On September 9, 2020, providers from MassGeneral Hospital for Children (MGHfC) were featured in a virtual town hall, “COVID Fall 2020: Information and Tools to Help You, Your Family and Your Child Navigate School.” Below is a Q&A based on the town hall event.

Featured speakers were Vandana Madhavan, MD, MPH, clinical director of pediatric infectious disease and a pediatrician at MGHfC; Alexy Arauz-Boudreau, MD, a pediatrician and medical director of Pediatric Primary Care at MGHfC; and Aude Henin, PhD, co-director of the Child CBT Program in Psychiatry at Massachusetts General Hospital.

Watch the town hall on YouTube.

About COVID-19 and MIS-C

What is known about COVID-19 so far?

Information about COVID-19 changes very quickly – sometimes within the day. Here is what we, as doctors, know so far:

About COVID-19 in the United States

  • Since January 2020, there have been over 513,000 confirmed cases in children of COVID-19 in the US. They make up about 9 out of every 100 total cases, but doctors do not know the exact number of total cases. This is because of changing availability of testing and changing reasons for testing.
  • We do expect another surge of COVID-19 in the fall, but we are not sure when or how it will compare to the surge this past spring. We are also not sure how it will interact with other respiratory viral infections.

How COVID-19 affects children

  • Children are far less likely than adults to develop severe cases of COVID-19. This means children are less likely to be admitted to the hospital or need intensive care.
  • Most children with severe cases of COVID-19 have underlying (other) medical conditions
  • Children are typically infected by other adults who have COVID-19. Children are less likely to spread it to other children or adults.

What helps and does not help

  • Remdesivir (an antiviral medication) and corticosteroids (medications that help ease inflammation throughout the body) have been shown to help ease, but not cure symptoms of COVID-19 for patients that are sick enough to be in the hospital. People who are well enough to stay at home can be treated with supportive care, like fluids and medications to control fever.
  • Antibiotics to treat bacterial infections, hydroxychloroquine (a medication commonly used to treat malaria or lupus) and antiretroviral therapies (medications that treat human immunodeficiency virus, or HIV) have not been shown to help. In some cases, these medications have been shown to be harmful.
  • Researchers are working on developing a vaccine for COVID-19, but we are not sure when it will be available.

What is the best way to prevent COVID-19?

There are currently no medications to prevent COVID-19. The best way to stop the spread of COVID-19 is by focusing on prevention efforts, such as:

  • Wear a mask correctly over your nose and mouth
  • Wash your hands frequently with warm, soapy water or hand sanitizer (if water is not available)
  • Keep up with physical (social) distancing
  • Keep up to date on vaccinations and routine pediatric care
  • Set a good example for your child by practicing these behaviors

Is frequent testing for COVID-19 necessary?

Regular screening for symptoms of COVID-19 is important, but frequent testing is not always necessary. Screening can have different meanings for patients and families versus providers. For patients and families, screening means keeping an eye on your child if they develop symptoms and letting their doctor know about those symptoms. Based on your child’s symptoms, their doctor can tell you whether a COVID-19 test is necessary.

CDC lists possible symptoms of COVID-19 as:

  • Fever
  • Fatigue
  • Headache
  • Myalgia (muscle pain or muscle aches)
  • Cough
  • Nasal congestion or rhinorrhea
  • New loss of taste or smell
  • Sore throat
  • Shortness of breath or difficulty breathing
  • Abdominal pain
  • Diarrhea
  • Nausea or vomiting
  • Poor appetite or poor feeding

It is important to note that many common and well-known childhood illnesses share the same symptoms as those listed above.

What are MGHfC and Massachusetts General Hospital doing to keep patients, families and staff safe?

The hospital is taking unprecedented steps to keep our patients, families and staff safe. Learn more about the steps.

What is MIS-C?

Multisystem inflammatory syndrome in children (MIS-C, formerly called PMIS) is a rare, but serious condition that can affect many systems and organs throughout the body. Doctors have found MIS-C in children who have been infected with COVID-19 or who have been exposed to someone with COVID-19.

What are the symptoms of MIS-C?

Symptoms of MIS-C can affect the heart, kidneys, stomach, intestines and, in some cases, the brain and nerves. Symptoms usually appear 3-4 weeks after a likely infection with COVID-19.

Symptoms of MIS-C can include:

  • Fever that last more than 24 hours
  • Symptoms similar to Kawasaki disease (a disease that causes inflammation throughout the heart and blood vessels), such as rash, swollen hands and feet and a swollen tongue that looks like a strawberry.
  • Symptoms of shock, such as low blood pressure and fast heart rate
  • Fever that last more than 24 hours
  • Diarrhea
  • Nausea or vomiting
  • Confusion or neurologic changes
  • Cough or shortness of breath

What is known about MIS-C so far?

