As waves of the coronavirus battered the U.S., parents of young kids could comfort themselves with the knowledge that COVID-19 tends to have milder effects in children and that most — but not all — kids who get infected are fine. Many parents aren’t willing to risk their children’s health for the low-risk nature of COVID-29. And others might be more worried that their kids will spread COVID-19 to elderly or immunocompromised loved ones who might not fare as well. The highly contagious Omicron variant has been causing a surge in cases. Most young children are still not vaccinated. Children under 5 are still ineligible for vaccinations, and as of Dec. 29, only 23% of kids 5 to 11, and 53% of 12- to 17-year-olds, are fully inoculated in the United States. With so many unknowns, it is difficult to balance the need to protect our families with maintaining a sense of normalcy.
We asked experts to help parents with unvaccinated children navigate the Omicron surge. It’s difficult, they acknowledged. However, each family’s risk tolerance and vulnerability will dictate how many decisions are made. Here are their recommendations.
What has changed with Omicron?
Omicron is much more infectious than previous variants, but so far seems to be less severe. “The number of cases is just too high, really everywhere,” stated Tara Kirk ,, a senior scholar at Johns Hopkins Center for Health Security. “And even if they aren’t high enough, they will soon be. It’s incredibly transmissible.”
As a result, more children are being hospitalized with COVID-19. Experts believe that the rise in cases is due to the rising number of people infected and not the severity of the disease.
This is the natural progression for viruses, explained Dr. Catherine Le ,, an infectious disease physician at Cedars-Sinai Medical Center. Viruses can mutate to survive but will not survive if their hosts are killed. So over time, they generally evolve to be more infectious but less dangerous.
Symptoms with Omicron could be slightly different. “These are early days in the Omicron pandemic, but it seems like we are seeing more upper respiratory tract symptoms, including croup in children,” said Dr. Grace M. Aldrovandi, professor and chief of infectious diseases at UCLA Mattel Children’s Hospital. “Generally, symptoms in children are less severe than in adults, and they may have more gastrointestinal symptoms, compared to adults with COVID.”
Dr. Priya Soni, a pediatric infectious disease specialist at Cedars-Sinai Medical Center, said Omicron symptoms tend to include fevers, dry cough, sore throat, body aches and night sweats. She said that it is difficult to identify Omicron symptoms in children under age 5. “So mostly, I’m seeing high fever and kids that have a runny nose.”
There’s more we don’t know. With kids, “we’re talking about a group that perhaps may not be at a higher risk, but to tell you the truth, the jury is out,” said Dr. Neha Nanda, medical director of infection prevention and antimicrobial stewardship at Keck Medicine of USC.
For example, a report from the Centers for Disease Control and Prevention showed that children with COVID-19 could be twice as likely to be diagnosed with diabetes after a coronavirus infection, compared to those who had not had the virus.
We also don’t know whether it’s associated with multisystem inflammatory syndrome in children, known as MIS-C, which is “rare, but scary,” Le said, because it can result in organ failure weeks after a coronavirus infection. It’s too early to know if Omicron causes long-term COVID in children. A national survey in England found that up to 14% of kids with COVID-19 prior to Omicron’s emergence had continued symptoms more than 12 weeks after diagnosis. These kids experienced fatigue, headaches, insomnia, trouble concentrating and it really, really limited the quality of their life and participation at school,” Soni stated.
What hasn’t changed?
All the precautions we took since the outbreak of the pandemic remain in place. When there is less COVID-19 in the community, there is less risk and more room for relaxation, but the surge is a good time to ramp up your masking, social distancing, hand-washing and other safety protocols, experts say. This is especially true for children because they may be interacting with others, such as at school or daycare, who might not have been vaccinated.
Which kids are most vulnerable?
“Children younger than one year old, those with chronic diseases — neurologic, immunelogic or respiratory — and those who have been overweight are at greater risk of getting sick with SARS-CoV-2. These children are those who have had a history of leukemia or are receiving chemotherapy or transplants. Soni stated that
Dr. Kawsar R. Talaat, associate professor of international health at the Johns Hopkins Bloomberg School of Public Health, encouraged worried parents to talk to their pediatrician. She said that there are certain children who should be left at home while the surge subsides. “It’s a very individual conversation between the parents and the doctors: what their risks are and how to best protect their kids.”
What can concerned parents do?
Make sure everyone around your kids who is eligible is vaccinated and boosted. It’s safer to have a get-together if everyone is masked, vaccinated, and boosted. Talaat stated that this creates a protective environment around the children. It’s important to make sure your children know that daycare employees have been vaccinated, boosted, and masked. If they are sick, they can come to work. Having support from people who have been vaccinated or boosted can help you in the event that you are tested positive and wish to be able to stay home with your children. Kirk Sell encourages parents to plan for all possible outcomes.
Mask up, even when outside. Soni stated that even though children are returning to school, it is recommended that they remain covered in heavily populated outdoor spaces.
This includes playgrounds where many children are in the same place.
Parents should also move toward better quality masks for kids — such as surgical masks or KN95s — if they haven’t already, Aldrovandi said. She recommends the website cleanaircrew.org/kids-masks as a resource.
Experts do not recommend using masks for children younger than 2 years old due to the risk of drowning. Parents of children in this age group may choose to socially isolate more depending on their comfort level.
Avoid crowds of people. Suellen Hopfer, an assistant professor of public health at UC Irvine, recommended avoiding places where there are a lot of people gathered, especially indoors. She recommended delaying travel plans.
Get kids tested. Kids get many colds, so it’s important to test when they have symptoms to see if it’s COVID-19, Soni said.
Testing children is the same as testing adults. However, it is difficult to get the child to cooperate. Aldrovandi stated that before COVID, children were subject to nasopharyngeal tests. This was done in order to diagnose respiratory viruses infections. She said that the virus is the same for children and adults. Therefore, rapid tests can be performed in children
. However, testing sites can differ in terms of safety. “This virus is spread through the air so it is important to go to a testing site with good ventilation — outside or in your car — [and where] people are wearing high-quality masks and kept distanced.”
Your pediatrician’s office should also be able to test.
When they are eligible, get them vaccinated. Because COVID-19 is unpredictable, experts urge parents to vaccinate their kids. A Moderna pediatric COVID-19 vaccine for children 6 months to 5 years old could be authorized in late March or early April, and Pfizer and BioNTech are expected to submit data to regulators to support authorization of their vaccine in the first half of the year. Soni stated that you are preventing long COVID or MIS-C. “We should be very confident in this vaccine to give it to these children in this age.”
In addition, it makes it less likely that your child could spread the coronavirus. Kirk Sell stated, “It just makes it less worry about it.”
Try to stay calm “Parents’ anxiety can be sensed by young children,” Aldrovandi said. Parents should model how they would react in stressful situations. Parents can decrease anxiety by focusing on the present and not worrying about what might happen in the future. Establishing routines can help both parent and child.”
“There’s no zero-risk scenario,” Kirk Sell said. She said that it was about living a low-risk lifestyle and having a life that is comfortable for you. All these experts reiterated that the majority of children, regardless of whether they are infected by Omicron virus or not, will recover. “But don’t panic.”