrive.
- All examination rooms undergo routine disinfection with an EPA-approved product between patients.
In order to keep our offices as safe as possible, we ask that all families review our COVID-19 office policies prior to coming to the office.
Deciding About Childcare
The decision on whether to send your child to childcare is complex and personal. We cannot make this difficult decision for you, but we believe you should consider 3 main factors:
1. Does your child have any underlying higher-risk medical conditions?
In contrast to seasonal influenza, which so far has claimed the lives of 179 children this past season, COVID-19 has not affected children in the same way that it has affected adults. Less than 2% of all COVID-19 cases in the U.S. have been in children, and children 0-17 years have had the lowest rates of hospitalization due to infection with this virus, compared to other age groups. As of May 28th, 19 U.S. children between 0-15 years of age have died so far during this pandemic, according to the CDC’s COVID-19 mortality report.
We still have much to learn about risk factors for severe COVID-19 in children. Much of what we know is extrapolated from what is known for adults, and what underlying conditions appear to be more commonly present in children who are hospitalized. As of May 23, 2020, 46% of children who have been hospitalized so far due to COVID-19 have had no underlying conditions reported. That said, children with underlying chronic lung conditions (e.g. asthma), obesity, neurologic conditions, metabolic disorders (e.g. diabetes mellitus), and immunocompromised state (either due to medications or due to a primary condition) may be at higher risk.
2. Are there any special household-based considerations?
A child attending outside childcare will be in contact with other children and adults for extended periods of time, on a regular basis. Anytime you or your household members expand the household “bubble” of social contacts, the potential for exposure to COVID-19 increases, requiring every family to weigh potential risks and benefits. If outside childcare is essential in order for caregivers to maintain employment, if a child or caregiver’s mental health is suffering due to prolonged isolation, or if staying at home with the available caregiver is not providing adequate social, emotional, or educational stimulation for the child, the benefits of outside childcare may outweigh the risks. If, on the other hand, one of the household members or a frequent household contact (e.g. grandparent) has a higher risk condition that increases their vulnerability to severe COVID-19, including age > 65 years, you may want to arrange another childcare option.
That being said, there is growing evidence that unlike seasonal flu where children are a primary contributor to the spread of that virus in the community, young children may not be playing a major role in the spread of COVID-19. Also, childcare has continued to be offered for essential workers during this pandemic, and so far, no outbreaks of COVID-19 due to childcare attendance have been reported. While children certainly can become infected with the virus and may release similar amounts of virus as adults when infected, they may not be as likely to transmit infection as adults. However, the data we have on the role children play in COVID-19 transmission is limited, and caution should still be exercised.
3. How has your potential childcare provider responded to the COVID-19 pandemic?
If your child is not a high-risk child and the household benefits outweigh the risks, then the last important factor is the safety and reliability of the childcare provider you are considering. How adequately has the childcare center adjusted operations in order to enhance the safety of the center for both its staff, children, and caregivers?
We strongly encourage you to ask your childcare center to provide a written plan in accordance with the CDC guidelines for childcare providers. Below are a few of the considerations you should expect, but we encourage you to closely look at the detailed CDC recommendations linked above.
- Promotion of healthy hygiene practices: Will the center teach and promote timely and frequent hand hygiene and covering of coughs/sneezes amongst staff and children? Have they posted visual reminders in the building on proper hand hygiene technique or cough etiquette?
- What kind of cleaning and disinfection protocols will be used? Are EPA-registered disinfectants and cleaning measures recommended by the CDC for COVID-19 being used? Will toys and items that cannot be cleaned properly (e.g. stuffed animals, fabric chairs) be removed?
- What kind of personal protective equipment will be required by staff or children? While face masks are not advised for children < 2 years of age, the benefits and evidence for having young children 2 years and older wear masks in group childcare are unclear. Concerns include compliance, frequent touching of the face or mask due to mask discomfort, importance of social cues provided by facial expression, and need for a laundering policy for cloth masks. Some childcare centers may opt for face mask use by staff and face shield use by children and/or teachers. Check with your center to see what their policy is.
- Is the center adopting social distancing policies? Measures may include smaller class sizes, avoidance of mixing between classes and teachers, restriction of visitors or parents entering the childcare center, and refraining from field trips while COVID-19 activity is still present in the community.
- What kind of sickness policy does the daycare have for staff and children? Ideally, child care centers will screen both staff and children for signs of illness upon arrival on-site, will have strict policies for sending home those who are showing signs of illness, and rapidly notify the local public health department and communicate openly with staff and families if there is a confirmed case of COVID-19 in the center.
Talking to Your Child About Racism & Race Issues
Racism is harmful for all children, not just children of color. Our society and our communities are stronger, healthier, and more productive when we can confront obvious or hidden racial bias in ourselves and educate our children to do the same. Parents may be struggling not only with their own feelings about current events, but with how to have conversations with their children in constructive ways. We’ve put together a list of resources to help parents with this important task.
Parent Toolkit – How to Talk to Kids About Race and Racism
31 Children’s Books to Support Conversations on Race, Racism, and Resistance
National Geographic: Talking to Kids About race
NPR – Talking Race with Young Children
Build Your Stack: Affirming Black Boys outside the Context of Police Brutality
NY Times: Books to Explain Racism and Protest to Your Kids
Healthychildren.org – Childhood Exposure to Violence
Healthychildren.org – Talking to Children About Racial Bias
Mental Health Matters
Parents and caregivers are dealing with many sources of pressure right now, from work-related stress and health concerns to childcare and parenting challenges, all while managing worries in their children and themselves. We’ve put together resources for families to help them access mental health on-line support materials and experts remotely. Remember, you’re not alone.
- While our on-site workshops have been temporarily suspended, several of our facilitators are conducting virtual classes and support groups – many of them at no charge. Check out our class calendar for details and registration links.
- Specifically, in the weeks ahead you’ll find we have virtual workshops to help with sleep issues affecting school aged children and for parents of younger children to play your way to a happier quarantine. Register online to reserve your space.
- The CDC’s COVID-19: Stress & Coping page contains information and advice on identifying signs of mental health distress in children and adults, accessing community resources including the National Domestic Violence Hotline, and provides planning and preparation advice.
- The Child Mind Institute provides phone consultations, remote evaluations, Facebook Live video chats, and comprehensive on-line resources directed towards helping parents and children, including those with special needs, cope with the COVID-19 crisis.
- The American Academy of Pediatrics parent education platform, healthychildren.org, has put together some helpful tips on positive parenting and how to manage those times when parenting feels overwhelming.
- On April 2nd, Pennsylvania launched a statewide Support & Referral Helpline – (855) 284-2494. This service is available 24/7 to counsel PA residents struggling with anxiety and other challenging emotions, and to help refer them to community-based resources.