Halloween During COVID-19

Parents, the following is an article by a pediatric psychologist which discusses celebrating Halloween during the pandemic. The following discussion and article will be comfortable for some and less so for others. Keep in mind that perceptions, opinions and dispositions vary widely amongst parents regarding the disease and the proper way to approach it.

As we enter into a new season with the ongoing coronavirus (COVID-19) pandemic and ongoing social distancing guidelines, many families are wondering how to modify their fall traditions — most notably…Halloween. Children who have been lacking social interaction with alternate schooling formats and drive-by birthday parties may be especially excited about Halloween. They are likely anticipating what is “normal” — dressing up in costumes, having parades, parties and running with large groups of neighborhood kids to collect candy during trick-or-treating. With the ongoing COVID-19 pandemic, many of these traditions are simply not a safe option. Halloween, as with everything else since March 2020, will need to look different this year.

Parents may feel nervous about “crushing their child’s dreams” and piling on yet another disappointment in a long string of losses. Some parents may avoid thinking or talking about Halloween because it feels difficult and, let’s be honest, all the parents are exhausted. But parents will likely find that mustering the energy to plan ahead will make Halloween more fun and exciting.

Children and teens (like their adult counterparts) do best when they know what to expect. Halloween looking different this year will be more disappointing if your child spent weeks creating and looking forward to a plan that is not workable. However, if your family can slowly start talking and planning ways that Halloween — and the fall season in general — can look different this year, you can create fun and exciting opportunities that your kids will look forward to.

How to start: remind your kids that fall means that Halloween is coming up. Ask them about what they have enjoyed most about Halloween and fall in the past. Talk about the social distancing precautions and how things like school parades and large indoor parties will not be taking place. Be honest — if you are unsure if your friends or neighbors will have modified trick-or-treating, let your kids know that it is still unclear. If you know your family will not participate in any trick-or-treating, let your kids know that, too. Now, the important part, brainstorm ideas together. Think about ways to modify your favorite activities or create new activities that may become part of your future family traditions. Add activities to your schedule so your kids can look forward to the next fun event.

Trick-or-treating alternatives

Here are some brainstorming suggestions to help your family get started:

  • If your kids typically dress up for Halloween, let them help order or make costumes. Consider trying themed costumes with your family or with some of their friends.
  • Plan a Zoom Halloween party for your kids’ friends or for your extended family. Encourage everyone to dress up. You can plan games or send ahead craft plans so the kids can do a shared activity.
  • Research themed snacks and treats to make and share as a family.
  • Plan a socially distanced (outdoor with masks) pumpkin carving party for a small group or with neighbors from everyone’s front yard.
  • Decorate the yard/house in the days leading up to Halloween. Consider starting a house decorating contest in your neighborhood.
  • Make signs or chalk drawings for neighbors to enjoy.
  • Look into safe/socially distanced pumpkin or apple picking farms near you.

Remember, different isn’t necessarily bad, it’s just different. The more time your kids have to adjust to disappointments with any traditions that will be cancelled or modified, the more time they have to create fun alternatives and build excitement about new plans!

Returning To School

As this highly abnormal school year gets underway, you probably have questions about returning to school. To help you, we’ve compiled some FAQs about COVID-19 transmission in children, masks, school buses, physical distancing at schools and more.

Will my child infect other family members?

Available evidence has revealed that children, especially those under 10 years of age, are unlikely to spread the virus to others. Studies from Australia, Ireland and The Netherlands have shown that children usually were infected by other family members and not the initial source of infection.

What kind of face covering should I use?

There are many types of face coverings available. A recent study by the University of Florida tested several types of face coverings and found that the best face covering for home and the community was the cloth face mask made with at least two layers of cotton cloth and stitched together. Higher count cotton material and more layers worked the best. A commercially-available cone-shaped mask also worked well.

At what age should my child wear a mask?

Children older than 2 years can usually wear a mask for a period of time. Like any new activity, wearing a mask takes practice, to allow the child to tolerate mask-wearing for a long period of time. It also helps to model good behavior by having adults wear masks to help children and adolescents see it as normal behavior. Of note, children should only wear a mask if that does not lead to touching the face more than usual. Most children with medical conditions, including asthma, are able to wear masks as well.

What is recommended to keep students physically distant at school?

