[Music] welcome to the John's Hopkins women's health podcast a woman's Journey insights that matter I'm Kelly gear Ripken and I invite you to listen to John's Hopkins specialist discuss the latest topics in women's health now here's your host Lily shockney hello this is Lily shney thank you for joining us for the second audio presentation about covid-19 what follows is John's Hopkins Children Center's pediatrician Dr Rachel Thornton who reviews the symptoms of covid-19 in children and Adolescenc
e when parents should contact their doctor and the importance of maintaining preventive Health in the second half pediatric psychiatrist Dr Hal kronsberg offered guidance to discuss covid with Children and adolescents and consider ways in which anxiety and stress May man man EST in children keep up to dat with the latest women's health information by visiting a woman's Journey website hopkinsmedicine.org aww woman's Journey or by following a woman's Journey on Facebook and Twitter my name is Rac
hel Thornton um I wanted to open up our conversation this evening with a little bit of general information for parents and caregivers of children regarding covid-19 the symptoms that generally We Believe are associated with infe what we know about severity of covid-19 in children and uh several other considerations that are incredibly important in the care of children now and and always first of all uh for all the parents out there uh in general our understanding is that covid-19 tends to presen
t as flu like illness in most children uh compared to what we know about adults it seems for the most part that covid-19 symptoms are generally less severe in children and generally um re generally present um less complications that being said children can also have significant complications from covid-19 it's it's just generally less frequent of An Occurrence so what are the symptoms of covid-19 that parents may want to look for in their children and what should you do if you think your child i
s ill with covid-19 we know that similar to adults some of the most common symptoms are cough fever um and shortness of breath can be less common but is also one of the frequently presenting symptoms though compared to adults where these symptoms are present about 90% of cases um based on recent reports from the CDC in children we think it's about 70% of those who've tested positive in the United States have cough fever and shortness of breath other types of symptoms to keep in mind things that
we screen for or might ask you about if you call your pediatrician's office our sore throat muscle aches or mygas headache and diarrhea which also can be presenting symptoms for children who have covid-19 sometimes children will have mild symptoms that a caregiver might not identify as covid-19 and there have been some documented cases of children who have no symptoms at all with the infection so we're learning a lot and uh there are many unanswered questions and this is rapidly changing the Cen
ters for Disease Control and prevention continue to provide updated information as it becomes available on how covid-19 is experienced by children and people of all ages in the United States so if you're worried that your child has symptoms that could be covid-19 what should you do in general pediatricians recommend that you start by calling your primary care provider but if the symptoms seem emergent or urgent we would recommend that you seek medical care so how do you tell the difference like
I said cough fever shortness of breath sometimes diarrhea or headache are ways that this infection can present um but when your child is having respiratory distress so this we would characterize as difficulty breathing turning glue around the lips un able to catch their breath those are more severe symptoms that should warrant immediate medical attention I think a lot of people also wonder about the difference in symptoms between younger children and infants and older children uh what we know so
far as I've as I understand it from having uh looked at some of the more recent reports from the centers from Disease Control and what we're learning from the Infectious Disease experts at Johns Hopkins who are help helping us to understand how to screen and manage covid-19 in children is that it is possible that infants may present with more severe symptoms than older children but youth are also at risk of symptoms um and may require hospitalization so I think it's really depending on the age
of your child uh you want to be cognizant and aware of when they're really not acting like themselves um and though that's a time to call the pediatrician if you're child has a fever or a cough and you're really concerned about it or you want more information to know what you should be looking for call them early and start a conversation but like I said any signs that suggest a child is really having trouble breathing that requires urgent attention and you should seek medical attention in an eme
rgency department or an urgent care center in in short order for that and then also with the diarrhea and um other symptoms that can sometimes come with fever or with h we we want to make sure kids are well hydrated and hydration is a particularly sensitive issue for infants and young children so we oftentimes recommend parents keep track of whether their child's making wet diapers the way they normally do whether they're producing tears all of these things are important things to keep in mind a
nd and just to emphasize again pediatricians take great pride in being advocates for children in listening to and honoring parents concerns about their children and so I would encourage you to start that dialogue with your primary care pediatrician there's a lot of conversation out there about what's happening in community pediatric practices are really just the practice of medicine in general are doctor's offices still open are they here to see patients what do I do if I need my doctor um can I
come into the office 1 and I will tell you as always pediatricians are here for their patients in in our community I know what's happening in Maryland better than anywhere uh but we take very seriously the obligation we have to patients and families and there are other things we're doing every day that are Essential Medical Services and critically important this includes prioritizing vaccination of infants and young children the Maryland the acad American Academy of Pediatrics has continued to
