The First Line of Defense to Opening Schools: Parents and Caregivers

“First and foremost, parents should not send any child who is symptomatic of illness to school. This means that parents should develop a routine for quickly checking their child for a fever in the morning and also confirm that their child does not have a cough or any other sign of illness. If a child does have a fever,the parent should not give the child fever-reducing medication and sendher/him off to school, but instead be sure to keep the child home.”

– Michael LaSusa, superintendent of schools in Chatham, New Jersey

Schools are reopening for person-to-person learning. The first line of defense against outbreaks of COVID-19 are parents and guardians. These adults must diligently check their students each day for symptoms of the virus. Any student showing any symptom should be quarantined at home. Failure to take these necessary steps could lead to mass infections and eventual school closures.

Parents and caretakers should trust their instincts and contact their pediatrician or family care practitioner if their child seems ill, especially if cough or fever are present.

What Are the Symptoms?

Generally, COVID-19 symptoms are milder in children than in adults. Pediatric patients with COVID-19 may experience the following signs or symptoms over the course of the disease:

• Fever

• Cough

• Nasal congestion or rhinorrhea

• Sore throat

• Shortness of breath

• Diarrhea

• Nausea or vomiting

• Fatigue

• Headache

• Myalgia (muscle pain or muscle ache)

• Poor feeding or poor appetite

The predominant signs and symptoms of COVID-19 reported to date among all patients are similar to other viral respiratory infections, including fever, cough, and shortness of breath. Although these signs and symptoms may occur at any time during the overall disease course, children with COVID-19 may not initially present with fever and cough as often as adult patients.

There have been multiple reports to date of children with asymptomatic SARS-CoV-2 infection. In one study, up to 13% of pediatric cases with SARS-CoV-2 infection were asymptomatic. The prevalence of asymptomatic SARS-CoV-2 infection and duration of pre-symptomatic infection in children are not well understood, as asymptomatic individuals are not routinely tested.

Signs and symptoms of COVID-19 in children may be similar to those for common viral respiratory infections or other childhood illnesses. It is important for pediatric providers to have an appropriate suspicion of COVID-19, but also to continue to consider and test for other diagnoses, such as influenza.

(“Information for Pediatric Healthcare Providers.” Centers For Disease Control and Prevention. July 17, 2020.)

It's important to understand recent reports about pediatric inflammatory multisystem syndrome, or PIMS, a very rare condition that might be related to exposure to the coronavirus. PIMS can cause inflammation of the blood vessels throughout the body. The inflammation can limit blood flow, damaging the heart and other organs. PIMS has features in common with toxic shock syndrome and an illness called Kawasaki disease.

Certain symptoms may mean an inflammatory problem such as Kawasaki disease or PIMS.

Parents should look out for:

Abdominal (belly) pain

Vomiting and diarrhea

A red rash

Red, cracked lips

Red eyes

High fever

Swollen glands on one or both sides of the neck

Swollen hands or feet

(Aaron Milstone, M.D., M.H.S. “Coronavirus in Babies and Kids.” Johns Hopkins. May 13, 2020.)

Treatment At Home

Everyone at home with a child suspected of having COVID-19 must practice everyday preventive actions. The child should stay home except to get medical help. In addition, as much as possible, the patient should stay in a specific room and away from other people and pets. If possible, the child should use a separate bathroom. If he or she needs to be around other people or animals in or outside of the home, the child should wear a mask.

For the child to safely have no interaction with the parent or caregiver, the child should be old enough to legally be home alone and mature enough to care for themselves.

If the parent or sole caregiver will be caring for the child while sick, they should contact the child’s healthcare provider for advice on how to best protect the child from infection.

• Young children should be supervised at all times.

• If the parent or the sole caregiver is too ill to care for the child, they should see if there is a caregiver outside of the home with whom the child can stay.

• The caregiver should not be someone who is at higher risk for severe illness from COVID-19, as the child has likely been exposed to the virus. The caregiver will need to help the child quarantine for 14 days since they last had close contact (less than 6 feet way from someone for more than 15 minutes) with the sick person.

If the child will stay in the home with a parent or caregiver who is sick, you should:

• Wash your hands frequently with soap and water for at least 20 seconds. If soap and water is not available, use hand sanitizer containing at least 60% alcohol and rub your hands together until they are dry.

• Try to stay 6 feet away from the child, if possible and if safe.

• Wear a mask if you are in a room where the child may come into contact with you.

• Note that masks should not be placed on:

  • Children younger than 2 years old

  • Anyone who has trouble breathing or is unconscious

  • Anyone who is incapacitated or otherwise unable to remove the mask without assistance

• Increase ventilation by opening a window in a room that you are in.

• When you need to bring items to the child, disinfect the items before giving them to the child.

• However, do not disinfect food when you need to bring food to the child.

• Watch for symptoms. During this time the caregiver should monitor themselves for symptoms and practice everyday preventive actions.

• Check the child’s temperature twice a day and watch for symptoms of COVID-19, such as fever, cough or shortness of breath, or symptoms specific to children.

• If the child does develop symptoms, call the child’s healthcare provider for medical advice and follow the steps for caring for someone who is sick.

• If possible, the child should stay away from people who are at higher-risk for getting very sick from COVID-19.

(“Sick Parents and Caregivers.” Centers For Disease Control and Prevention. July 1, 2020.)

During the pandemic, parents and caregivers have a tremendous responsibility to their own children, to the schools, and to the community. We all know children need to be back in school; however, on-campus education will be impossible without the full attention of those whose duty it is to monitor students. All adults must comply.

It is apparent that all parents and caregivers must have certain essentials at home to insure the safety of their children. These include the following:

• Thermometer

• Masks

• Disinfectant

• Sanitizers

To close, remember that COVID-19 can look different in different people. For many children, being sick with COVID-19 would be a little bit like having the flu. Most people who have gotten COVID-19 have not gotten very sick. Only a small group of those who get it have had more serious problems. Still, no parent should allow a student with coronavirus symptoms to attend school.