There are several strategies to keep students physically distant at school:

  • First limit the number of students in class, depending on the size of the room, to allow at least three to six feet between students.
  • Keep students and teachers in one class or cohort, particularly in elementary school, though this may be harder at the middle and high school levels. Limit switching students or teachers between classes.
  • Hold class outside when weather permits or open windows and doors in classrooms to increase ventilation. Fans, however, are discouraged to avoid spreading air particles.
  • Stagger start times to limit the number of students in the hallway or school entrances.
  • Use Plexiglas in areas that do not allow distance or when masks cannot be used – lunch, certain types of instruction, etc.
  • Mark the floor to remind students and teachers of spacing requirements.

Should my child play on the playground?

Physical activity is important for everyone and may help students concentrate during class time. Therefore, the risk of exposure on the playground does not outweigh the benefits of play for children. The most important factor is to wear masks, avoid touching your face and either wash hands or use hand sanitizer when finished playing.

Can my child ride the school bus or van?

Yes, but use good practices to physically distance students. Buses or vans create a close environment where viruses can be spread.

  • It is important that students wear a mask when traveling in a school bus or van.
  • If weather permits, keeps the windows on the bus open to allow for good flow of air.
  • Seating should be limited to 50% occupancy or one student per seat in a school bus.
  • Students should board and exit the bus in an organized manner allowing six feet spacing between students in the aisle.
  • Students should wash hands or use hand sanitizer after exiting the bus.
  • The bus should be cleaned after each trip, including seats, handles and windows.

What if my child becomes sick?

If your child becomes sick, you should notify your school so they can determine when your child can return to school and monitor your child’s class/cohort for signs of illness.

Do not send your child to school if he/she has any of the following:

  • Fever (100.4°F)
  • Coughing
  • Sneezing
  • Runny nose
  • Diarrhea
  • Vomiting
  • Headache
  • Sore throat
  • Is not well

What if someone in my child’s class gets sick?

Fortunately, studies have shown that children are less likely to spread the COVID-19 virus. Your school will inform you if any monitoring or change in school location needs to occur.

Should my children receive their vaccinations?

Children need to be protected against vaccine-preventable diseases. Check ups are essential services and help make sure children are protected. Children who are not protected by vaccines may be more likely to get diseases like measles and whooping cough.

As communities are opening up, it’s important for parents to work with their children’s doctor or nurse to make sure their children stay up to date on routine vaccines.

Feeding Solids

I am often asked about the right time to start introducing solids. It is recommended to start introducing solids between 4-6 months of age if your baby is developmentally ready. However, age alone cannot be the only indicator of whether or not your baby is ready to start solids. He or she also has to be developmentally ready; some of the developmental cues to look for to assess their readiness include: Do they sit up unsupported or with minimal support in a high chair? Do they have good head control? Are they bringing hands/toys to their mouths? Are they interested in food when other people are eating around them?

Once you determine whether or not your baby is developmentally ready for solids, you can start to offer infant purees (usually stage 1 baby foods or you can choose to make at home. Start by offering 1 tablespoon 1-2 times per day for play/exploration of these new foods and textures. If you notice they are turning their head away, pushing food out of their mouths or refusing to open their mouth, this could indicate that they’re not quite ready for solids. Stop for now and consider restarting in another few weeks or consult with your pediatrician.

When starting solids, you want to introduce one new food every 5 days to monitor for allergic reaction. Once your baby has had several different foods and tolerated them well without sign of reaction, you can start to combine foods to diversify flavors. Examples include pureed bananas mixed in oat cereal, sweet potatoes mixed with carrots, green beans and avocado, etc. By 6 months of age, it is also recommended to start introducing pureed meats, poultry and fish, as complementary foods, into your baby’s diet.

According to healthychildren.org, “there is no evidence that waiting to introduce baby-safe (soft), allergy-causing foods, such as eggs, dairy (cheese or yogurt; no straight milk), soy, peanuts or fish, beyond 4 to 6 months of age prevents food allergy.” If you or a family member has a known food allergy or if you believe your child has an allergic reaction to a food (diarrhea, rash, vomiting) talk with your child’s healthcare provider. You can introduce peanut butter by thinning it out with breast milk or formula (to prevent choking) and mixing it into infant cereals or fruit purees. You can also puree a boiled egg (whole egg including yolk is great!), again, mixing with breast milk, formula or water and offering it to baby. Be sure to introduce all foods, especially high allergenic foods, every 3-5 days to allow time to monitor for allergic reaction.

Pickey Eaters!

Pediatric clinicians frequently encounter parents who express concern for a child who they describe as a “picky eater.” This complaint is often associated with children between 2 and 5 years of age.