recommend and Advocate that pediatricians prioritize and that everyone consider essential visits that are um part of our normal preventive health for children where we vaccinate them and those are the TW month four month six month anytime between zero and two years there's a series of vaccines that are really critical for keeping children protected against other illnesses that can cause them significant um illness and disease we're also prioritizing the four-year-old visit where we do a variety
of essential vaccinations uh in addition to this when mothers are discharged from the hospital after giving birth babies are still being born now we're here to make sure that those babies are growing as they should when they first get home to their mothers um many offices are doing visits electronically or remotely um and doing everything within their power to ensure that the healthy children who need vaccinations who need weight checks can come to their office at a time that's separate from any
time where they might be taking care of children with other illnesses we're also prioritizing giving ongoing care to children who have chronic diseases in many cases we can do that remotely by checking in by video or phone and practices have adapted quickly to doing this um the other thing I just want to call out because this often comes up with a lot of things in the care of children is how do we talk to Children about complicated topics where there's uncertainty topics that even we as adults
may have questions or um worries about I would encourage people who are caregivers of children who are looking for age appropriate resources to check out the um the Maryland the excuse me the American Academy of Pediatrics website healthychildren.org it always has amazing information for parents but they have a whole section on age appropriate information for talking to Children of different developmental stages about covid-19 and a variety of things for parents to keep in mind um I would just s
ay that in general I'm a big proponent of honest open developmentally appropriate communication with children they never cease to amaze me at what they're taking in and observing in their world um and in these unprecedented times uh I think that all children are aware that things aren't quite the way they normally are for them that their routines have changed that uh life around their homes is different and I I would really encourage parents and other caregivers to engage children in a conversat
ion about what they know and um what they're feeling in these times um it's really empowering to children to be able to share their their wealth of of knowledge and skill and understanding of the world with the adults in their lives and it's also really empowering to them to know that some of the things they're doing right now are helping in the fight against the spread of covid-19 I think most School AG children out there are familiar with things like hand sanitizer and coughing in your elbow b
ecause these are the kind of things that in normal times their teachers are reinforcing as important practices to prevent the spread of the flu of and of other uh infectious uh illnesses that may may be more prominent in winter time and practicing these things at home are are good skills for children to continue to reinforce it's also uh helpful for them to understand why we're keeping our distance from one another um and that that's a way of of preventing the spread of Corona virus and I will a
lso say that I think that I was just on healthychildren.org today I know that the Centers for Disease Control and prevention have recently recommended that we uh have recently made some recommendations around masking I think parents may have a lot of questions and children may have a lot of questions about why people are wearing masks and parents may have a lot of questions about when their children should wear masks um and and there's great information and guidance on the American Academy of Pe
diatrics website about this and I'd be happy uh to talk about this further if if this is something that is is of interest to folks in the question and answer and the final thing I want to say for for caregivers and parents of children out there is that pediatricians um and the other practitioners and clinicians who take care of children I believe all of us really value our partnership with parents um and we understand that this is a stressful and difficult and challenging time for everyone and I
think think it is incredibly important uh that we open up those conversations with parents so that and other caregivers so that uh so that you know that it is safe it is appropriate it is welcomed for you to bring forth any concerns that you have about the stress of uh the covid-19 pandemic and the response that different uh governmental organizations and others are implementing to keep us safe how that how that's affecting you um we really want to know we want to support you uh we we have a cr
itical role to play for example for new mothers and new parents in screening new mothers for things like postpartum depression in the year after birth of their child and we understand that the health of the child depends on the health and the well-being of the parents and the family so bringing those concerns those challenges forward to your people Patrician or your other provider who's taking care of your children and maybe taking care of you forward to us so we can provide support and connect
you to resources is critically important in this time more than ever um so you know I hope that I've given you a little bit of a picture of what to look for um in terms of symptoms that may be related to covid-19 they're really common symptoms of things like the flu as well for children when those symptoms should be caused for concern and should push you to go and seek medical attention immediately and when those symptoms might suggest might be something that you could first talk over with your
pediatrician and monitor at home um I just want to continue to reiterate that the importance of vaccination for young children um and how much we pride ourselves on continuing to provide access to those essential services for children and uh finally that um we encourage all parents to keep the lines of communication open with the pediatrician around how this is affecting your family as a whole um and know that your pediatrician or the other you know pediatric provider clinician who's taking care
of your children is likely still available through other means to address the other needs your children have um other things that people may want to get into but I wanted to leave space for Dr cronberg to talk about the so the emotional and psychological considerations right now but other things that we may want to talk about if people have questions is what to do if you think your child may have mild symptoms related to covid-19 I think we can talk in more detail about the importance of some o
