Due to the COVID-19 pandemic, our world has changed dramatically in just a few weeks. As the virus spreads and societal norms change, it’s common to feel fear and anxiety and to wonder about the best way to keep your family safe. Parents of chronically ill children, or children who take medications that suppress their immune system, may have particular concerns. Though much is still unknown about COVID-19, we do have answers to some questions.
What are the symptoms of coronavirus? Are they different in children?
The most common symptoms of COVID-19 are fever, cough, and shortness of breath. These symptoms typically start within 2 to 14 days of exposure and may be mild or severe. Some people may also have gastrointestinal symptoms, including diarrhea, vomiting, or loss of appetite. These may start before the respiratory symptoms. Decreased sense of smell and/or taste have also been reported. Many children have a milder course of COVID-19, and both children and adults may have no symptoms at all.
My child has an autoimmune disease. Is he or she at higher risk for severe COVID-19?
We don’t know yet whether having an autoimmune disease increases the risk of a severe form of COVID-19. A higher risk could be due either to the disease itself or to the medications used to treat it. A recent report from Italy suggests that immunosuppressed children are NOT more at risk than their peers, though more data is needed to confirm this finding. Previous coronavirus outbreaks (SARS and MERS) have also not shown worse disease in immunosuppressed people.
My child takes an immunosuppressive medication. Should I stop it or change the dose?
We do NOT recommend that you stop or change the dose of your child’s medication. Stopping medication may cause a flare of the underlying disease. This could require stronger medication or even hospitalization. Some medications, particularly steroids, are dangerous to stop abruptly. If you have concerns about your child’s medication, please call your doctor to discuss before making any changes. If your child takes a weekly medication and develops a fever or other symptoms, speak with your doctor before giving them any more doses.
How can I keep my family safe?
The best way to keep your family safe right now is by socially distancing as much as possible. If you leave your house, try to maintain a six-foot distance from other people. Avoid visibly sick people. Wash your hands frequently with soap and water for at least 20 seconds, and if you must cough or sneeze, do it into the crook of your elbow or a tissue. Avoid public transportation and large gatherings of any kind. If your child’s school has not been canceled, contact your child’s doctor.
A member of my family has symptoms or has been diagnosed with COVID-19. What should I do?
If someone in your family is diagnosed with COVID-19, have them stay in a room that is separate from the rest of the family and use a separate bathroom if possible. Avoid sharing items like dishes, towels and bedding. If you have a face mask available, have the sick person wear it if he or she needs to be near other family members. Everyone in the family should wash their hands frequently and avoid touching their faces.
When should I call my child’s doctor?
Your child’s doctor is your partner in keeping him or her healthy. Feel free to call any time you have a question. In particular, it is important to call the doctor if your child develops a fever, cough, diarrhea or any other symptoms you find concerning. You should also call the doctor if your child has symptoms consistent with a flare of his or her underlying disease, including joint swelling or new rash. HSS has currently suspended nonessential onsite care, but virtual care options are available. Your child’s doctor can assess over the phone if he or she needs to be seen in person.
When should I bring my child to the emergency room?
Many adults and children with COVID-19 have only mild symptoms and can be cared for in their own homes. However, it is important to know the warning signs that mean someone is seriously ill. Emergency warning signs include trouble breathing, persistent pain or pressure in the chest, new confusion or lack of energy, bluish lips or face and inability to keep down liquids with signs of dehydration. If you, your child, or any other family member develops any of these signs, please seek medical attention immediately.
My child has been feeling anxious or depressed. How can I help him or her?
Children of all ages may be psychologically affected by the COVID-19 pandemic. They may experience stress, anxiety, depression, and a host of other emotions. It is important to talk to your child in an age-appropriate way about what’s going on. Remain calm and reassuring, but be honest and accurate and avoid assigning blame. Make yourself available, as children may need extra attention or have questions. Monitor what children see on television and social media and avoid watching or listening to upsetting information when they are present. As much as possible, try to stick to a routine. Try to spend some time outdoors if you can do so while maintaining social distancing. Remember, children look to adults to determine how to respond to stressful situations, so the best way to take care of your child is to make sure you are taking care of yourself.
Dr. Sarah Taber is a pediatric rheumatologist at HSS, and is board certified in both pediatrics and pediatric rheumatology. Dr. Taber specializes in the diagnosis and treatment of children with rheumatic diseases, including juvenile idiopathic arthritis, childhood systemic lupus, dermatomyositis, vasculitis, and systemic and localized scleroderma. She is a Consult Editor of Rheumatology for Medscape, and winner of the #1 Consult Case of the Year for 2019. Dr. Taber has also been a featured speaker for the Scleroderma Foundation, Charla de Lupus, and A Lasting Mark Foundation.