If your child has a history of poor growth, you may be especially prone to hypervigilance regarding their eating, which can lead to stress and anxiety surrounding mealtimes. While there are some children that will require intervention, most parents can be reassured that their child is getting the nutrients they need to grow and thrive.

Portion sizes

The following portion size pictures may be helpful for parents of young children who are felt to be difficult or picky eaters.

sample portion sizes

Easy to chew proteins

Protein foods can be challenging for some kids in this age group. Foods that are easy to chew are good alternatives to more traditional options.

Eggs

  • Scrambled
  • Poached
  • Soft boiled
  • Fried
  • Hard boiled, chopped or sliced
  • Egg salad

Dairy

  • Cheese stick
  • Grated cheese
  • Melted cheese
  • High calorie yogurt
  • Whole milk
  • Sliced cheese – rolled, cut in strips or fun shapes
  • Cottage cheese
  • Cream cheese
  • Powdered milk
  • Yogurt (no fruit added)

Fish

  • Canned tuna or salmon
  • Flaky white fish or fish sticks
  • Crab meat – fresh or canned

Meat and poultry

  • Hot dogs – chopped, cut in long strips
  • Deli meats – thin slices, rolled, cut in strips
  • Breakfast sausage – chopped, cut in long strips
  • Bacon cooked crispy
  • Chicken nuggets or sticks
  • Cooked ground chicken
  • Turkey meatballs

toddler nutrition guide

General feeding guidelines

  1. Meals should be offered at 3-4 hour intervals with only water offered in between. Even small amounts of juice or milk can diminish appetite for the next meal.
  2. Offer your child 2-3 foods in small amounts that include at least two foods you know they have eaten happily in the past. If they don’t eat any of these, do not look for alternatives.
  3. Eat family meals whenever possible. Role modeling is probably the most powerful step you can take to help improve your child’s feeding behaviors.
  4. Your child should sit at the table whether or not they are eating for at least 15 minutes. Tell them that they need to wait until everyone else is finished.
  5. Do not pay attention to whether or not your child is eating consistently at mealtime. Do not cajole or plead with them to eat. No games (think airplane in the hangar) to get them to eat more.
  6. If your child does not eat anything after 15-20 minutes, they should be allowed to leave the table if the family meal is completed. Nothing should be offered until the next scheduled meal or snack. If they ask for food soon after the meal, tell them that the kitchen is closed for now and then remind them when the next meal or snack is.
  7. Be creative when it comes to foods offered at meal times. An example would be serving pancakes and eggs for dinner!
  8. Offer the highest calorie foods to your child first when they are most likely to eat them. Lower calorie foods such as fruits and vegetables can be offered towards the end of the meal.
  9. Aim for one or two good meals a day. If your child seems super hungry at snack time, make sure you offer them something substantial such as yogurt, cheese, or granola bar.

Feeding division of responsibility

It is your job to decide:

  • when your child will eat
  • what your child will be offered to eat
  • where they will eat

It is your child’s job to decide how much they will eat!

Visiting Grandparents?

We understand that these have been really challenging times for families and that it has been very hard for people to remain physically distanced from their loved ones during the pandemic. Many people are starting to question when it may be okay to have grandparents visit their grandchildren or to travel themselves to visit family members. While social distancing and isolation are crucial to controlling the spread of the COVID-19, we recognize that mental health and family relationships are also critical during this strange “new normal.”

Evaluate your risk factors and risk tolerance

There is no single answer, but here are some things to consider when evaluating your family’s risk factors and risk tolerance. Do the grandparents have high risk medical conditions? In general, the risk of getting very sick due to COVID-19 is higher in older people, but medical conditions such as lung disease, heart problems and diabetes can place people at higher risk for a more serious infection. Consider how well each family member has been socially distancing – have any family members still been working outside the home on a regular basis? Some jobs may be riskier than others (for example, healthcare and grocery store workers) due to how much contact they have with other (potentially sick) people.

If you do visit, reduce the risk

If you decide to visit with grandparents, some options for reducing risk of the visit could be:

  • Spend the visit outdoors (studies show that transmission of COVID-19 is significantly decreased outdoors compared to a closed indoor space).
  • Do not share utensils or a family style meal together.
  • Consider driving instead of flying and minimizing public rest-stops.
  • Consider traveling to the grandparents instead of grandparents traveling to you if air travel is required for the visit.
  • If possible, both the grandparents and the visiting family should be diligent about socially distancing for two weeks prior to the visit to reduce the risk of any member of the group acquiring and even unknowingly spreading COVID-19 infection.
  • Consider meeting somewhere geographically neutral if family members live in a high COVID-19 prevalence area.
  • Consider pre-visit testing if this is available in your area. The nasal PCR test can accurately identify active COVID-19 infection; but, so far, none of the antibody tests can reliably determine immunity or confirm past infection.

