3 questions every pediatrician needs to ask during the return to school

In her primary care clinic just outside of Washington, D.C., Nana Adu-Amankwa, M.D., has seen a tough decision process playing out time and time again for parents this fall unlike any other.

“Most of the parents I talk to are concerned about when, and if, their children can return to school,” Adu-Amankwa, who is founder and medical director of Total Access Pediatric Urgent Care in Rockville, Maryland, told Fierce Healthcare.

Although there is still so much that is unknown about COVID-19, physicians, especially pediatricians, have found themselves navigating an uncertain terrain of guiding parents through questions about going back to school safely.

How should they be handling it? Doctors need to be asking their patients three important questions for determining what is right for the individual child and family this school year, said Halee Fischer-Wright, M.D., CEO of the Medical Group Management Association.

First, she said: Is your school following the latest Centers for Disease Control and Prevention (CDC) guidelines and taking all of the necessary precautions for minimizing the risk of spreading the virus? Second: What is the infection rate in your community, and are the numbers going up or down?

And third, perhaps most importantly: Is your family relatively healthy?

It's part of the delicate dance for doctors as they work focused on the still-emerging science behind the disease while sidestepping the politics of school districts and states, said Fischer-Wright, a former pediatrician of almost 20 years.

Better guidance, better testing

If in-person school is going to be an option, then the U.S. will need to look to other countries that have successfully done it as models, Fischer-Wright said.

A noninvasive, 48-hour turnaround test for COVID-19 could be a big factor in bringing children back into buildings.

But in the meantime, schools should be following the latest CDC guidelines for safety. This has been a point of controversy in recent days after the CDC released relaxed testing guidelines which raised protests among the medical and scientific communities about concerns of political interference. 

Adu-Amankwa says that schools, educators and parents need to implement into practice those measures that are known to decrease infection transmission: social distancing, wearing face masks and frequently hand washing/sanitizing.

It is imperative that anyone with any symptoms remains at home and gets appropriate care and testing if indicated. “We are all in this together,” she said. “I remind parents/children frequently that viruses don't move, people do.”

Physicians need to look to data to determine the rates of infection in their community before advising patients.

“If you live in a cold zone, such as Colorado, for example, there is a less than 3% infection rate at this time,” Fischer-Wright said. “But in a hot zone, like Florida, infection ranges from 9% to 28%, and yet the state is mandating people go back to school.”

Personal decisions

According to a recent survey published in JAMA Pediatrics, one-third of parents (31%) said that even if their child’s school opens for in-person instruction they would probably, or definitely, keep the child at home this fall.

Each decision for returning to school will need to be made on an individual basis, Fischer-Wright said.

For example, if there are family members with chronic diseases or multigenerational households, the decision could mean life or death, as opposed to a household with relatively healthy children and parents.

Beyond schools, some parents are still even nervous about bringing children into a clinical setting for risk of contracting the virus. Looking at it from a higher point of view, Fischer-Wright says that the business in pediatricians’ offices has picked up in some regions, but not all.

“It kind of depends on the socioeconomic status of a parent, their ability to get in to see the pediatrician, and the geographic location,” she said. For example, Florida is telling patients that if they suspect they have COVID-19 to stay home because they don’t have the resources to test and treat in clinics.

Still, overall, primary care and pediatric care visits are back to 80% to 90% of last year’s levels.

“When I talk to parents, I encourage a healthy balanced diet, regular activity and to keep or create routines and schedules,” said Adu-Amankwa. “It is important that parents also check in with kids (and themselves) emotionally and address feelings of anxiety, depression, fear, etc. that they may be feeling.”

A family’s personal school decision can also hinge on mental health. Adu-Amankwa notes that everyone is feeling the toll.

“Six months into this pandemic, I believe ‘COVID fatigue’ is real. Parents, children and families are frustrated and tired of quarantine and social distancing. They want things to ‘get back to normal—business as usual.’" 

Therefore, Adu-Amankwa finds herself inquiring more frequently about the emotional and mental well-being of patients than in the past.

“I believe children are resilient and they are looking to us ‘adults’ closely on how to navigate through the ongoing pandemic,” she said.

No matter what a parent decides about returning to in-person schooling in the fall, Fischer-Wright encourages families to go with the flow as much as possible.

“If you can embrace that uncertainty, it’s as close to security as you’re going to get and it can give you piece of mind,” Fischer-Wright said.