f the social distancing and isolation measures that are being recommended um but I'd really like to give Dr cronberg the floor to talk more about um these other important important considerations in dealing with the stresses that are affecting all of us in these times and have particular implications for children's health and well-being so thank you so much uh thank you so much Dr Thorton I really appreciate uh hearing your input from the the Pediatric side of things and and thank you to everyon
e for inviting me here today um I just want to start actually with an an anecdote um to kind of put the the covid uh crisis in perspective from a child mental health point of view um as soon as the social distancing measures were really put into place and we had to start reconfiguring how um our own clinics were operating a bunch of colleagues and I were involved in an email exchange where we were really wondering you know what's going to be the best way for us to provide care for the kids that
we're treating and do we have to start adapting the kind of treatment that we are providing to fit this sort of to fit what we know about providing mental health care in settings like natural disasters and actually um someone who's an ex who uh is an expert on providing that sort of care who did a lot of research um around her Katrina chimed in and sort of helped us to understand this a little bit differently and he had said you know this isn't the same sort of Crisis as something like Hurricane
Katrina was where um you had kids and parents um in this sort of acutely lifethreatening situation Instead This is really a slow burning and kind of gradually evolving medical and societal Challenge and you know we should really be thinking a little bit differently that this isn't the sort of situation where we're going to see you know lots of incidences of like post-traumatic stress disorder or something along those lines um but it is a really significant stressor on kids and on families and s
o you know it is possible that we can see um it causing uh the emergence of new disorders um in particular depression and anxiety and it can make existing depressive and anxiety disorders a little bit worse and basically the the message was you know from a child mental health perspective um we should be thinking that you know this is a marathon it's not a Sprint so um there is some good news with that though um and the first is that actually children's emotional and behavioral responses to stres
sful situations are often um a lot less intense than we might anticipate kids are naturally really resilient in the face of stress and actually there are lots of things that we can do to help them be able to tolerate the stressors better and when I say resilience that's what I mean um helping uh strengthen kids capacity to handle uh the stress of not only uh the covid situation but also being in quarantine as well so there's some things that we know about how to help kids be more resilient um so
for starters social and Community connectedness can really help protect kids from the sort of stress that they might experience during the quarantine um so kids are uniquely able to maintain social relationships when there is physical distance so I know we often think of uh social media use as uh something oh boy uh you know our kids are spending way way too much time connecting with their friends using social media online things like that that's actually a strength right now for them their cap
acity to maintain their friendships and their close relationships even when they can't actually physically be around their friends so that's actually really positive um and the fact that schools are reopening in some capacity you know often uh with virtual meetings with teachers um I think is also really helpful for them to maintain their sense of connectedness with others and um and in particular you know we can make use of technology that exists right now to help fam stay stay in touch with on
e another so again we really want to um to the extent that we can maintain social relationships that we already have um maybe the most important social relationships that we have right now um that can help kids is within the Family itself and we know that family cohesiveness and and positive relationships can really help kids tolerate stress so there's some good news here too um uh maybe too much good news in in that we have so much time now in many cases to spend with our immediate families so
this is a great opportunity and it's one that we can put to good use so I I really highly recommend that families start um making use of that time uh having things like game nights or movie Nights within the family um and family dinners are really great opportunities to do something like that there's something online called the family dinner project which is a really great free resource for families that has everything from recipes that you can uh use for dinner that that puts your um your kids
to to help as well and also you know conversation topics something to get people's minds off of of what's happening right now routines are also really really essential especially right now for kids uh mental health the sleep wake cycle especially is really important for making sure that kids moods stay pretty stable um it's really easy for the time that kids go to sleep and the time they wake up to really start to drift H especially for kids who who like playing video games and they like to play
late at night I'm really glad that school in some cases is coming back online because if kids have to check in with a teacher um at 9:00 or something along those lines we know that they'll be awake and ready to start the day around those times maintaining a normal eating schedule is also going to be really important uh three meals a day it's really easy to just sort of wander aimlessly through the house buy the refrigerator open it up start snacking go back to what you were doing and then repea
ting this process over and over again and finally exercise is really important for kids emotional health as well I know um exercise opportunities are fairly limited right now but even just going on short walks with the entire family is something that um can be really helpful there's certain activities as well that can be helpful for kids emotional health right now in particular things that give them a sense of Mastery and by that I mean helping them learn like a new skill or a new hobby where th