We know that MIS-C is rare, but serious. We also know that it appears to be a complication of COVID-19.

In the United States, there have been about confirmed 800 cases of MIS-C in children ages 1-14 years of age throughout 42 states. All 800 of those children had COVID-19 or were exposed to someone who had COVID-19. About 7 out of every 10 children with MIS-C were Black or Hispanic/Latino.

What should I do if my child shows symptoms of MIS-C?

If your child shows symptoms of MIS-C, call the doctor right away.

How can I schedule a virtual visit?

If you want to schedule a virtual visit, call your doctor’s office. They can help determine if a virtual visit is the best option to meet your or your child’s needs. Learn more about virtual visits.

Preparing for School

How can I help my child prepare for the upcoming school year?

Is it important to remember that each town or district is handling the start of the school year differently. It is balance of what is best for the needs and resources within each community, your family and your child. Here are some tips to help you prepare your child for the school year:

  • Get your child’s perspective. Ask your children what excites them about school this year and what are the challenges they see. This is an imperfect, evolving journey we are on with our children
  • Ask your child about what they are most excited for and worried about. This helps them remember the excitement of the new school year they may have felt in the past. It also helps them express their fears or worries. Together, you and your child can come up with solutions to their challenges.
  • Keep up with traditions your family follows as the school year begins. For example, getting new notebooks and pencils or meeting the new teacher over Zoom. This helps create a sense of continuity rather than creating a new normal.
  • Make a daily routine for yourself and your child. Make routines for school, work, sleep, meals and play.
  • Make time to organize and set a schedule for your family. Then, share and talk about the plan with your family.
  • Set up a dedicated space in your home for school or work. If the same space is being used at different times of day (such as a kitchen table for meals, school, and work), set hours for the space to be used for each task. This helps children understand the schedule and stick to a routine.
  • Have a dress code for school, even if your child is going to school remotely. This helps your child develop a routine for getting ready for school.
  • Give grace to everyone, including yourself. This is a challenging time for everyone. It’s important to give everyone – yourself included – that little extra sense of understanding and compassion.

Building Resiliency

What is resiliency?

Resiliency is the ability to adapt to and manage challenges. It is a skill we build throughout our lifetimes. Resiliency is especially helpful during stressful or challenging times, such as the beginning of the school year amid the COVID-19 pandemic. Children in particular are resilient, especially if we can help guide them.

It is easy to forget that humans are designed to adapt to and overcome difficult situations. Even though this may be the first time we are experiencing a crisis such as the COVID-19 pandemic, it can be helpful to remember that humanity has dealt with these types of events throughout history. Although we do not like uncertainty and change because they are uncomfortable, this is an opportunity to practice learning how to lean into that discomfort and tolerating it just a little more.

My child is going to school remotely. Will this affect their development?

From a developmental perspective, most children will be okay throughout the pandemic. There is no perfect solution for school. It is important to do what you feel is best for your child and your family.

How can I help my child build their resiliency skills?

Resiliency is all about how you bob and weave through life. It is not the absence of fear or anxiety. It is the ability to manage those feelings to adapt to the situation.

Here are some tips to help your child build their resiliency skills as the school year starts:

  • Change what you can and cope with what you cannot. This is an important time to distinguish what you can and cannot change. For things you cannot change, ask yourself how you can learn to accept them and adapt to the situation. At the same time, identifying things that are still within your control, even in the face of uncertainty, can be helpful.
  • Make a list of healthy coping tools you or your child can use during times of stress. Think about what you or your child enjoy or what helps relieve stress in a healthy way. Focus on activities that allow you and your child to focus on the here and now, and activities that can bring a sense of relative calm and/or well-being. These can include physical activities, connecting with loved ones or engaging in a pleasant or meaningful activity.
  • Notice signs of stress and use them as a signal to engage in coping behaviors. Teach your child to notice their own signs of stress too. When you or your child notice signs of stress, it is time to wind down and take care of yourself.
  • Pay attention to the thought you or your child have. Practice challenging unhelpful negative thoughts by replacing them with helpful ones. Help your child practice this too.
  • Set a good example. How are you modeling healthy coping skills and managing emotions to your child?
  • Remember that children pick up on how adults manage and express their emotions, especially with school. For example, it can be more helpful to say, “Your school is working hard to make sure school is safe. Sometimes, that means plans change,” is more helpful than saying, “Schools don’t know what they’re doing.”
  • Reinforce the message that while we, as adults, may not have all the answers, we are alongside your child. Together, we will figure it out.