Sick kid? Protect yourself

Try to contain virus when child is ill with COVID-19.

My 10-year-old’s sputtering, empty cough lasted a weekend. He didn’t show any other symptoms, and his chest barely bounced when he turned his head to aim at his sleeve. It was early March and reports of an outbreak felt distant — in Washington state and overseas. We convinced ourselves that we were safe on the East Coast.

When my 7-year-old developed a similar dry hack, it was more powerful and persistent, and it was accompanied by a low fever and fatigue. My sick child insisted on sleeping in my bed — cuddling close and holding my hand for comfort — making it hard to dodge the overnight coughs. Within a few days it was as if the kids had never been ill. But a week later, I developed that same cough, and my symptoms progressed quickly to pneumonia. A chest X-ray and other testing confirmed I had COVID-19.

I’ve recovered, for the most part, though I’m still coping with fatigue and some other lingering symptoms. But now, as many states have begun reopening and families inch back toward normalcy, including camps, activities and larger gatherings, I’m concerned that health and safety will become an afterthought. And I worry about the challenges faced by parents who find themselves caring for sick kids while trying to stay healthy themselves.

Angela Rasmussen, a virologist at Columbia’s Mailman School of Public Health, says that despite early reports that children were largely unaffected by the novel coronavirus, kids are at risk of contracting and spreading the virus, and while most children are able to recover without issues, parents shouldn’t assume that all kids will be just fine if they are exposed.

“A small percentage of infected kids can develop very severe COVID and in some cases die,” Rasmussen says, and she emphasizes that even if the child doesn’t

get very ill, they can transmit the virus to others. “This is especially true for the close contacts with whom they spend significant time indoors — such as members of their household.”

I didn’t do a good job of protecting myself from my children’s illness, and I’m still living with the consequences. As kids reenter social settings, it’s important to teach them to protect themselves while they’re away from home, to reduce the risk of them bringing the virus back to their parents, says Kristin Moffit, a pediatric infectious-disease specialist at Boston Children’s Hospital. And if they do get sick, there are some simple preventive measures you can take to try to minimize the chances of another family member getting infected.

Stock up

Moffitt says parents need to plan ahead for possible illness. Stock up on essentials, including over-the-counter fever medications, a humidifier, bleach or other CDCrecommended cleaning supplies, hand soap, face coverings and some extra groceries, in case someone gets sick. Parents should also consider designating a point person outside the home who can bring in supplies in the event someone in the home gets sick and the family has to quarantine.

Separate

Rassmussen notes that if a child tests positive or presents symptoms, the best way to avoid spreading the virus is to separate the child from the rest of the household, but this isn’t always practical — particularly for young children.

In those cases, Moffitt says, families will need to be creative. Children should sleep in a bedroom alone, even if it means rearranging sleeping quarters. If co-sleeping or room-sharing must occur, she suggests sleeping head to toe if children are old enough or rearranging furniture to reduce transmission. Good ventilation is key, because droplets could linger in stagnant air. Moffitt recommends opening windows and using fans.

Designate a caretaker

Designate one adult, ideally one who is not in a highrisk population, to monitor and interact with the sick child, but even that person should keep contact to a minimum. If the child’s typical caretakers are highrisk, consider enlisting the help of other community members. If possible, both the child and the caretaker should wear masks. Moffitt says that caregivers can continue nursing if children rely on it for comfort or nutrition. In this case, the adult should wear a mask and carefully wash their skin with soap and water after each encounter. Bottles used to feed babies should be sterilized after use.

Explain why

Parents of younger children may have to explain why the precautions are so important. “Teach them why they’re separated and use age-appropriate language to explain the illness,” Moffitt says. “Use toys or videos to show how germs are passed from one person to another who is too close and demonstrate which distances are safest.” If a child must be held, caregivers should use personal protective equipment and wash regularly.

Moffitt also emphasizes the importance of empowering children to be part of the solutions the family develops. “They should be told that they’re sick and need time and space to get better,” she says. “Show them that there are other ways to stay connected by using tablets or mobile devices. Brainstorm together about the ways you can play while maintaining distance.” Some examples include reading a book or telling stories from across the room, playing a game that does not require proximity, such as Pictionary or I Spy, or watching a movie. Make sure they have their favorite blankets, stuffed animals and pajamas, and let them use communication devices when they are feeling lonely.

Maintain distancing

Physical distancing and other protective measures should continue until 10 days after the onset of symptoms, or until the child is symptomfree for three days. Moffitt says people who test positive are most infectious two to three days before and after developing symptoms, so that is the time frame to really focus on.