Population Care

Back to school: What physicians can say to parents weighing the decision

Brendan Murphy , Senior News Writer

Should children return to school this fall? Amid the COVID-19 pandemic, it’s a question physicians—most notably pediatricians and those practicing family medicine—are likely to hear with increasing frequency in the coming months from patients. And it’s not an easy one to answer.

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"Like any issue related to COVID-19, you are going to find a lot of opinions about it,” said John Andrews, MD, the AMA’s vice president for graduate medical education innovations, who has been a practicing pediatrician for three decades. “Parsing those opinions is not at all easy.” So how should physicians address parental concerns about a return to school? Dr. Andrews offers these thoughts.

In late June, the American Academy of Pediatrics (AAP) released a statement that, with a number of caveats, strongly advocated “all policy considerations for the coming school year should start with a goal of having students physically present in school.”  Andrews says data that indicates children appear less likely to contract the disease, and when they do, they tend to recover well. Further, spread of the disease from asymptomatic children to other children or adults is uncommon. Communicating that to worried parents and presenting the adverse outcomes from keeping children home may, in fact, outweigh those of sending them back to school.

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“It’s clear that the remote learning that many schools went to at the conclusion of the school year last year was essentially no learning at all,” Dr. Andrews said. “Educational outcomes will suffer if kids aren’t in school come the fall.

“When kids are at home there are risks to that, as well. There may be increases in behavioral health issues. And, the risk of maltreatment as their families face distress is higher.”

While it’s important to consider sending children back to school, there’s going to be a risk, which many parents will, naturally, point out. Pushing back on those concerns isn’t the role Andrews believes a doctor should play in current circumstances.

“I’m a pediatrician,” Dr. Andrews said. “I’m a source of advice. The decision-makers in the lives of children are their parents. My approach is to share the information objectively and when asked for my opinion offer it. But it’s important to recognize parents make independent decisions.

“When things really are a judgment call, and this is a case where that is true, I’ll present the evidence and offer my opinion, but I’ll acknowledge there will be some parents who won’t be comfortable sending their kids back to school and that’s something we’ll have to figure out how to manage.”

There’s more debate surrounding how the disease presents and afflicts older children, so the AAP advocates for schools to mandate more preventative measures—such as mask-wearing and physical distancing—in facilities that host older children. Even still, at any level of education, certain children will be more at risk. “The risk profile of the child is important,” Dr. Andrews said. “There are kids who are unique cases. The benefits of a structured education have to be weighed against the risk of exposure to infection.”

As far as reducing the risk of that exposure, it is likely going to fall on the school systems to be realistic about what they can and cannot do. The AAP calls for policies to be nimble and responsive to new information regarding the pandemic. It also calls for them to be “practical, feasible, and appropriate for child and adolescent's developmental stage.”

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Physicians can offer their take on what that could look like. “Parents need some reassurance about their ability or the ability of the school system to manage the behavior of children in a way that will reduce the risk of infection,” Dr. Andrews said. “Parents and the school systems may have unreasonable expectations about the way children behave at school. Activities like meals and recesses that promote uncontrolled contact between children may need to be carefully evaluated. As a physician, to have some frank conversations about that will be helpful.” Stay current on the AMA’s COVID-19 advocacy efforts and track the pandemic with the AMA's COVID-19 resource center, which offers resources from JAMA Network™, the Centers for Disease Control and Prevention, and the World Health Organization.