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COVID-19: Daycare? Summer Camp? Kawasaki Disease?

by |  May 14th, 2020
  

COVID UPDATE—May 15

We have been getting lots of the same questions, so hopefully this update gives you some science-based guidance as we endure this pandemic.

 

  1. Office Update
  2. Telemedicine Update
  3. Sports pre-participation physicals
  4. Decisions about daycare
  5. Decisions about summer camps
  6. COVID-19 and Kawasaki Disease/multisystem inflammatory disease
  7. COVID-19 and kids
  8. Vitamin D supplements?

 

  1. Office update: We are seeing patients of all ages for in-office well child visits. We have separate office hours for well checks, and only see in-office sick visits after all well checks are done for the day. We continue vigilant cleaning practices, bringing patients directly to the exam room, testing both parent and child for fever, and requiring all parents and children age 10 and up to wear a face mask in the office. You and your child’s health are the utmost priority.

 

  1. Telemedicine Update: Our virtual housecalls are very popular! We are doing a most sick visits by telemedicine and some well child visits. There is great variability on copays and deductibles depending on health insurance plans. You may hear “there are no copays for telehealth visits during the COVID 19 pandemic”—but in the fine print, insurance companies only waive copays IF the telehealth visit relates to COVID-19 symptoms or diagnosis. If your child has a health issue that has nothing to do with COVID-19, your insurer will not waive the copay. If you have questions, call your insurance company and find out what your plan will cover. The good news: Texas Medicaid just approved telehealth well checks for children over 2 years of age which means that private insurance companies should follow suit (for now).

 

  1. UIL Sports Pre-participation Exams: Summer is our busiest season for school-aged well child visits. Please schedule your appointments now. The American Academy of Pediatrics recommends a well child visit every year from ages 3 and up (whether or not you need a form filled out!) The University Interscholastic League (UIL) may modify rules for completed forms in the 2020-21 school year but know that your child still needs his annual well check.

 

  1. My child’s daycare is re-opening and they are following CDC guidelines, is it safe to send him?

It depends. Right now, Austin has fewer COVID-19 infections than others–thanks to sheltering at home (and people are not travelling in and out of our town). Once guidelines relax, I feel certain our infection rates will rise. Experts believe 75-80% of people will need to be immune (either by infection or vaccination) for us to have a handle on this virus. And even if levels do go down over the summer, the fall/winter is likely to include COVID-19 as well as the other usual respiratory viruses–Flu, RSV, croup, etc. That said, we should be as mindful as possible (wearing masks and social distancing) to reduce exposure while resuming life–which yes, includes work and childcare. Your daycare center should check a child’s temperature every day prior to entering the classroom, increase the distance between children during play and naptime, and reduce toy sharing.

But even with these modifications, there will be a risk of exposure to COVID-19 and other infectious diseases when children are playing together in groups. If you have family members who are at greater risk of serious illness with COVID-19 and spend time with your child, you may want to explore other childcare options.

 

  1. We were planning on sleep-away camp this summer. The camp has not made any decisions yet, but if the camp is open—is it safe for my child to attend?

We think sleep-away camp is a great experience! But, unlike daycare, summer camp is optional. Many activities and sleeping arrangements in cabins increase the risk of spreading infection. And, some campers come from other cities and states that have higher incidence of COVID-19 than Austin. These are all important considerations.

Most camps are waiting on official guidelines from their state health departments to determine if they can successfully implement them before making formal decisions.

 

  1. I’ve heard about Kawasaki Disease/ severe inflammatory illness related to COVID 19 in children. Should I be worried?

The Centers for Disease Control posted an official health advisory on May 14, 2020 regarding Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19. The first eight cases were reported in the United Kingdom at the end of April 2020 and as of May 12,  over 100 cases have been identified in New York City and New York state. Other cities are reporting a few sporadic cases. These children developed symptoms about a month after their community had a surge in COVID-19 infections, which seems like a post-infection immune response phenomenon. In general, these children did not show signs of COVID-19 infection prior to the MIS-C symptoms.

These children are extremely ill—and extremely ill appearing—so it is not something a parent would miss. Similar to a well-recognized disorder called Kawasaki Disease, these children have high fever, red eyes, very red cracked lips, red tongue that looks like a strawberry, swollen lymph node on one side of the neck, swollen hands/feet, abdominal pain, vomiting, diarrhea, rash, extreme irritability or lethargy.

The children are treated in the intensive care unit and most respond to the medications (IV immunoglobulin, steroids, aspirin) which are used for Kawasaki Disease. Yes, this is scary. But know that the number of cases of MIS-C are very small compared to the number of kids who have been exposed or ill with COVID 19.

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  1. 7. Is COVID 19 still considered a mild illness for children?

Yes. Most children who become infected have no or mild symptoms. Children under one year of age and teens over age 15 are the higher risk groups in childhood for hospitalization, but the numbers are significantly lower than in older adults and those with pre-existing health conditions.

 

  1. Should my child take a Vitamin D supplement? I’ve read that people with Vitamin D deficiency may be at risk for more serious COVID illness or Kawasaki Disease.

Regardless of COVID and Kawasaki Disease, everyone probably needs a Vitamin D supplement. Vitamin D is an important nutrient that is essential for healthy bones and most people are not out in the sun long enough (without sunscreen), drinking 4 cups of milk or eating 3 oz of salmon daily to get their Vitamin D needs met. We recommend 400 IU Vitamin D3 daily for babies ages 0-1 and 600 IU daily for ages 1 and up.

While there are many studies about Vitamin D protecting against cancer, autoimmune disease, infectious diseases, high blood pressure and heart disease, the data is much murkier.

With COVID-19, people who are getting sicker are the same at-risk populations for Vitamin D deficiency (e.g. elderly, obese) so while there is an association, it is hard to prove causation. However, there is no harm in taking a Vitamin D supplement even if you do not have a deficiency.

 

We will continue updating you as new information arises. We hope these newsletters are helpful! Be well!

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About

Dr. Ari Brown is a pediatrician and a mom. Dr. Brown is Board Certified and a Fellow of the American Academy of Pediatrics. She has been in private practice for over 20 years. Her passion to advocate for children and educate families extends beyond the office setting. She is the co-author the bestselling "411" parenting book series including Expecting 411: Clear Answers and Smart Advice for your Pregnancy, Baby 411, and Toddler 411. Dr. Brown has received several professional awards including the Ralph Feigin, MD Award for Professional Excellence, the prestigious Profiles in Power Award by the Austin Business Journal for her service to the community, Austin's Favorite Pediatrician by Austin Family Magazine, and Texas Monthly Magazine's Super Doctor.

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