Leon County schools restart this Monday, and as a pediatrician in Tallahassee, I am hearing than many children (and parents) are feeling the grip of anxiety. With so many changes, such as masks and new drop-off rules, it is appropriate to feel some level of anxiety. Here are a few tips to cope with the new changes and the new school year:
1. Talk to your child about the changes
If you haven’t already, talk to your child about the changes. Younger children (like elementary school) will need these in more concrete terms, while older elementary, middle, and high school children may want to discuss topics more deeply. Sometimes this discussion is easier over a snack or a meal.
For example, you might say to your first grader, “School is starting tomorrow. You are going to get to see friends and your new teacher. School is going to be a little different this year. Teachers and kids will be wearing masks, and you will need to have your temperature checked every morning, but after a few days, the new changes will start to feel normal. What do you think about that?”
(It is sad for our kids that this will be the new normal for a time.)
For younger kids, give them the facts, and then wait and see how much more they want to know (if any).
2. Validate worries
It is totally appropriate to feel anxiety about this new school year as there are so many changes. If your child expresses worries about the new year, validate their concerns before telling them they will be okay.
To a first grader, you could say, “Jennifer, you are right. It is normal to feel sad that your best friend won’t be at school this year. But you know what? We will try to arrange playdates with her outside, AND remember all the new friends you made last year at school?”
3. Plan some special rewards
Looking forward to something special after school can help your child make it through the day. Consider rewarding your child for the first few days of school with a joint activity that includes one-on-one parent time. Examples are baking, doing a puzzle, playing chess, exercising, or going out for ice cream.
4. Practice anxiety-forming activities
If your child voices concerns about new procedures, such as getting his or her temperature checked or school drop-off, then practice these with your child. Practice should be just playing a make-believe or pretend game.
For example, if you child is nervous about getting her temperature checked everyday, explain to him or her how it will happen. Then ask your child who would they like to be, the adult or the child? Then act it out a few times, maybe even trading places. You can do the same for school drop-offs and walking into the classroom.
5. Contact your school’s guidance counselor and/or pediatrician
If you have spoken to your child and practiced everything, and the anxiety or fear is just overwhelming, then I recommend speaking to your school’s guidance counselor or pediatrician for more help. Most schools can make exemptions for children who are significantly affected by anxiety. For example, the school may be able to provide a consistent person for car drop-off. Sometimes it may help to have a note or a call from your child’s pediatrician.
In general, going back to school is going to be beneficial for so many kids. The lack of social interaction has been very hard on children and their families. But for many kids, Monday is going to be a tough day. Some kids will not make it out of the car, AND THAT IS OKAY, just make sure and contact your school’s counselor and/or your pediatrician.
Good luck everyone! Message me with questions or comments!
Dangerous websites, such as pornography, are just one Google search away from our children.
The exponential increase in children opting for virtual school will give children unsupervised access to the internet like we have never seen before. The computers that they will be using to access virtual classes and homework, give anyone access to anything on the internet.
And parents, including myself, don’t think that our eleven year-old would ever start looking at pornography. I mean, where would he or she get the idea? How would they know what to search for? And wouldn’t I find out?
But let me tell you, as a pediatrician and the parent of tweens, our kids are finding this stuff. In the exam room, many teenagers have confidentially shared what they have seen and watched online–and it’s not healthy. And not just teenagers but preteens as well!
And online pornography is dangerous for the mental health of our children, much like the pornographic magazines of the 80’s and 90’s, but even more so. There are many harmful effects of pornography on the childhood brain, and I will briefly review two here:
Online Pornography is Unhealthy
First, like a drug, Online Pornography is Addictive
Online pornography acts like a drug on our brain. Online porn scenes cause rapid and high levels of dopamine to be released into the brain. And just like a drug, teens who engage in online pornography will want more and more exposure to more and more provocative images, to experience this rapid and high level of dopamine release into the brain. This can lead teens to “waste time” on their computer, spend less time with their friends, and become lonely and depressed.
And recent research has shown that this effect is more pronounced on the teenage brain!
Second, Online Pornography can lead to Sexual Dysfunction
As adults, we know that pornography scenes are staged and fake, but children will take what they see as normal. This can lead to unhealthy expectations in their sexual encounters and can also lead to sexual dysfunction. And as “addicted” children watch more and more graphic pornography, they will have trouble with “normal” sexual function in a “normal” encounter.