ey can see themselves grow and progress it gives them a little bit more of a sense of control of their own ability to to you know tolerate things and and work through challenges um and even things that are a little bit altruistic maybe making masks for people without them is something that can help them feel like they're contributing to the effort and then finally U mindfulness practice is something that can be really valuable and mindfulness practice basically are meditative techniques that can
help people stay focused in the moment and calm down their bodies and Minds there are lots of free resources online to help guide practice um and you don't need to necessarily spend all day trying to engage in mindfulness meditation you can imagine how difficult that would be to do with a a five or six year old um I do want to put a plug in for um uh one of my colleagues who's going to be joining this program in a couple of weeks named Neta Gould who is our sort of mindfulness Guru over at Hopk
ins she's really really wonderful and I really highly recommend people tune in for that I do want to mention that maybe the most important factor in how kids are going to respond to the stress of the covid crisis is actually how parents respond to the stress of the covid crisis and that might be a little counterintuitive and we know from Research into kids weathering challenges like this that actually how parents handle the stress of a major event predicts how kids are going to do even better th
an how exposed to the event kids are um this is sort of like being on an airplane when you hear the message that you have to put your oxygen mask on before you can assist your child you know we want to be the best parents that we can and in order to do that it's really helpful for us to really focus on managing our own anxiety to manage our own anxiety we also have to be aware of it it can be really easy uh especially when we're stressed out about things to assume that we're seeing anxiety in ou
r kids when it's actually our own and this is a common phenomenon um that's actually has its own sort of name in Psychiatry called projection it can happen sometimes when we're in situations where we ourselves feel helpless so I really want to encourage you know all parents all caregivers right now to um do the best that they can to also take care of themselves and this is in some ways a really great opportunity for adults and parents to seek treatment for themselves if they feel like they're st
ruggling um there's a really common uh form of treatment called cognitive behavioral therapy that's really effective in treating anxiety in particular and it's treatment that can be administered over you know somewhere between maybe 10 sessions maybe 12 sessions and there are lots of uh providers that are currently have moved a lot of their practice to doing things through video and with hours that are uh wouldn't typically happen uh in other situations there are also some things that parents ca
n do that can sometimes make stress a little bit worse for kids that's always worth just paying close attention to um parents who show a lot of overprotected with kids can actually increase the level of stress that kids experience and that's the same thing for high levels of of negativity and criticism that's expressed within the house I do want to talk a little bit about just common responses uh to kids who are experiencing the prolonged stress of something like the covid crisis these are commo
n symptoms this doesn't mean that a kid necessarily has an anxiety disorder or a depressive disorder but it's actually something that we'll often see in lots of kids so really commonly you can see mild disturbances and sleep and Nightmares you can see uh somatic complaints and that that basically means uh anxiety that's expressing itself sometimes through physical symptoms like headaches or stomach aches and we can often see Al also a small amount of social withdrawal as well in really young kid
s um we're actually less likely to see these post-traumatic stress symptoms in really young kids but you do see kids really mirror their parents in terms of their ability to to manage the stress of of this crisis um younger kids in particular also don't often understand that sometimes things just happen by chance so as parents sometimes we may want to correct some Mis misconceptions that they may have about why this sort of thing happened younger kids also are more likely to have those sorts of
sematic complaints the headaches the stomach aches in older adolescence um a sort of typical trait for a lot of adolescen is that they see themselves as being fairly invulnerable and all of a sudden this sort of Crisis uh can suddenly help them to to realize that actually life is a lot more fragile than maybe they had realized and that can lead to a couple of things in some cases uh kids May wind up doing things that are a little bit more impulsive um as a reaction to that feeling and or the opp
osite can happen those those kids May suddenly try to close themselves off from lots of different activities and then schoolage kids and I'm talking about kindergarten through Middle School are somewhere in the middle uh you can often see disturbances of sleep patterns and appetite changes and um and some blending of the symptoms that you see in preschool kids and Adolescence again this doesn't necessarily mean that there's anything uh disordered about the behavior but actually something that we
very commonly see in kids that are experiencing stress however a lot of parents are really curious about well what's a sign that my kid might actually need treatment or might benefit from treatment and like I said before um anxiety and depression are the sorts of symptoms that we might be most likely to see under conditions of really prolonged stress so one of the things that that we always wonder about is how are they functioning are they too anxious or depressed to engage in activities that t
hey might otherwise enjoy or participate in are they you know not spending time with family are they sometimes completely Paralyzed by even the thought of leaving the house at all so worried about the possibility of getting the illness or spreading the illness and always you know anytime a kid thinks um or has concerns about wanting to harm themselves is a time where we would want to reach out and and and find treatment for for our kid individuals that have the most amount of exposure to stress