As we continue to learn more about this new virus, please note that the above guidance may change. Lastly, remember that frequent hand washing, wearing a mask, while in public, avoiding touching your face, social distancing and sanitizing high-touch surfaces remain critical to controlling viral spread.

Multisystem Inflammatory Syndrome in Children (MIS-C)

If you’ve been keeping up with the news lately, you may have heard about a new illness called Multisystem Inflammatory Syndrome in Children (MIS-C) that’s affecting children. Doctors and researchers are still trying to learn about this new disease, but here’s what we know so far.

Symptoms of MIS-C

MIS-C is a condition in which different body parts become inflamed, such as the heart, lungs, kidneys, brain, gastrointestinal tract, skin or eyes. Children with MIS-C can have a variety of symptoms, including:

  • Fever
  • Abdominal Pain
  • Vomiting
  • Diarrhea
  • Neck Pain
  • Rash
  • Bloodshot Eyes
  • Feeling Extra Tired

If your child experiences the following more severe versions of MIS-C symptoms, you should seek emergency care immediately:

  • Trouble breathing
  • Pain or pressure in the chest that does not go away
  • New confusion
  • Inability to wake or stay awake
  • Bluish lips or face
  • Severe abdominal pain

What causes MIS-C?

We do not yet know what causes MIS-C, however many children with MIS-C have tested positive for the novel coronavirus (COVID-19).  We also don’t know if children with certain health conditions are more likely to get MIS-C than others. Fortunately, unlike COVID-19, MIS-C does not appear to be contagious. MIS-C is also a relatively rare condition – less than 10 percent of patients that test positive for COVID-19 contract MIS-C.

The link between MIS-C and COVID-19 is evolving every day, and pediatricians and researchers at Children’s National Hospital and the Centers for Disease Control (CDC) are working tirelessly to understand its current and long-term effects on children. For additional information, please visit the CDC page on MIS-C.

While MIS-C is a serious condition, with proper medical care most children are able to recover. If you have concerns your child is suffering from MIS-C, please call your primary care provider.

Bike and Walking Safety

In the midst of the coronavirus pandemic, it’s important to practice social distancing and stay in the house as much as possible to protect ourselves, our families and the health of others. However, we do understand that getting out for a bit to stretch and play is important for children (and adults). As you work to strike that right balance, here are a few simple safety tips to help your kids stay active and injury free.

  1. Teach kids to look left, right and left again before crossing the street. We know that many of you are now balancing working from home and supervising your children so at times they may be outside playing on their own. This is a great opportunity to reinforce this simple tip and practice a few times with the younger ones to make sure they know the right thing to do when an adult isn’t there.
  2. Make eye contact with drivers. Everyone is just a little more distracted nowadays so remind kids to make eye contact with drivers before crossing the street, and to pay full attention while crossing by putting phones, headphones and devices down.
  3. Wear a properly-fitted helmet. Taking a bike ride is always a great activity for kids, and it seems more and more kids are cruising around either by themselves or with their families. This is no time for a needless trip to the hospital so remind your children the importance of wearing a helmet every time they ride. And if you’re going with them, remember to be a good role model and wear your helmet as well. Kids look up to you.

Washing Hands

Colds, viruses and flu abound at this time of year, but there’s a very simple way to keep them at bay: wash your hands.

According to the Centers For Disease Control (CDC), a large percentage of foodborne disease outbreaks are spread by contaminated hands, and appropriate hand washing practices can reduce the risk of foodborne illness and other infections.

When should you wash your hands?

To help avoid illness, you and your children should wash your hands:

  • After using the bathroom
  • After sneezing, coughing or blowing your nose
  • After changing a child’s diaper or cleaning a child who has used the bathroom
  • Before, during and after preparing food
  • Before eating food
  • Before and after touching someone who is sick
  • Before and after treating a cut or wound
  • After working and playing with your hands

When in doubt. Wash your hands.

How to wash your hands

Washing your hands is easy. Just follow these five simple steps from the CDC:

  1. Wet your hands with clean, running water (warm or cold), turn off the tap and apply soap.
  2. Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers and under your nails.
  3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
  4. Rinse your hands well under clean, running water.
  5. Dry your hands using a clean towel or air dry them.

