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Bill Klaproth (Host):  This MarinHealth podcast on Covid-19 recorded on April 24, 2020. The Coronavirus pandemic has affected all of our lives including our children. So when it comes to their safety and potential COVID-19 risk, what do you need to know? Let’s learn more with Dr. Sydney Sawyer, a Pediatrician at MarinHealth.

This is the Healing Podcast from MarinHealth. I’m Bill Klaproth. Dr. Sawyer, thank you so much for your time. It’s great to talk with you. So, as of this point, which issues in children have you seen as a result of the Stay at Home Order and COVID-19?

Sydney Sawyer, MD (Guest):  Thanks so much for having me Bill. So, I guess what I would say is I’ve seen two big categories of new issues. The first being that parents are really coming to see us for behavior issues. A lot of times, they are preexisting issues in kids who have already struggled with problems with mood, or behaviors, if they have already struggled with anxieties or challenges with school; these all seem to be quite exacerbated. And in particular, in younger kids, we’re seeing behavior regressions and nightmares and in the older kids and teens, we’re seeing a lot of mood and sleep disturbances.

Host:  So, mentally this is having an effect on children, no doubt about it. Is that right?

Dr. Sawyer:  Absolutely. As a pediatrician, what I am seeing is that while we’re not necessarily getting inundated with children who are suffering directly from COVID-19; we are seeing so many of the downstream consequences of the Shelter in Place due to the pandemic. And unfortunately, these things are going to remain somewhat hidden from view but we’re seeing them crop up in, in large numbers in our office.

Host:  So let’s stay with these behavioral issues while we’re talking about it. Help us out. What can parents do for a child who is acting out or having nightmares or exhibiting behavior issues? What can a parent do at this point?

Dr. Sawyer:  A lot of times, what I am reminding parents of is that kids are looking for reassurance. Even the sullen teenagers are looking for reassurance. When I step back, I think about you know what’s going on and in terms of our – the global pandemic, we are actually suffering as a society from a toxic stressor. Now when we think about stress, sometimes it can be a positive stress and it can be like that little bit of anxiety or excitement that you get before you go into a test and that can enhance your performance. Unfortunately, as this pandemic continues to affect us, lots of kids and families are suffering from more of the toxic stress effects and when I talk to parents, about how to buffer their children from this and how to support their kids; I really start with going back to the basics.

So, all of my patients who see me will hear me talk about the basics. And it starts with you know making sure that you are trying to eat well. Eating from all the food groups, trying to eat fruits and vegetables. That can be a little more difficult right now but there are strategies to do that. Making sure you’re continuing to drink lots of water. Kids sometimes when they’re at home, you know they just want to eat their snacks and not drink water and that’s not going to help them.

The other really big one is reminding families that even with the Shelter in Place, we need to get exercise. Kids are getting much less physical activity than they normally do because they’re not getting that incidental activity from going to school and running around and seeing friends. So, reminding families that kids need at least an hour of exercise a day and if possible, getting outside while safely social distancing.

The other big ones are reminding families, it sounds silly but remember to brush teeth and floss. Nobody is going to see the dentist right now. And we want to make sure kids are maintaining their dental health. The other big one and the one I end with is sleep. Sleep is huge and a lot of kids are getting less sleep right now because they’re not moving their bodies and because they are sitting in front of screens for a lot longer. And so, reminding families that protecting children’s sleep habits is really important.

Host:  Okay, that’s a great list Dr. Sawyer. I love that. Go back to the basics as you said as a lot of people are suffering from toxic stress effects. Eat well, stay hydrated, make sure you exercise, keep brushing those teeth, make sure you floss and lastly, make sure you concentrate on sleep. So, that’s a great list for parents to remember. And then what about the physical issues of being at home, slips, falls, tripping over the dog, those kinds of things, what about that?

Dr. Sawyer:  So, we’re definitely unfortunately seeing more accidents at home, probably a combination of families struggling to balance working from home while also trying to homeschool or help their children with remote learning. Kids are at home for longer stretches of time and they’re potentially a little bit less supervised as mom and dad are distracted. And so they’re doing things like bouncing off the walls and jumping off of things that maybe they shouldn’t. So, we are definitely seeing some more injuries and unfortunately also ingestions. So, medications, also things like soaps and detergents again, from probably under supervision. So, reminding parents that you know you got to make sure that your home is safe. If you have younger kids, trying to get those poisons and medications up out of reach. Um and trying to maintain supervision as much as possible.