um tend to be most affected by this so that might be kids who have close family members that are affected by the illness or or parents or other family members that are healthcare workers they're probably experiencing a little bit more stress than than they otherwise might also kids with pre-existing anxiety disorders or similar sorts of experiences to this maybe kids that have lost a family member suddenly illness before are at higher risk for really really experiencing um more anxiety uh so Dr
Thorton did a really nice job talking about uh how we might want to share with kids and I do want to talk a little bit about when the communication goes in the other direction and how we might want to uh talk to kids when they're sharing with us and there's really one principle that I think is especially important really for all times but especially Times Like These which is we want to validate our kids feelings so what validation means is communicating to our kid that we can recognize how they
feel and that they have a right to feel that way so whenever kids um Express their anxiety or sadness to us as parents a lot of times we have this temptation to swoop right in and fix the situation make the feeling go away because it's really really hard for us to see our kids in distress but a lot of times that actually can have the opposite effect it can make the distress go up um so what this means is we have to tolerate um our kids being in distress a little bit in order to really be able to
talk with them and sort of help them to feel seen so for example if a if if one of our kids expresses real fears about the illness even fears that that may not be completely grounded in the facts about the illness you can still validate the feeling you can tell them that that this is indeed a scary time and that it makes sense that they might be frightened and at the same time you can use that as an opportunity to correct some mispers perceptions about illness without telling them that they don
't have a right to feel that way there are also lots of other things that kids have I think a pretty good reason to be upset about um working with a number of uh teenagers and high school seniors in particular a lot of them have spent time sharing with me how upset they are to lose prom uh as as an example or lose graduation and it's really tempting as a parent to say you know in the grand scheme of things maybe cancelling promise is the right move and maybe it's not that big a deal right now an
d so that's an effort to try to help them to feel a little bit better but often times their immediate emotional response can can just intensify and the reality is PR is a big deal and I think it's really important that we can um we can recognize that they have every right to feel upset under these circumstances um so when we're listening to our kids communicate with us helping to recognize that you know not only do we understand how they're feeling um but that it makes sense that they would feel
that way is going to be really important so finally one thing I just wanted to run through very very quickly um for we are spending a lot of time with our kids in many cases they're not going to school and so I just wanted to share a couple of tips for how to weather Sheltering in place so um for starters uh establishing a regular routine as I discussed before is really really important we often want to give kids choices but we don't want to give them so many choices that it kind of becomes ove
rwhelming or that the choices all sort of blur together it's a really great time to keep in touch with family and friends especially using video chats um we want to encourage our kids to choose something new to learn and and to try to learn how to master we want to help them stay Physically Active we want them to participate in meal planning and help them really feel a part of the family and just one piece of advice that I have for parents really all the time but especially now um we often expec
t kids under stress um to slide back a little bit in their development and uh so just a reminder for parents we want to pick our battles with our kids um and not uh use and and use this as an opportunity to be a little bit flexible in how we respond to them so those those are those are sort of my my tips for what I think can be especially helpful for for managing the the co crisis with with your kids and with your family and I turn it back over to our our moderators questions um so I'm to start
with Dr Thorton and I'm going I'm reading the questions that have come in from the audience which um thank you very much for sending those in uh the first one would be uh Dr Thorton when would it be safe to have surgery with a child that has complex medical history to reduce the risk of covid-19 wow that's a a really great question I I will say I can I can generally say in our system um and based on our state's uh response at the level of the governor at this point um any non-emergent surgery um
is is being uh so any elective procedures rather surgeries are are being cancelled at the moment or postponed but CH life is still happening you know babies are being born you know sadly unfortunately people are battling you know sever diseases like cancer and um children may have may need life-saving or life prolonging surgeries or other interventions or treatments and those things will continue um and should continue and I I can say that um I I believe this to be broadly true but I can defini
tely say that I know within John's Hopkins and the John's Hopkins medicine system those of us who take care of children children are wholeheartedly committed to continuing to do so and to continuing to prioritize uh optimizing their ability to be healthy so I think that the question about a specific for a specific child with a particular medical or surgical need is one that should be discussed in detail with the team caring for your child and I'm you know I would defer to them on any specifics a
round the risks and the benefits and and um the timing what I will say and what I can definitely say without equivocation in the John's Hopkins system is that every necessary or every known precaution to minimize any risk of exposure for any child who is in need of care in our system to covid-19 is going to be taken and um I think that uh you know there are there are a variety of challenges in in ensuring that all the appropriate resources are available everywhere um but that um Health Care Prov
iders particularly in settings that are providing sort of um Specialized Care uh for children with significant um you know potentially rare or complicated conditions are are committed to ensuring that procedures that need to happen can happen in a safe way um so I know that's not a direct answer as far as timing I think the other part of this that is still evolving for all of us is the timing of of of our current um response and mitigation measures to covid um 19 you know are it's a rapidly evol
