Pediatrician's Advice for the New School Year

After more than a year in which many families’ main health concern was COVID-19, there may be additional preparation needed to make sure kids return to school healthy – and stay that way.

Roshni Mathew, M.D., is a pediatric infectious disease physician at Stanford Children’s Health and a parent of a 10-year-old and 7-year-old twins. She shares the following advice for a healthy start to school.

Are there concerns that children are behind on regular check-ups and immunizations due to the pandemic?

Definitely. In the beginning with the shelter-in-place, most people – as part of following the rules – were staying at home. There were a lot of potentially missed well-child visits and immunizations because of that. There was a lot of avoidance of healthcare facilities in general. We do know that regular childhood vaccination rates have dipped. There is some catch-up to do. … Some pediatric practices are proactively sending notices, (but) this is a good opportunity for families to look for themselves to catch up on things.

When is the COVID vaccine anticipated to be approved for kids under 12? Why should children get it?

We know the trials for children less than 12 are ongoing and they’ll have to finish the trial and analyze the data. What I’ve heard is that they anticipate around fall of this year for potentially some information on at least the 5-11 age group. (Pfizer – the maker of the only vaccine approved so far for adolescents – announced in June that it hoped to seek an emergency use authorization for the 5-11 age group in September and could have data from trials in children ages 2 to 5 soon after, followed by ages 6 months to 2 years by October or November. Moderna is also testing its vaccine in children.)

Overall, COVID’s impact on children has been very different (and less serious) than in adults. However, COVID has caused severe disease in children, deaths in children and resulted in long-term impacts like MIS-C, Multisystem Inflammatory Syndrome in Children. And there are other long-term consequences we don’t understand very well, like long-haul COVID. … We know children can get it.

If you have a vaccine to avoid serious disease and death, you should get it, just like with influenza.

One of the things we saw with COVID is that we couldn’t anticipate which children would get really sick. Children don’t have the usual comorbidities you see in adults, but even healthy children ended up getting MIS-C. Even healthy children should be vaccinated for that reason.

Once children are eligible for their COVID shot, are there timing considerations with getting other vaccines?

The good news is that the (Centers for Disease Control and Prevention) and the American Academy of Pediatrics provided guidance on this specific issue and they now allow for COVID vaccinations to be administered at the same time as regular childhood vaccines in order to avoid any further delays in getting regular vaccines. We’ve had millions of people at this point already vaccinated and we do know the vaccines have generally been very safe. Originally the CDC recommended spacing (COVID and other vaccines) 14 days apart, but now that we have so much more information beyond the trials, we have real world experience and know the vaccines have performed very well. Now the concern for any interactions is much less.

After more than a year of masking and social distancing, is it more likely that kids will get more colds and other routine illnesses this coming school year?

We do know masking and physical distancing protected us from many other viral illnesses. Once we lay down our guard, we don’t know what will happen this winter, whether influenza cases will rise. We had barely any influenza. It’s hard to predict.

(But) our immune system is a pretty sophisticated system. Even if you are walking around social distancing or wearing a mask, it doesn’t mean our immune system isn’t actively performing its duty. Our immune system is primed to work, but it’s hard to predict what we are going to face in terms of specific pathogens.

What can parents do to keep kids healthy?

Get caught up on regular vaccinations. Just as COVID is very much a reality, other childhood infections are very much a threat to children.

Particularly for children less than 12, parents should probably be prepared to have children mask indoors (at school), at least in the beginning of the school year when vaccination for that age group won’t have rolled out.

Regular things like hand hygiene – children have mastered it, and it works for influenza, RSV and other illnesses. Staying home if sick is still a good idea.

Screen time for the past year and a half has become part of our children’s regular day. … Have some alternative options for children to do to engage in physical activity. Playing outdoors is safe. Creating a community of friends so you can play outdoors, and outdoor activities as a family, like hiking, are safe and should be pursued to keep everyone healthy.

What we have all learned is that we are all resilient and our children are resilient to change and have mastered it quite well. The rules are going to change, but I think they are used to change management. Get back to physical activity and routine care – pediatric care as well as dental care and anything that may have been missed in the past year and a half. Perhaps we can get back on schedule a bit.

Janine DeFao is an associate editor of Bay Area Parent.