Now when those injuries do happen, we actually do offer Telehealth appointments. We’re seeing families and children during our regular work hours Monday through Friday in our office via Telehealth as well as safe in-person appointments and we’re trying to help families stay out of the ER if they can during those office hours. There’s also the Pediatric After Hours Clinic which is currently open on the weekends where we also offer Telehealth appointments. Of course, in the even that it’s a medical emergency, families should absolutely head to the Emergency Department if needed. And I would just add that I think one of the other things that we’re seeing is um, delays in seeking care because people are trying to avoid seeing the doctor or you know because they are trying to abide by the Shelter in Place. So, if there is an injury, don’t hesitate to reach out to your pediatrician to get advice, that people should not be delaying care due to fears of COVID-19.

Host:  Yeah, so that’s good to know. So, what happens if a more serious injury occurs to a child? Should parents go to the ER or an Urgent Care and how do they know which one to go to?

Dr. Sawyer:  That’s a great question. So, what I would say is with a small injury for example, you think there may be is possible broken arm or a sprained ankle, there’s mild cold symptoms without respiratory distress, there’s fever but the child is well hydrated; those are reasons that you can go to the Urgent Care. But again, parents don’t need to make this determination in a vacuum. We have advice nurses available throughout the day during our office hours as well as in the evenings, overnight we have advice nurses available through our answering service. But again, if it’s a medical emergency, so, there’s respiratory distress, a child is becoming unresponsive, there’s a concern about a possible toxic ingestion or it seems to be more of a life threatening emergency; that’s a reason to call 9-1-1 or go to the Emergency Department.

Host:  So, as you’re talking about those things we need to watch out for, let’s quickly touch on COVID-19. As we know, children aren’t immune from it. Children can catch COVID-19. If you suspect your child has come down with COVID-19 and it’s a mild case, do the same rules apply as an adult just stay home, and then call your physician or use Telehealth but in the case of a child, just put a call into the Pediatrician? What should they do?

Dr. Sawyer:  Absolutely. It’s a great question. So, as most people are now aware, it appears that most children, especially healthy children are probably going to have mild cases of COVID-19. They may even go undetected. But when you do have a child with respiratory symptoms, so fever, and cough of course, your pediatrician wants to heat about that. We want to know so that we can help guide your care. If it’s mild, it seems like mild cold symptoms, then homecare is absolutely appropriate. And if you’ve been sheltering in place, with limited exposures, then we are going to be suspicious for COVID-19 and we are going to recommend that if you have those mild symptoms that you are self-quarantined with the family for the next two weeks.

And if those symptoms seem to progress and worsen, then we have the capacity to safely see patients to assess if this could potentially be COVID-19 versus some other cause for fever, cough and respiratory distress.

Host:  Really good information Dr. Sawyer. That certainly should help parents understand what to do if they suspect their child may have COVID-19. So, as we wrap up, any final tips or advice for parents on how to keep their children safe and protected?

Dr. Sawyer:  That’s a great question. I always remind parents at check-ups that they need to remember their own self-care. You know the idea of putting on their own oxygen mask first. So, one of the best ways that we can help kids after or from the affects of toxic stress is by modeling resiliency in the face of it ourselves and that means taking care of ourselves physically and mentally. And that means for parents, you know modeling good eating habits and drinking water and getting exercise. It also means you know, limiting alcohol use because what we want is for our kids to see us modeling healthy behaviors when we’re stressed. And for them to develop those skills themselves.

And then the other two big ones I would say are being really open and honest that there are a lot of I don’t know moments in all of this and to acknowledge feelings of loss or frustration, to empathize with our kids and to let them see that we’re in it with them and we get that. This is hard for everyone. And then finally, a little bit more directed is now create structure for your family. It’s easy for these days to feel endless but creating agreed upon daily structure for the weekdays and weekends, it gives a framework for the day and can lead to a little bit less conflict especially when it comes to deciding when kids can have screen time and for how long.

Host:  Really, really good advice Dr. Sawyer. So, I love those three things, parents hopefully you wrote those down. Number one, pay attention to your own care, very important. Number two, acknowledge feelings of loss and frustration. It’s okay to not have all the answers. And then create structure. The structure is really important. If you have that regular daily routine, it certainly can help in times like these. Dr. Sawyer thank you so much for this great discussion and information. Thank you again.

Dr. Sawyer:  Thank you so much.

Host:  That’s Dr. Sydney Sawyer and for more information please visit www.mymarinhealth.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is the Healing Podcast brought to you by MarinHealth. I’m Bill Klaproth. Thanks for listening.