ving changing landscape and so I think it's about ensuring that that the decision you make is made with the health of your child in mind with in partnership with the medical and surgical team um with the expertise to care for your child and I I wish um you every you know sending positive um and healing um thoughts to your family I know this it this circumstance makes those decisions even more difficult but um but we continue to Prior prioritize needed interventions for children um that are you k
now are necessary for their for promoting their health and well-being um so so I think that that you know it's a personal decision but I I just do want to be clear that um precautions are being taken that things that need to be done for children medically surgically um that are Urgent or emergent are continuing to be done safely what to do about kids when if they're acting out in mood swings what would you suggest about kids who are acting out with mood swings so that's that's a really good ques
tion and and I think the biggest thing to get an understanding of is um you know what's the source of of the mood swing so so the first thing that I think we want to do is to try to provide an environment that's going to be as conducive to healthy emotion regulation as possible for kids so the first thing we want to do is try to make sure that the envir enironment that we're in right now especially because the world feels so unpredictable is as predictive is as predictable as possible and so tha
t means sort of the standard routine that you would try to keep as much as possible prior to this happening same wakeup times making sure that they're sleeping appropriately because we know those sorts of things can affect kids ability to kind of uh control and regulate their moods um I also think especially now clear and uh clear and natural consequences and by natural consequences I kind of mean reasonable consequences to uh whatever the action that that occurred was and making sure that they'
re consistent so the way that we respond to it is the same on Monday as it is on Tuesday as it is on Friday as it is on Sunday um and the more clear we are about expectations that we have in the house the less likely we are to suddenly find ourselves in a conflict in the Heat of the Moment so really the more kind of simple information that we can provide to kids um in the beginning and in the middle of a conflict I think the the better and the easier it is to help um uh reduce how intense it can
get and then finally I do want to just always go back to the idea of validating so kids mood can swing for all sorts of reasons but if a kid expresses an emotion um that makes sense if they're upset about something like not being able to go outside and see their friends um that makes sense and even though it's also understandable why that's something that we may not be able to permit at the moment we do want to recognize that they have every reason to be upset under these circumstances and if w
e feel um if we had any ability to make things different we we would thank you very much Dr Dr thoron are children with asthma diabetes or an autoimmune disorder at greater risk and if so how do I best protect them great um so I can tell you what I am learning and what I think all of us are learning as more information is available um so the the Centers for Disease Control and prevention puts out um uh epidemiologic reports on illness and I believe last Friday put out a report specifically looki
ng at complications and severity of illness from covid-19 in children um and there was an increased risk of hospitalization for children with at least one chronic condition um that included things like heart disease lung disease including asthma um and um I think in general for children with autoimmune diseases who may in the treatment of those diseases be receiving medications that also uh impact the functioning of their immune system um those children in particular I think we're we're paying c
lose attention to um their risk of infection just because if their immune system is suppressed in the treatment of an autoimmune disease it may also make them more susceptible to infe infection in general um so I think that while we do know that there does seem to be in the United States some information that that these children may be at more risk of hospitalization I I think that the picture continues to evolve and I would really um you know defer to colleagues who are completely focused in th
e realm of infectious diseases and epidemiology as we continue to learn more um I would say that for the most part similar practices in terms of looking for signs and symptoms would apply to any child and I and I I just want to reiterate again that in our training for those of us who are clinicians who primarily take care of children or entirely take care of children we honor and we respect and we partner with parents and so I think that parents who know their child know what illness uh looks li
ke in your child um may know what respiratory distress looks like in your child may know uh specifically how um the difference between a fever that's you know a fever but probably getting better and a child with a fever who's really not themselves we want you to reach out to us and call us and talk that through with a with a pediatric provider clinician who really who knows your child's uh specific medical context um but like I said I think that there is um at least the the report um from Friday
's um mmw from the Centers for Disease Control and prevention um did identify chronic diseases as a potential contributor to hospitalization um again I do want to emphasize that compared to what we know about the severity of illness and the um mortality of illness in adults um the risks of of of severe illness and mortality in children are less but that doesn't you know when it's your child and you're concerned um I want to validate that and I want to encourage you to reach out um to to talk tha
t over with a clinician who knows your family or like I said if your child has severe symptoms to seek urgent medical attention thank you very much Dr kber is this the right time to switch anti-depressants in children or adolesence so I think a lot of it would depend on the the guidance that you might be getting from whoever is doing the prescribing um in many cases psychiatrists are prescribing anti-depressants but in in many other cases pediatricians are as as well um I can't speak to any one
