Frequently asked questions answered by Atrium Health’s Levine Children’s pediatric infectious disease specialist Amina Ahmed, MD; pediatric pulmonologist Ashley Chadha, MD; assistant specialty medical director of pediatrics Patricia Grinton, MD; Levine Children’s Hospital facility executive Callie Dobbins, RN; obstetrics & gynecology specialist Lorene A. Temming, MD; and pediatric psychologist Gillian Regan, PhD.
Subject to change as we learn more about coronavirus disease 2019 (COVID-19).
Question 1: What is a coronavirus?
Answer 1 | Dr. Amina Ahmed: The term coronavirus refers to a specific family of viruses that causes respiratory problems and fever. They can infect people and are linked to illnesses including the common cold, pneumonia, and other respiratory infections.
Q2: What is different about this coronavirus, COVID-19?
A2 | Dr. Ahmed: COVID-19, or SARS-CoV-2, is a novel (or new) virus, so no one has a preexisting immunity to it. This strain is related to two other coronaviruses that appeared in recent years: severe acute respiratory syndrome (SARS) and middle east respiratory syndrome (MERS).
Q3: How contagious is COVID-19?
A3 | Dr. Ahmed: It is very contagious, and is spread easily from person to person, particularly in confined spaces. The most common mode of transmission is through tiny respiratory droplets in the air, which are produced when an infected person talks, breathes, sneezes, or coughs. It is also possible to contract the virus by touching a surface and then touching one’s face.
Q4: What is the incubation period?
A4 | Dr. Ahmed: It can be between 4-7 days after exposure before symptoms appear. During this period, a child can spread the virus, which is why social distancing is important even for those who are well.
Q5: What are the primary symptoms?
A5 | Dr. Ahmed: Symptoms can include a dry cough, fever, shortness of breath, and fatigue. Most children have very mild disease, not requiring hospitalization.
Q6: How does coronavirus affect children?
A6 | Dr. Ahmed: The virus is most dangerous for older adults. Children between 0-9 are the least at risk, and there have been no reported deaths of children in that age range. For children between the ages of 10 and 19 and adults between 20 and 39, the risk of death is 0.2%. However, children with pre-existing conditions, such as asthma, are more at risk than their healthy peers.
Q7: What pre-existing conditions make children more at risk?
A7 | Dr. Ashley Chadha: Children with asthma, cystic fibrosis, or other chronic conditions that cause them to be immunocompromised are most at risk. Since the virus causes respiratory problems, children with lung problems should take measures to stay inside and limit contact with others, including family members who may be asymptomatic carriers of the virus.
Q8: What if my child has a preexisting condition such as asthma or cystic fibrosis?
A8 | Dr. Chadha: Children with respiratory problems are just as susceptible to acquiring the virus, but the severity would be worse. You would need to take the same precautions that you would with any other child: make sure they wash their hands for 20 seconds whenever they come inside, use hand sanitizer whenever possible if not in an area with access to soap, and avoid large crowds. If your child is showing symptoms, follow the sick day plan that your specialist will have provided to you for viral infections, and if symptoms grow worse, don’t hesitate to reach out to your doctor.
Q9: If my child becomes ill and needs to self-isolate, what are some guidelines to follow?
A9 | Dr. Chadha: In the event of your child being ill, continue all chronic therapies related to their pre-existing conditions and follow their sick day plan. Quarantine all other family members away from the child, especially older adults, and wipe down hard surfaces such as doorknobs to minimize any risk of transmission.
Q10: What should I do if I think my child is showing symptoms of the coronavirus?
A10 | Dr. Patricia Grinton: According to the Centers for Disease Control (CDC), most children with test-confirmed COVID-19 presented with mild symptoms, including cold-like symptoms, fever, runny nose, and cough. Vomiting and diarrhea have also been reported.
If your child presents with above noted symptoms, treat children less than 12 years old with plenty of rest, encourage fluids, and nasal saline for nasal congestion. Perhaps a teaspoon of honey may subside an irritating cough. For children 12 years old and older, they may use over-the-counter products such as nasal decongestants and cough suppressants for symptomatic relief. For a fever, treat with acetaminophen. Connect with a Levine Children's provider via virtual platform if needed.
For children with fever lasting longer than three days, evidence of increased work of breathing, poor fluid intake or listlessness a face to visit office visit will be needed.
Q11: How is Atrium Health Levine Children’s using technology to help diagnose coronavirus and other respiratory illnesses?
