What to look for in daycare during the COVID-19 pandemic
As more people are returning to work, daycare is becoming a necessity for many families. To help ensure that your child’s daycare environment is as safe as possible in the COVID-19 environment, we asked Dr. Matthew Trokel for advice. Dr. Trokel, a pediatric emergency medicine physician, is on the medical staff at Community Hospital of the Monterey Peninsula and practices with Pediatric Group of Monterey.
Do you have any specific advice for parents whose child will be returning to daycare?
While coronavirus has been shown to be very transmissible and children are well-known for their lack of adherence to social distancing, with just a few simple techniques, daycare centers can reduce the ability for the virus to spread within their facility. I recommend parents ask the day care facility about:
Handwashing. As we all know, handwashing is one of the most effective ways to prevent the spread of any viral infection including COVID-19. The American Academy of Pediatrics recommends frequent handwashing in daycare. All personnel should wash hands upon entering and leaving the daycare. There should be multiple opportunities for the children to wash their hands during the day, especially before eating. Under normal circumstances, children under 5 years of age should not use hand sanitizers; however during the COVID-19 outbreak, this recommendation has been amended. If no soap and water is available, all children should use hand sanitizers and hands should be washed frequently. Young children should be supervised when using sanitizer, as the product can contain up to 60% alcohol and could be very dangerous if swallowed.
Disinfection efforts. The CDC recommends an increase in how the physical space of a childcare center is cleaned in the setting of the COVID-19 pandemic. Parents should ask the daycare center how they have changed their disinfection routines. All high-contact surfaces (tables, highchairs) should be cleaned before and after use. Childcare areas should be cleaned several times during the day and disinfected at the end of the day. Special attention should be paid to anything related to eating or drinking. Food preparation surfaces should be sanitized before and after use, all utensils sanitized after use, and drinking fountains should be disinfected daily.
Screening both children and employees. Any person with a fever of greater that 100.4 should not be allowed in the facility. Children should be screened at home prior to drop-off. If possible, children should be screened prior to entry with at least a physical inspection for any evidence of cough, flushing, or lethargy. There should be a plan in place for absenteeism among the staff in face of possible staff illness. There should be a rapid assessment and isolation of any person who becomes ill during the day, with good follow-up measures to ensure that person stays away from the center until they have fully recovered.
Can you share any information parents need to know about pediatric inflammatory multisystem syndrome?
On May 14, the CDC released a health advisory describing a new syndrome in children. A small subset of children who become infected with the COVID-19 virus undergo a systemic inflammatory response currently called multisystem inflammatory syndrome in children (MIS-C) or pediatric inflammatory multisystem syndrome (PMIS). This is a very rare complication and there is very little known about this disorder. Studies are currently underway to get us more information. To date, there are some case reports that have shown that:
- All children experience several days of persistent fever
- Around 80% had gastrointestinal symptoms (abdominal pain/diarrhea/vomiting)
- 40% had conjunctivitis (red eyes)
- Other associated symptoms include rash, chest pain or racing heart, lethargy, or confusion
If PMIS becomes a concern, obtaining lab work is vital. While there is no specific blood test that can diagnose PMIS, lab work is still key to understanding how your child is doing. If the lab work shows no evidence of inflammation, then PMIS would be very unlikely. If there is evidence of inflammation, further testing would be needed.
Overall, children do well with this disorder. Of those admitted to an ICU, 30% had a mild or moderate severity of illness, and 60% did not require intubation. Unfortunately, some children did become very sick, requiring advanced, lifesaving measures including long-term ventilation (up to 10 days), multi-organ system failure (8%) and death (4%). As additional studies become published, we will know more about this condition and our ability to test, diagnose, and treat.
Do you have any specific recommendations for parents who have a child with an underlying condition or when a member of their family does?
If a child has an underlying medical condition, they may be at increased risk of complications from a COVID-19 infection. In one study of 48 children admitted to pediatric intensive care units, 17% had no other identifiable health conditions, 40% had long-term dependence on technologic support associated with developmental delay or genetic anomalies. Of note, only 4% of these ill children had asthma or other chronic lung disease. I would recommend that if your child has significant underlying medical conditions, you should contact their pediatrician and discuss the risk of daycare so you can make an informed decision about how to proceed.
Any family member with significant underlying medical conditions should try to distance themselves from the daycare center. If possible, another family member should do pick-up and drop-off. If this is not possible, then the family member should wear a face mask and try to practice social distancing. Ask the daycare if they can offer a staggered pick-up\drop-off schedule to reduce the possibility of close contact among multiple adults and children. The children should wash their hands upon return from daycare before interacting with anyone in the home.
CDC: Guidance for Child Care Programs that Remain Open
Caring for Our Children: National Health and Safety Performance Standards - Routine schedule for cleaning, sanitizing, and disinfecting
American Academy of Pediatrics: Guidance Related to Childcare During COVID-19
CDC: Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19)
NLM NCBI: Characteristics and Outcomes of Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units