What Can You Do? “CPR”
There is no perfect solution. If not at our own home, our kids may be exposed to dangerous websites at a friend’s home or on a friend’s device. But the best strategy consists of three tiered approach I call “CPR”:
Communicate with your child about the dangers of the internet.
Physically monitor potentially dangerous internet use.
Restrict internet or device access to dangerous websites.
1. Communicate with your child about the dangers of the internet.
This is just like other important conversations that we will have with our children: sex, drugs, alcohol, and now add the internet. Depending on your children, around 9 to 11 years of age, I recommend sharing your views on the good and bad of the internet with your child. And if you don’t know what you believe, do some research. Read about how pornography, screen time, meeting strangers, etc. can all affect your child.
2. Physically monitor potentially dangerous internet use.
Most of the time, you can restrict your home internet or your child’s device from having internet browser (Chrome, Edge, Firefox, etc) access, but sometimes you can’t. If your child needs to access his virtual classes through a browser, then you have no choice but to allow internet browser access. But, you only need to allow them access to this device as necessary, and try to physically monitor what they are looking at. You cannot be there 100% of the time, but make sure that their device or computer is in a public area where you or other family members can easily see what they are doing. I strongly recommend against allowing a child to have internet browser access alone in their room.
3. Restrict internet or device access to internet browsers
It is much harder on computers and still very difficult on tablets and phones, but try to use parental monitoring software, like Apple’s Screentime, Google’s FamilyLink, or Disney’s MyCircle to completely block browser access. For example, with Apple’s Screentime, you can choose what apps your child has access to. If you really feel like they should be able to “browse” the internet, you can download child-friendly apps and browsers that allow you “whitelist” only certain websites that your child can visit.
Life with tech is tough
Technology has made our life better in so many ways, but it has definitely made it difficult to keep our children from being exposed to harmful material. Our parents had to make sure we didn’t have Showtime or HBO access as kids, but the internet is a whole new monster. And now that thousands of children will be spending thousands of hours online, we parents need to be proactive and protect our children. Our tween and teens will put up a fuss, but we need to do what is best for them.
Advocate for Change
One last thing we can do is advocate for our children. Ask your teachers and schools to include all their material in one internet location. For example, if a teacher requires a student to watch a video on YouTube, then you must leave YouTube unblocked, and your child will have access to anything on YouTube. But, if your school places all of their educational material on their own website or portal, then you can restrict YouTube access, protecting your child from potentially harmful material.
After a double-length summer, many kids are going to have trouble staying focused in class (or at home)! As a pediatrician, I know that many children already had trouble focusing in the classroom, and now parents are telling me that they are having even more trouble at home. So, given the popularity of my last post “Vitamins That Boost Your Immune System,” I am sharing safe and effective doses of supplements that boost your child’s focus and attention. This is the same information I share with my parents in my Tallahassee pediatric office, Canopy Pediatrics.
Omega Fatty Acids – total milligrams (mg) per day of DHA, EPA, and ALA
Age
Starting Supplement
Maximum Supplement
2-4
500mg
*speak to your pediatrician
5-9
750-1000mg
*speak to your pediatrician
10+
750-1000mg
2000mg
The supplement should consist mostly of DHA and EPA with about 10% ALA. Some studies have shown improvement without ALA supplementation.
The omega 3 fatty acids, DHA and EPA, are the most effective supplements to improve focus and attention. Studies have show that even some children diagnosed with ADHD show modest benefits with proper omega 3 fatty acid supplementation. In addition to an improvement in focus, DHA and EPA can improve oppositional (or uncooperative) behavior and emotional lability (getting sad or upset easily) in children as well. There is even some evidence it can help a depressed mood.
The omega 3 fatty acid ALA is the most common in the American diet, and the body can make DHA and EPA from ALA, just not very well. This is why most of supplementation is in the DHA and EPA form.
Most studies of omega 3 fatty acids in children use a dose between 750 and 1000mg per day. One downside of omega 3 fatty acid supplementation is that it can take up to three months to show an improvement, so don’t give up too early! I recommend the starting doses in the chart above. If your child is age 10 or older, and the starting dose is not effective after 3 months, then you may increase the dose, just stay under 2000mg per day.