A11 | Dr. Grinton: Using two-way, live video streaming via a secure platform, Atrium Health Levine Children's clinicians are able to diagnose many pediatric upper respiratory tract infections. Pediatric providers examine a child's throat, nasal passages, eyes and external ears. Simply observing a child's interactions provides pediatric clinicians a baseline general physical assessment. With examination of the child's rib region and abdominal muscles, pediatricians can evaluate for increased work of breathing.
Many common pediatric viral upper respiratory infections such as common cold, sinusitis, viral pharyngitis and croup may be diagnosed via our Virtual Visit platform.
Testing for COVID-19 currently is limited to patients who meet certain criteria such as travel to high risk areas, contact with a person with known diagnosis of COVID-19, and children presenting with influenza-like illness who are immunocompromised or have severe lung disease. Most children with COVID-19 will not undergo testing. The viral illness will simply run its course with the child being cared for in the comfort of their home.
Q12: If my child is diagnosed with this virus, when is the best time to bring them to the hospital?
A12 | Callie Dobbins: If your child is having life-threatening symptoms that require emergency care, you need to go to the closest emergency department. If you're not having an emergency, call your pediatrician for guidance.
Q13: In the event a child needs intensive care, how is Levine Children’s Hospital prepared to handle that?
A13 | Dobbins: Levine Children’s Hospital has pediatric intensive care, neonatal intensive care and cardiovascular intensive care. All of our units are well-prepared and staffed by doctors and nurses who specialize in caring for the sickest children. In some situations, coronavirus can cause difficulty breathing, and a child may need to be cared for in an ICU. We have plans in place to make sure we can support these children – and all children - at all times.
Q14: What if I’m pregnant? Am I at risk?
A14 | Dr. Lorene A. Temming: Although most pregnant women who contract coronavirus will do well, pregnant women undergo changes in the way their bodies fight infection that increases the risk of respiratory complications, including pneumonia and respiratory complications. These lead to a higher risk of obstetrical complications such as preterm labor and early delivery. Pregnant women should engage in social distancing and avoiding crowds. If you are pregnant and notice flu-like symptoms, including fever and cough or shortness of breath, you should call your primary care doctor or OB/GYN. Although data is limited, there has so far been no evidence of “vertical transmission,” where mothers pass on the virus to their babies.
Q15: How should I explain the virus to my children?
A15 | Dr. Gillian Regan, PhD: Try to find the most simplistic explanation possible based on their age and developmental stage and give them the appropriate amount of information. For younger children, this may be very little information – and information that is presented in a digestible way. For example, there are picture books and comics now available about COVID-19. For older children, it may be helpful to have a more in-depth conversation and ask them what they have heard. Especially for older children and teenagers who are more readily accessing social media, it may be necessary to clear up any misinformation they receive. Communication is key to help you and your child cope.
The CDC and some other reputable sources (e.g., KidsHealth) have provided handouts for parents on how to speak to their children. To the best of your ability, try to remain calm and reassuring, as that will model for them how to react. Lastly, so much is unknown at this time about COVID-19 and the impact it is going to have on everyone’s lives. Focus on identifying the things you can control; social distancing, hygiene, and encouraging your child to engage in positive coping skills (e.g., drawing, talking to friends via phone, deep breathing) are things that you can do.
Q16: If my child contracts the virus, how would I go about explaining to them that they can’t see their friends?
A16 | Dr. Regan: You should have this conversation in the same way that you would in reference to any other illness, such as chickenpox or strep throat. Use available educational resources, if needed. Let them know that this is what’s necessary to keep everyone as healthy as possible.
Q17: What are some things we can do to keep our children occupied?
A17 | Dr. Regan: There are many free educational activities that are available to parents online right now. PBS Kids, Scholastic, and National Geographic are some of the sites offering activities, although there are many others available as well. Seacrest Studios at Levine Children’s Hospital is now hosting KidTime sessions, including virtual science experiments, music therapy, bingo and storybook readings, every weekday at 11 a.m. ET on Levine Children’s Facebook page, www.facebook.com/LevineChildrens.
This may be a time to get creative too. If family and friends are unable to visit, an option would be to setup a way to interact virtually to read a book or play a game together. If you are able to be outside while practicing social distancing, fresh air and activity is highly recommended. I also suggest trying to stick to a schedule while your child is home. This may not be doable some days, and that is okay, but creating a schedule will help them get used to this “new normal.” Younger children may enjoy drawing pictures of the day’s or week’s activities, while older children may prefer a written one with times and detailed activities.