What about hand sanitizer?

Parents often give their children hand sanitizer because it is convenient and quick and many believe labels that say “kills 99.9 percent of germs” as fact, but hand sanitizer is not the best option for fighting infection.

If soap and water are not readily available, you can use an alcohol-based hand sanitizer that contains at least 60% alcohol, but the bottom line is that washing hands with soap and water is the best way to get rid of germs.

Valentine’s Day Stress

Valentine’s Day is supposed to be a fun and festive holiday filled with giving and receiving gestures of appreciation and love. However, sometimes it has the opposite effect and makes us feel lonely or unappreciated. This is especially true for kids and teenagers who are particularly sensitive to what others think of them. As a parent, there are a few things you can do to help alleviate some of your kid’s Valentine’s Day anxiety.

For children and teens, Valentine’s Day celebrations may be filled with dread, as they worry about not receiving positive feedback from friends or peers. Teenagers in particular may become stressed around this time, either because they would like to be the recipient of a grand gesture but worry they won’t, or because they want to avoid such public displays.

Alleviating a child’s anxiety

  1. Listen to their concerns: Talk to children or teenagers to get a sense of how they are feeling about Valentine’s Day. If you sense they are anxious or concerned about whether or not they will receive cards from their peers, or if they are hoping for a gesture from someone in particular, ask them about it and listen without passing judgment or trying to solve the problem for them.
  2. Offer moral support: The next best thing you can do is to try to normalize their feelings. Let children know that it is okay to feel worried, anxious, or to even want to avoid the whole day altogether. Help them think about the situation more positively by reminding them that it is one day, and the events of that day are often quickly forgotten.
  3. Check in with your child’s school: For younger kids, touch base with a teacher to find out if there is a classroom rule that each student gives and receives cards so there are no hurt feelings. With older kids or teenagers, try not to get too involved aside from providing moral support. Encourage teens to set an example and be inclusive with their own gestures, whether it be cards or treats.
  4. Be sensitive: When children come home from school on Valentine’s Day, try to read their mood and demeanor before you decide how to react. Be supportive, understanding and ready with a listening ear and fun distraction if the day did not turn out how they expected.
  5. Give your child a Valentine: Make sure to give your children a Valentine, even if that just means an extra hug to let them know they are loved at home. Also, remind children that every day is an opportunity to show how you feel.

Fever

What is a fever?

A fever is a body temperature of 100.4º F and higher.

Body temperature is controlled by a small center in the brain called the hypothalamus.  It’s a little regulating center in the brain that can purposefully raise or lower body temperature in response to different stimuli. The most common reason the hypothalamus raises the body temperature is to help the body fight an infection, whether it’s caused by bacteria, viruses or something else.

In adults, the hypothalamus keeps the temperature tightly regulated, but children tend to swing up and down all over the place, so they can jump from low to high and back down again fairly quickly.

In most fevers, the temperature can go really high – kids can go up to 105-106º F very easily, and it doesn’t necessarily mean they are any sicker than if they were in the 102-103º F range.

How to treat a fever

There are two basic categories of medications you can give your child as a fever reducer: acetaminophen and ibuprofen. Both work slightly differently, and both work to stimulate the body to lower the temperature.

Your doctor, nurse, or pharmacist can help you figure out the correct dosing for your child. Both medications are available over the counter, meaning you don’t need a prescription for them.

When to seek medical care for a fever

If you have a baby that is three months or younger, you should take them to the doctor or emergency department as soon as they have a temperature of 100.4 º F or greater.  Fevers can indicate serious illness in young babies, and they definitely need a work up and evaluation by a physician immediately.

Babies in the 3-6 month range who received their two, and possibly four, month shots also need to be seen urgently for fever.

In older children who are fully vaccinated, fevers are very common. A fever can mean a simple cold or viral illness. It can also indicate ear infections, strep throat, influenza, pneumonia, urinary infections or vomiting and diarrheal infections like gastroenteritis. Some of those conditions require treatment, and some don’t.

You’ll also want to bring your child in if their fever isn’t responding to the appropriate doses of fever reducers, or if your child is showing any signs of difficulty breathing, decreased responsiveness or lethargy, changes in behavior, signs of dehydration or other concerns.

The truth is, kids get fevers. They just don’t regulate their temperatures the way adults do, and it’s perfectly normal for their temperatures to bounce up and down. Depending on your child’s age and the timing, you probably need a trip to the pediatrician to figure out the source, or if under 3 months, to your local hospital.