Since COVID-19 was declared a world pandemic on Jan. 31, the numbers of confirmed cases continue to rise across the world.

As of April 13, the World Health Organization (WHO) reported globally, there are 1,773,084 confirmed COVID-19 cases. The United States is responsible for 524,514 of the confirmed cases.

Interestingly, confirmed cases of COVID-19 in children are much lower than in adults. Data provided from the Centers for Disease Control indicate children under the age of 18 only made up 2,572 cases of COVID-19 in America as of April 2.

However, since diagnosis cannot be determined by symptoms alone and testing is required for diagnostic confirmation, the actual number of cases of COVID-19 is likely underestimated by current data in both adults and children. With such limited data, the CDC is reporting an overall pediatric hospitalization rate of six to 20 percent and an even lower mortality rate for children of 0.1 percent.

Dr. Richard Turner, a pediatrician in Batesville at Margaret Mary Health pointed out that even with a low mortality rate for children, the pediatric mortality rate is likely highly overrated since the mortality rate is calculated from confirmed positive cases and there are likely countless more unknown COVID-19 cases in the pediatric population given the limited testing.

Limited testing for COVID-19 has also prevented parents from being able to take children to the doctor for a COVID-19 diagnosis and plan of treatment, leaving parents concerned how to identify COVID-19 in their children. Turner encourages parents to first, watch for signs of serious illness such as fever, cough, and especially labored breathing or shortness of breath. According to Turner, COVID-19 has also been associated with gastrointestinal symptoms such as nausea and vomiting. He advises parents to watch carefully for signs of dehydration: dry lips, dry mouth, sunken eyes, decreased urine output and to seek medical attention if there are concerns your child has any of these.

Turner recommends children two years and older should wear a mask or cloth face-covering. Children under two are at higher risk for suffocation and should not wear a face covering.

With such low statistics regarding the under 18 population of the United States, parents have still seen a huge impact on the daily lives of their children and routines.

Many daycares were able to implement recommendations from Governor Holcomb and remain open while others made the decision to close. However, many families utilize grandparents for babysitting regularly or in an emergency situation, but Turner warns parents of the risks associated with not practicing social distancing, even with grandparents.

“Let's face it, children are cesspools for germs,” Turner said. “While children are more likely to have milder disease, or even no symptoms with COVID-19, those around them may be at higher risk for serious disease or death. While we all should be practicing social distancing, it is especially important for children not only to prevent them from COVID-19, but to try to prevent the spread to others at higher risk for complications.” 

Turner reminds families that COVID-19 can be spread from asymptomatic carriers, and children are more likely than adults to not have symptoms but still be infected.

“This is the reason even asymptomatic children, who by nature, have no boundaries and are little germ factories, should not be around people at higher risk for severe COVID-19 disease,” Turner warned.

Limit time with older adults

Dr. Turner made the following recommendations regarding children and older adults.

-If there are others in your home at higher risk for serious disease, consider taking extra precautions to keep children separate from those higher risk household members.

-Grandparents should not be involved in childcare, nor should children visit them. This can be particularly difficult, especially for families who depend on grandparents for child care while the parents work. It can also be emotionally painful for children and grandparents. However, this is the safest practice during the pandemic.

-Certainly, the older the grandparent is and the more health problems he/she may have increases the risk of serious disease due to COVID-19. Individuals may want to consult their family physician for guidance in specific cases. Remember, many people, especially children, may be exposed/infected with COVID-19 and show little to no symptoms.

To complicate the situation regarding children further, Indiana schools announced they will not return to the traditional brick and mortar setting for the completion of the 2020 school year. Instead, eLearning is the new normal for families across the state.  Turner reminds parents and caregivers that these changes are not only stressful for adults but children as well. 

“They are out of school, missing their friends, school activities, sports,” Turner said. “Older kids are missing graduations and prom. These can all have significant adverse mental health effects on children, including anxiety, depression irritability and increased behavior problems. Other signs of stress to watch for are poor sleep, changing eating habits and lack of exercise.”

What can parents do to help their child

-Keep your kids active and engaged. Go outside, take a walk with your kids. Ride a bike. Play catch or hide and seek. Or just let them run around outside and play (in a safe, supervised environment, of course). Have a movie night. Play board games. Read to your child. Tell stories. Anything that you and your kids enjoy doing together in and around the home. If your local park is open, let them play there, maintaining social distancing.

-Make sure kids still have a structured, but flexible where appropriate, schedule with consistent mealtimes, playtimes, bedtimes and sleep routines.

-Simple reassurance form caregivers can go a long way at helping alleviate some of the anxiety kids are feeling. Also, children are acutely aware of their care giver’s emotions and moods. They will absolutely take their cues from you. The more stressed you appear, the more stress your child will feel. Also, keep kids away from disturbing images in media related to COVID-19.

Turner also reminds parents of the importance of learning during this time. He encourages parents to keep children's “developing brains engaged in learning and encourage and instill a love of learning.” He also encouraged parents to stay in contact with children's schools and, where possible, make sure they are engaged in online learning.

Social distancing also presents the challenge of keeping kids connected to their friends. Turner encourages parents to help children connect with age and developmental appropriately monitored video chats, phone calls, etc.-- are excellent ways to help your child stay engaged with friends. When thinking of new ways to help children stay engaged, Turner recommends keeping the following in mind.

Limit time with other children

-Stay at least six feet away from non-household members. Some experts recommend at least 10 feet.

-Play-dates with children from outside households should not occur or should be canceled if scheduled.

-Children may miss their classmates, so telephone or video communication may be encouraged and age-appropriately supervised.

About Dr. Richard Turner

Turner is a Pediatrician at Margaret Mary in Batesville and also does hospitalist locems work in Newark Ohio. Turner Graduated med school in 2005, and residency in 2008. He attended medical school at Wright State School of Medicine and residency training through Wright State/Dayton Children’s. He has been practicing for 12 years post residency. 

Turner became a doctor because he has always loved science and biology and is a people person. 

I "I like and value the human interaction and relationship that comes with being a physician and helping heal, both physically and mentally," Turner said. "Why Peds? Because I love kids. They’re a blast. I particularly enjoy development, behavior, and autism." 

Even though the pediatric side hasn't been hit medically as hard as other demographics, Dr. Turner's love for being a doctor and his patients shows in some final thoughts he had for families as they navigate their way through the COVID-19 pandemic.

“In any difficult situation, I always try to find something positive,” Turner said. “With that in mind, during the boredom and frustration of imprisonment and confinement to our homes, with our lives turned upside down, maybe this is an opportunity to reconnect with our immediate families, engaging in the lost art of  - dare I say it, eating meals together, sharing activities as a family, just sitting down and talking to one another.

“These are stressful times for all of us. It will take time, but it will get better. We will get better. Through community and family, we will overcome and grow stronger as family, community, and as a nation. Finally, my sincere condolences to the families and friends of loved ones lost to this pandemic.”