Zinc – in milligrams (mg) per day
Age
Recommended
Maximum
Supplement
1-3
3
7
3
4-8
5
12
5
9-13
8
23
10
14-18
9,11*
34
20
19+
8,11*
40
25
*males 14 and older require more daily Zinc than females
Zinc is another supplement that has helped children with focus and attention. In one of my favorite studies, American children with ADHD supplemented with Zinc used 30% less Ritalin to control their symptoms. If Zinc is good can help children with ADHD, then it can help “normal” children stay focused–in addition to helping the immune system!
Melatonin and Sleep
Getting plenty of sleep is important for focus and attention. Some children may not be focusing well, because they are not getting enough sleep or good quality sleep! These children may have a medical reason for poor sleep (such as large tonsils or adenoids), or they may have poor “sleep hygiene” (using electronics too late, leaving a TV on all night, drinking caffeine in the evening, etc.). These children first need to be evaluated for medical causes of poor sleep. If no medical reasons are found and sleep hygiene has been addressed, then talk to your pediatrician about melatonin supplementation.
More Help
Many children need more than supplements to improve their focus. I approach focus and attention problems holistically: I examine the child’s diet, sleep, school performance, and environment. And before jumping straight to medications (which are important for many children), I suggest a variety of natural and safe alternatives. Contact my office for a free consultation!
As a pediatrician in Tallahassee, Florida, I have been supplementing my immune system with three vitamins, Zinc, Vitamin D, and Vitamin C since the COVID-19 Pandemic began. I wanted to do everything I could to keep myself well for my pediatric patients at Canopy Pediatrics.
Our children in Tallahassee will be returning to school soon, and they WILL be exposed to COVID-19. Prepare your child’s immune system with the same vitamins that I have been taking. The far right columns below contain a safe amount of vitamin that you can use to supplement your child.
My suggested supplementation is a little less than the difference between the National Institute of Health’s maximum intake and the recommended intake (RDA) for each vitamin. To be safe, you do not want to go over the maximum daily amount, as even vitamins can be harmful. I do not recommend simply supplementing with the maximum daily amount, as many American children already get the recommended daily amount of each vitamin through their diet (so supplementing with the maximum amount would give them more than the daily maximum).
Zinc – in milligrams (mg) per day
Age
Recommended
Maximum
Supplement
1-3
3
7
3
4-8
5
12
5
9-13
8
23
10
14-18
9,11*
34
20
19+
8,11*
40
25
*males 14 and older require more daily Zinc than females
Besides boosting the immune system, Zinc is important for wound healing and focus. The best natural sources of Zinc are shellfish (especially oysters), meat, legumes, and cheese.
Vitamin C – in milligrams (mg) per day
Age
Recommended
Maximum
Supplement
1-3
15
400
200 – 300
4-8
25
650
400 – 600
9-13
45
1,200
500 – 1,000
14-18
65,75*
1,800
1,000 – 1,500
19+
75,90*
2,000
1,000 – 1,500
*males 14 and older require more daily Vitamin C than females
Although people who supplement with Vitamin C still catch viral infections (like COVID-19) their symptoms are milder and last a shorter amount of time. Besides boosting the immune sytstem, Vitamin C my also prevent cancer and cardiovascular disease. The best natural sources of Vitamin C are citrus fruits, kiwi fruit, strawberries, cantaloupe, tomatoes, and broccoli. Also, check labels, as it is added to many packaged goods and beverages.
Vitamin D – in international units (IU) per day
Age
Recommended
Maximum
Supplement
1-3
600
2,500
1,000 – 1,500
4-8
600
3,000
1,000 – 2,000
9-13
600
4,000
2,000 – 3,000
14-18
600
4,000
2,000 – 3,000
19+
600, 800*
4,000
2,000 – 3,000
* people 70 years of age and older require more daily Vitamin D
Some research has shown a correlation between vitamin D deficiency and severe COVID-19 illness, and there an ongoing study investigating whether vitamin D supplementation at the time of COVID-19 diagnosis can reduce the severity of symptoms.
