Pediatricians take a look at the challenges ahead as kids head back to school

Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.

In part two of a two-part series, AMA Chief Experience Officer Todd Unger talks to pediatricians about the impact of COVID-19 on children, including the challenges with kids going back to school.

Learn more at the AMA COVID-19 resource center.

Speakers

• Sonja O'Leary, MD, medical director, Denver Health School Based Health Centers
• Stephanie Guarino, MD, MSHP, pediatric hematologist/oncologist, Nemours/Al duPont Hospital for Children
• Greg Blaschke, MD, MPH, pediatrician and professor of pediatrics, OHSU

Unger: Hello, this is the American Medical Association's COVID-19 update. Today, we continue with part two of our two part series discussing the impact of COVID-19 on children. We return to our conversation with Dr. Stephanie Guarino, a pediatric hematologist oncologist at Nemours A.I duPont Hospital for Children and clinical assistant professor of internal medicine and pediatrics at Sidney Kimmel Medical College in Wilmington, Delaware. Dr. Gregg Blaschke, a pediatrician and professor of pediatrics in general pediatrics at Doernbecher Children's Hospital at Oregon Health and Science University in Portland, Oregon, and Dr. Sonja O'Leary, president elect of the American Academy of Pediatrics council on school health and pediatrician and medical director of the 18 Denver Health School-Based Health Centers in Denver. I'm Todd Unger, AMA's chief experience officer in Chicago. A lot of concerns here about kids going back to school. How do we balance the health concerns that come with in-person learning and the challenges that are posed by remote learning?

Dr. O'Leary: Yeah, I mean, that's a great question. I mean, two of the bad outcomes of COVID are the decreased number of kids who are getting immunized, especially our teenagers. We could be prime for a pertussis outbreak or a measles outbreak if it continues. The second is just the decreased number of eyes on children, meaning looking out for signs of abuse, looking out for signs of physical or emotional abuse. Not a lot, but we're seeing kids come in with a lot worse outcomes than we would have otherwise.

I think the biggest thing about getting kids back into the schools and the reason why we at COSH, The Council on School Health, really felt it was important to put getting kids back in school as the number one thing we do is because we know that they learn best there, both for their education, but also social-emotionally. Obviously, though, it has to be done with the community. It has to be done with public health. With that goes doing a better job talking to our teachers about being safe with PPE. I think that there's a lot of misinformation out there and we just have to be patient. We just have to lead the way so that our kids can get back to school as soon as possible.

Unger: What's your perspective on activities in addition, of course, the academics part of that? What about youth sports? I just passed by a park.

Dr. O'Leary: Right.

Unger: I saw there are tons of baseball teams out there.

Dr. O'Leary: Yes.

Unger: What's your feeling on that?

Dr. O'Leary: I mean, I think it's such an important part of youth development and their social-emotional learning. I think, though, that as a parent, you have to figure out your own risk. What kind of risk is acceptable to you as a parent? Then go with that as you move forward. Obviously, some sports like golf and tennis have are lot less risk than football, lacrosse, but there are ways to do this all safely. It's just going to take a little bit more time and a lot more cleaning.

Dr. Blaschke: I think I'm want to add in a couple of things here, too. One would be as a developmental behavioral pediatrician, too, I think kids returning to school, I think about even preschool, early intervention and the social-emotional development, those with learning disorders, and really maybe even more disadvantaged than just your average child as well. Then our state has been a bit more restrictive on returning to sports and things like that.

You know, I heard a story from a swimming coach who sort of said, "You can't even really expect kids to separate sometimes when they get together in these kinds of events and encounters." Thinking about the entire public health picture in addition to how important it is to kids, development, and mental health, and socialization and all those kinds of things, but there's not a one right way or one answer. I think it completely depends on the community involved, and what the infection rate is, and then what kind of precautions could really be implemented reliably.

The other thing we've seen is there can be a slippery slope, too. If you sort of loosen up somewhat on a restriction then suddenly you have teens and young adults having pool parties, meeting at the bars and all the things that we sort of expect teens and young adults to do developmentally and pretty normally because they think they're invincible and not subject to this virus. These are tough decisions, I think, on a community level, and then also for individual families, and even guiding parents on what they should do.

Unger: Let's talk a little bit more about that. What guidance do you give parents because we are seeing a lot of spikes here from teens and young adults who are not taking it as seriously. When they're back in school or college, there are a lot of temptations there. How do we reverse that trend?

Dr. Blaschke: That's a tough one, for sure, especially with teens and young adults. I think the more we can make it pertinent to their lives, it's sort of like what I think about when I talk to teens about smoking. It's not talking about lung cancer 30 years from now. It's about bad breath, and maybe discolored teeth and things like that. With COVID, that's tricky, too, because we don't right now know what the long term outcomes are for people who maybe even had mild illness or moderate illness. How to relate this to teens is for sure tricky since it's in their nature. It's on their development to respond more to peers, right? Their peer group is so important, especially to teens. While often we discourage media use, I think this is a time where they can still cope and interact with some of their peers in different ways, that sort of thing.

Dr. Guarino: I think sometimes it's helpful, too, to stop thinking about things as safe or unsafe and maybe more as a continuum of risk and to try to help people think about if you are going to see a friend or to socialize, which is important for a lot of reasons, how can you do it most safely? Things I always say are outside is better than inside, fewer people are better than a lot of people, continue to wash your hands, wear a mask, stay apart, don't share food or utensils or things like that. Maybe it's less of safe or not safe and more of how to appropriately manage the risk of things that you decide are important enough to do.

Dr. O'Leary: I love that. I also talk to them about how it's actually protecting the people that they love, right, and that when you wear a mask, you're protecting other people. When they wear a mask, they're protecting you, and just thinking about grandparents, and aunts, and uncle and that sort of thing as well.

Unger: Last question. All of you have mentioned to some extent that there's just a lot we don't know and the learning continues over the months of the pandemic. Let's talk. What do we still need to know about COVID and its impact on kids? Dr. O'Leary, why don't you start?

Dr. O'Leary: Yeah, I mean, I would be very interested in knowing more about why COVID really seems to hit our black and our brown students much more than the white kiddos because I think that this pandemic is also causing a lot of issues around equity, around educational equity, monetary equity and that sort of thing.

Unger: Dr. Guarino?

Dr. Guarino: Sure. I think that the thing that I want to know more about is long term risks to health in mild cases or even more moderate cases. What kinds of things do we need to look out for and do we need to monitor these kids for later down the road?

Unger: Dr. Blaschke, any final words on that?

Dr. Blaschke: Yeah. I would just add a couple. I mean, there's still things we don't know about immunity, whether or not you can get affected again, at what level do you have protection, obviously the vaccine issues. It's still somewhat of a mystery why this isn't more like other COVID vaccines, common colds, that young children in particular tend to spread it a lot. That doesn't seem to be the case in some observations that have been made, but again, we're still learning.

Unger: Well, thank you so much, Dr. Guarino, Dr. Blaschke, and Dr. O'Leary, for being with us here today and sharing your perspectives. That completes our two part series. If you missed part one of our update, you can find it on AMA's YouTube channel. We'll be back on Monday with another COVID Update. In the meantime for resources on COVID-19, visit ama-assn.org/COVID-19. Thanks for joining us and please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.