individual specific circumstances um but I do think when it comes to thinking about making a change in medication it's worth wondering to what extent are these new circumstances really driving the picture um are we seeing a kid reacting to a schedule that is dramatically changed or um expectations of the home that are suddenly very very different from what it is that they're used to um and so at least personally I would say My Philosophy overall is to kind of give kids a chance to really adjust
to the new reality um however I think that's a really personal conversation uh that's really worth having if you feel like the medication that that your child is taking really isn't working in the same way that it used to um I think that conversation is worth having with with the person that that's prescribing that with you Dr thoron uh two-part question for uh women who are pregnant or just had a child what precautions um are the maternity Wards taking to prevent covid for mother and baby and a
lso is it safe to breastfeed great well this is an actively evolving um landscape in the context of the care of pregnant women I can say um that there are you know different systems are approaching this differently um and that we continue to learn more and more um I believe that there have been some reports that um women who are pregnant can can be infected with Corona virus and not have symptoms in pregnancy and so um I my recollection is that some of that has come has been information that's c
ome out of New York and um as as a result I think that there are a variety of approaches being taken I think people particularly in our system are um following the guidance from the Centers for Disease Control and the expertise of the epidemiologists and infection control experts in our system um I know that within our system very recently we've begun testing all women who are coming in in labor um both because of the you know as a practice to really minimize the risk of transmission of covid-19
to healthcare workers in that context and also to keep women who are laboring in the safest circumstances possible uh for them um so I think there's a lot of of of focus on in preventing infection and spread of infection what we call nosocomial infection in the context of hospitalization um and that particular attention has been paid to pregnancy and and delivery um with respect to breastfeeding so I think there's a variety of questions and I don't want to get into a lot of hypotheticals for an
y one's individual case um but I can say that the um again healthychildren.org is a great source of information for parents on this topic um but that in general um my understanding is that breastfeeding and breast milk in particular breast milk uh can can still be safely given to inference if a woman herself is infected with covid-19 I think similar to the recommendations around distancing from people who are symptomatic or have infection um there is a lot of of challenging conversations around
what happens if a woman herself um is found to have be have covid-19 in the context of delivering her infant and um and how to manage you know keeping her safe from transmitting covid-19 to her child um so there's some elements of that that are personal to personal decisions and decisions that should be made in consultation with your um your OBGYN providers and pediatric providers and your and take into account family circumstances and there may be specific guidelines or practices in the hospita
l where a woman is delivering that will um will mean that certain practices have to be followed in that setting um and I think all of these practices are intended to prioritize the health and the well-being of moms and of babies um so this is this is rapidly changing but we're we're definitely prioritizing that I think in our system and I think um clearly you know every everywhere where women are giving birth I think the priority priority is keeping them safe from infection transmission within t
he health care context and in ensuring their ability to you know to keep their babies safe um so but but the question of breast milk I think is is a question that we've talked about a lot and that there is a fair amount of information to suggest that even if a woman is infected her breast milk um can still be safely given to her infant um so hopefully that's responsive to the question but Kelly if I left anything out please chime in and I'll I'll Circle back on it great information great informa
tion thank you Dr thoron Dr cronberg are there resources for teens out there for anxiety and in particular um teens who like you've mentioned earlier who you know are missing their Proms and so forth and also going off to college and um the things that they're missing on that yeah that's a really great question and and I would say so there are definitely resources that that are available some of the things that I had mentioned already like mindfulness practice which is anything that's in many ca
ses suitable for adults to try is also going to be suitable for teenagers as well um for kids whose anxiety feels not manageable um they're all sorts of things to try anywhere from you know workbooks that are rooted in the principles of cognitive behavioral therapy which I described but this also might be a really good opportunity for um for kids and teenagers to consider getting engaged in in therapy right now as well um and then finally the thing that I would just keep saying again and again a
nd again and again is uh for kids and teenagers especially that are struggling with anxiety so mindfulness practice is really helpful for helping them to stay in the present but also maintaining consistent schedule um and a consistency with within their day and making their day feel predictable can reduce their overall kind of level of anxiety that they might be carrying around with them throughout the day and then finally just one one other thing that I would I would want to add is just be mind
ful of what sort of media your kids might be consuming for kids that are just watching the news and just getting the same messages again and again and again and again and because they're having a hard time turning it off we may need to be a little bit more firm with kids under those circumstances at a certain point more information is not helpful for for anyone kids and adults so we we just want to be mindful of of what our intake is you Dr kohburg thank you very much Dr thoron for children um f