As a pediatrician, I sometimes screen children for vitamin D deficiency, and I am always surprised how many kids are deficient. I suggest not waiting, but rather start supplementing with vitamin D now. The best natural source of vitamin D is sunlight, and people don’t need much sunlight to meet requirements. 5 to 30 minutes (depending on your skin color, as lighter people need less sun, and sun brightness) of sunlight exposure twice per week is usually enough for someone to meet their requirement of vitamin D. Vitamin D is also added to most cow and vegetarian (soy, almond, etc) milk.
In addition to supplementing with vitamins, I have tried to be more consistent with my exercise, as COVID-19 frequently causes lung infections (aka pneumonia). So, don’t forget that children aged 5–17 should get at least 60 minutes of moderate-to-vigorous physical activity every day (my children often complain, but think of it as good medicine!).
Leave a comment with any questions or suggestions!
As a pediatrician in Tallahassee, Florida, I have only seen a few cases of Coronavirus in children. I have had no cases of COVID-19 in my pediatric office, Canopy Pediatrics, and until the last few days, I had only seen a handful of COVID-19 cases while working in the pediatric ER for Capital Regional Medical Center (and these were mostly teenagers). Only one child was ill enough to warrant a hospital admission, and this child probably had a severe complication of COVID-19 in children called “Multisystem Inflammatory Syndrome in Children,” (MIS-C) which I will discuss further below. Since I am gathering information for an interview with WTXL TV to discuss how children are affected by COVID-19, I decided to share what I’ve learned here:
First, let me paint an overall picture of the medical effects of COVID-19 on children. Like adults, children infected with COVID-19 experience “flu-like” symptoms (some or all of the following): fever, cough, sore throat, congestion, runny nose, body aches, and sometimes vomiting, diarrhea, and abdominal pain. Sometimes they can develop a rash.
So far, COVID-19 infections in children seem to be less common, less severe, and less contagious in children than in adults. I say “seem” for two reasons: First, compared to adults, children have been much more socially isolated than adults (for example, most schools have been closed since March, but many adults have continued working or going to the grocery store), so better social isolation than adults is definitely one contributing factor to fewer kids being infected with COVID-19. Second, new information is always being discovered about how children are affected by COVID-19 in children.
Children Have Less Severe Infection
Regarding severity, reviews of children have found that about 15% of COVID-19 infected kids will be asymptomatic and 80% will have some mix fever, cough, and congestion without a low oxygen level (Flu-like symptoms), and less than 1% will need to be hospitalized. Compare this to adults, where 1% of adults aged 20-49, about 5% of adults aged 50-59, and 18% of adults over 80 years-of-age infected with COVID-19 will require hospitalization. So, kids generally do pretty well with COVID-19.
But, even though the average child has a less severe COVID-19 infection, very rarely, in about 1 in 300 COVID-19 pediatric cases, a syndrome occurs called “Multisystem Inflammatory Syndrome in Children” (MIS-C). MIS-C usually occurs 1 to 3 weeks after the onset of the child’s COVID-19 illness or can even occur after an asymptomatic infection. I hope MIS-C does truly occurs in 1 in 300 children infected with COVID-19, because for me personally, it has happened in 1 of about 10 children that I have seen with COVID-19. As the name implies, many systems of the body are severely affected. Symptoms include high and prolonged fevers; headache, confusion, or seizures; heart abnormalities; abdominal pain, vomiting, or diarrhea; and skin rashes, sore throat, and pink eye. And to make matters worse, most of these children have negative nasal swabs for COVID-19, but have positive COVID-19 antibody blood tests, meaning that MIS-C usually occurs as a complication towards the end or after an infection with COVID-19. Treatment for MIS-C is currently under investigation.
Children Seem Less Contagious
Children (especially prepubertal children) seem to be less contagious and become infected less often than adults. Children of all ages can still get a serious COVID-19 infection, but most of the evidence points to children generally being less contagious. In studies, young children (less than 10 to 12 years of age) have been less likely than adults to catch Coronavirus whether they are at home, at school, or just living life. On the other hand, teenagers with Coronavirus are probably just as contagious as adults and just as likely to catch the disease. Much of this information comes from comparing high schools, middle schools, and elementary schools in the same town and by looking at whom gets infected in a household.
