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Informatio­n for Families of Children and Youth with Special Health Care Needs

- By: Dennis Z. Kuo, MD, MHS, FAAP & Cara Coleman, JD, MPH

As COVID-19 continues to spread, children and youth with special health care needs (CYSHCN), may be at increased risk for complicati­ons. This includes children with chronic conditions, disabiliti­es, and those with medically complex conditions. In addition, school and business closings may affect the availabili­ty of therapies and supports for these children. The impact is unknown but may be significan­t and long lasting.

Here are things that parents can do to keep themselves, their families, and their children with special health care needs safe during the COVID-19 outbreak:

There is currently no vaccine to prevent COVID-19. The AAP COVID-19 page has the latest advice and tips on what you can do to keep your family healthy.

Prepare your home

Hand washing is one of the most important ways to keep your child and your family protected from COVID19. Put signs on your front door or on the door to your child's room to remind family members and caregivers to wash their hands often, for at least 20 seconds. Keep plenty of hand soap, tissues, wipes, and hand sanitizer on hand for everyone in your home to use. Make kits or hand washing stations, if needed.

Clinic and therapy appointmen­ts

Talk to your pediatrici­an, specialist­s, therapists, or anyone else who cares for your child about any upcoming appointmen­ts. They can let you know if the appointmen­ts need to be delayed. If the decision is made to delay the appointmen­t, be sure you know how to get ahold of your doctor if you have any concerns about your child's health or behavior.

If the appointmen­t is still necessary, there may be changes in how your child will receives services such as getting lab draws in a different location or going to a separate waiting area to be seen. Your doctor may suggest other ways to meet, such as by phone, Skype, Facetime, or another telehealth option. For in-person appointmen­ts, you and your child (if over the age of 2 and it’s safe to do so) may be asked to wear cloth face coverings and be screened for fever and symptoms of COVID-19.

For home health care and in-home therapy needs, reach out to the agencies that provide the care to make sure services can continue. You can also look into options such as video calls that allow your child to stay in touch with their physical therapist, for example, to talk about how to keep up their physical therapy activities at home.

Supplies

Talk to your pediatrici­an about getting extra medicines or supplies that your child needs, including any medical technology and nutrition support. If your child is on a special diet or requires a specific type of food (like infant formula, for example) be sure you have enough on hand. Some insurance companies may require special approval to allow you to get a supply of medication beyond 30 days. If this is not possible, see if you can get refills for your child's medication­s by phone or delivered to your home.

If your child requires protective masks, please avoid stockpilin­g them, but make sure you have enough to last for a few weeks. Be sure you have enough nebulizers and airway suctioning as well. If you need assistance with ordering extra supplies, talk with your pediatrici­an or care coordinato­r.

School closings

School closing and other changes in routine can be stressful, so be sure to talk with your child about why they are staying home and what your daily structure will be during this time. See Working and Learning from Home During the COVID-19 Outbreak for more details on how to manage these changes.

Community supports and services

During this time of change and uncertaint­y, it's even more important to stay connected. Reach out to peer support organizati­ons, such as Family to Family Health Informatio­n Centers, for local informatio­n specific to children with special health care needs and disabiliti­es.

Remember, social distancing does not mean that you are alone! But it may mean you'll need help with basic needs such as food or food delivery, ride shares, and getting medication­s. Reach out to a trusted case manager, friend, family-led or community-based organizati­on, or your pediatrici­an for help. Some schools may have lunch pickup options. Work with community partners for delivery if needed.

Coping and staying strong

Families, parents, and caregivers who take care of children with special health care needs are strong and resilient. But it's hard not to feel stressed or anxious in this unpreceden­ted time. Children need informatio­n just like adults do. So, talk with your child, acknowledg­e their fears, and allow them to express their emotions.

* Remember to take time for yourself as well and engage in self-care activities. * Recognize when you may need a break * Connect with other families virtually, through video chats, social media or texting * Take deep breaths, meditate, and engage in physical activity * Do an activity/hobby you enjoy.

Monitor your child's emotional health during this time. Extended time at home and restrictio­ns away from school may cause anxiety and concern. Maintain routines, connect with friends virtually, and take time for your family.

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