or social distancing do you feel that there should be strict guidelines when they're playing with their friends and the next part of that question is and should they be wearing masks children so um I'm also a mom it's possible you hear one of my children upstairs is not super happy at the moment so I I I I can empathize and sympathize with all the parents and caregivers out there who want to um maintain fun experiences for their children and that connectedness I would say our sort of our our our
best recommendation is as much as possible um to to practice the physical distancing even with children and friends um so you know for younger children it's it's impossible really to kind of keep them six feet apart and with their friends in any kind of relational setting that's just not something they can really grasp and um operationalize and stick to um and so I think that in the in the most like strictest sense of the word I think that we're we're we're sort of encouraging families to consi
der um doing more more kind of virtual uh playd dates and interactions for kids um and and and trying to minimize those opportunities for uh um transmitting germs um you know I think as far as wearing masks with friends um you know I I would I would point you to the the CDC guidelines that suggest that in in public um when there's a chance that we could be within six feet of others so I'm thinking about settings not like taking a hike in the woods with your immediate family but in settings where
you may be in a grocery store or in a in a space that's shared and you can't always control distance the CDC is recommending the use of masks um the healthychildren.org website has really good information I think in general for toddlers and young toddlers uh and infants um we would have concerns about um Suffocation risks strangulation risks and so generally the aap's guidance the American Academy of Pediatrics guidance is no masking for children under age two and I think we also have to be cog
nizant of you know being able to ensure that um children are able to breathe and and that having a mask on doesn't um sort of push them to touch their face actually more than they otherwise would that's kind of defeats the purpose um so as with many of the guidelines right now I think it's a combination of doing our best to do our part as much as possible um with implementing physical distancing and uh trying to stay at home as much as possible um within our immediate kind of household at the sa
me time that we have to um manage um manage life and and so I think that that's a balance that is personal to families and to C circumstances um but I hope that this guidance is generally helpful helpful to you in thinking that through um you know it's amazing what kids can do together by FaceTime um and the the new fun adventures they can have um through sometimes having virtual contact even when they're they're young um so I would encourage you to think about those in addition to kind of doing
if it's older children or children who you think can kind of maintain distance um to really be cognizant of of those recommendations great thank you Dr thoron Dr cronberg what insights do you have on long-term impact on kids especially being in quarantine for so long so I think that's a really good question and to some extent it's worth kind of recognizing that this is fairly unprecedented um certainly since we've really um refined a lot of like research techniques and things like that I don't
know that we've had in this country an event that's quite like this before um when I think about things that um when I think about how I see there being some long-term impact for kids um one thing that I think is um worth acknowledging is as as we had already mentioned there are going to be a lot of kids who've missed milestones and who uh derive a lot of comfort and enjoyment out of doing certain things in certain types of the year that that are likely going to miss that so that's anything from
graduating from one grade to the next and getting the opportunity to say goodbye to teachers and in some cases friends um uh that's something that that they're going to miss and it's going to make those transitions a little bit harder for kids so I think we're going to have to be really creative to come up with ways for kids to be able to do things like say goodbye to friends say goodbye to um uh really beloved teachers to um experience uh special milestones in a somewhat different way and I th
ink schools are are working really hard to be as creative as possible in helping kids kind of feel connected to one another um and to come up with you know some sort of virtual alternative to things that that they might have been looking forward to for the entire year um you know I also think that um this may in some cases make certain things like flu season be a little bit scarier for kids they might be worried oh is this going to get really bad are we going to be right back in the same situati
on that that we were in before and I think kind of anticipating that sort of worry and being able to address that sort of worry with kids is is going to be really important in the future as well and Kelly if I could just add in addition to the long-term emotional consequences there are a lot of families who are already um maybe were before this or will be depending on how long this goes on experience Financial hardships that in and of themselves affect those uh fam's abilities to meet basic need
s of children that we consider as pediatric clinicians sort of the building blocks the necessary preconditions for Children's Health Dr cronberg mentioned things like family meals and access to healthy food and safe spaces to play and I I just want to lift up the fact that I think every pediatrician thinks about these necessary preconditions like a safe place enough food to eat a developmentally appropriate setting as things every CH child needs and that we should be doing our best to support ev
ery parent or caregiver to be able to provide and so um I encourage people not to you know feel shame and sharing those challenges with pediatricians we know many you know young parents are also in the essential Workforce in uh in jobs that have little glory and not that much pay and so um so we're here to help give voice to those challenges and help support families through these really difficult times emotionally and you know financially and everything else looks like we've run out of time and
I want to thank our doctors Thorton and kohburg for their expertise and time this evening really really appreciate it wonderful information and I would like to thank all of you for joining us this evening good night and stay [Music] [Music] well
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