There have been recent stories of outbreaks among children at camps, especially overnight camps. This reiterates that even if everything is done correctly, many children will still become infected with COVID-19. But it also reiterates that given the right (wrong) circumstances, like singing in groups or sleeping in a one room cabin with teenage counselors, COVID-19 will quickly spread from child to child.
Additionally, on July 30th, in a JAMA Pediatrics article, investigators found higher levels of COVID-19 viral RNA in children’s nostrils compared to COVID-19 positive adult noses. The clinical significance of this finding is yet to be seen. Many pediatricians think that since kids are not getting tested as much as adults (as many COVID testing sites will not test kids), the children in this study might have been more sick than the adults.
Why Are Children Less Affected?
So why is COVID-19 generally less severe in children than adults? Scientists are considering a few possibilities. One is that nasal tissue of younger children (less than 10 years of age) have less of the “ACE2” receptors that COVID-19 uses to enter into cells. A second possibility is that children have a less intense full body inflammatory response than adults. A third possibility is that children commonly co-infected with other viruses, and maybe other viruses are “running interference” leading to less COVID-19 virus production. And a fourth possibility is simply that children have relatively healthier blood vessels than adults.
How Are Different Ages Affected?
So, how are different ages of children affected? First, it does appear that children under 1 year-of-age, particular infants less than 3 months-of-age, are more susceptible to the effects of COVID-19 than older children. A few studies have shown an increased hospitalization rate in this age group. Also babies with Coronavirus may not have the typical fever, cough, and congestion of older children, but rather may present with trouble eating or fussiness.
Now the safest age to be right now is between 1 and 10 years of age. Many studies have shown that this age group is the least likely to get infected when exposed to COVID-19, the least likely to have serious illness from COVID-19, and the least likely to spread COVID-19 if infected. This may be because this age group has less ACE2 receptors than adults AND has a stronger body and immune system than an infant. But it is this age group that generally gets the severe MIS-C.
There is still some question as to whether kids over the age of 10 (tweens and teenagers) are less susceptible to COVID-19 than young and middle-aged adults. A few large studies, where large groups of people were swabbed, found similar rates of COVID infection in children 10-18 as adults. But, studies do show that teenagers are hospitalized less often than young adults. This could simply be that teenagers are less obese and have less chronic conditions than young adults.
So practically what does this mean?
First, for parents of infants or are pregnant: COVID-19 is more dangerous in babies than older children, so these parents should be extra careful to limit potential exposure to COVID-19, especially during the first three months of a baby’s life. These families should limit visitors and require that all visitors self-quarantine for 14 days before spending time with the baby. They can also limit the infant’s exposure to COVID-19 by finding a pediatrician who allows families to wait in the car (rather than a waiting room) or who provides home visits.
Second, for social interaction outside of school: Children, and their parents, are going crazy, not being able to interact with their friends and family. I think this data supports the idea that occasional close social interactions between toddlers or school-aged children (prepubertal kids) of different families (whose parents are otherwise being careful to social distance and do not have chronic conditions themselves), may be worth the risk for some families (as long as the parents keep their distance from each other). For many families, the low (but still substantial) risk of infection may be worth the trade-off for quality social interaction for their children. But again, the parents would need to practice good social distancing, so that they don’t accidentally infect each other.
On the other hand, close social interaction between kids over the age of 10 is more risky, which is too bad, because this is the age group that really needs social interaction. If kids of this age get infected, they will most likely do well themselves, but they are at high risk of passing the infection to siblings, parents, or other friends, which will lead to worsening of the COVID-19 outbreak.
And last, there is always the risk of a child developing COVID-19 Multisystem Inflammatory Syndrome in Children (MIS-C). As I mentioned earlier, scientists think it only occurs in 1 in 300 children infected with COVID-19, so hopefully my experience with MIS-C will not be the norm.
How Can Families Medically Prepare?
To be ready for this fall and winter, families need to have a pediatrician or family doctor that they can easily reach, and that they trust. When a child develops symptoms of a possible COVID-19 infection, this first thing to do is call or text your primary care physician for guidance.
And families can rest assured that Tallahassee has great emergency rooms and hospitals, like CRMC and TMH, that are prepared to evaluate their child in case of severe or concerning symptoms.
