The AAP strongly advocates that all policy considerations for the coming school year should start with a goal of having students physically present in school.
- Children comprise approximately 24% of population and account for approximately 2% of COVID cases. There are patients that develop complications and MIS-C but overall kids do better than adults.
- Less risk does not mean NO risk –all risk cannot be eliminated. The goal is to mitigate not eliminate risk.
- Schools play an integral part in providing academic instruction, social and emotional skills, safety, nutrition, physical activity, and mental health therapy.
- Social isolation has mental health implications. There has been a marked increase in anxiety and depression. When severe this can lead to teen suicide attempts. 1000 pediatricians with same EHR – 65% decrease in depression screens. Not seen by peds or schools and could have missed on anxiety and depression.
- There are also concerns for physical, sexual, and substance abuse going unchecked and unreported without observation and intervention by teachers and administration at school.
Recommendations:
- Stay current on well visits and vaccinations
- MMR vaccination rate dropped 50% - we need to stay up to date or we will be dealing with another pandemic
- Offices are safe – call your pediatrician’s office to find out what accommodations are made and procedures are in place. Make needed appointments.
- Yearly sports exams are still required for screening and development.
- Don’t send your kids to school if they are sick – take their temperature to screen them in the am before school. If the temp is 100.4 or greater the child should not go to school. Before school screening by school may not be possible based on size of student population.
- Testing is not feasible prior to the start of school in most locations and is not known to reduce the likelihood of spread in schools.
- Practice wearing a mask before school starts
- Be flexible and communicate with kids and teachers. Teachers and schools will need to be flexible in adjusting policies as needed.
- Your kids will follow your lead – stay positive and help teach perseverance and resilience
Social distancing, mask use
How to effectively observe social distancing and wear cloth face coverings is addressed in the guidance, which examines factors such as students' ages, developmental stages and special considerations.
"Evidence suggests that spacing as close as 3 feet may approach the benefits of 6 feet of space, particularly if students are wearing face coverings and are asymptomatic," according to the guidance.
Schools should weigh the pros and cons of enforcing 6 feet of distancing. If it is not feasible without limiting the number of students, other risk-mitigation strategies may be more favorable.
High- and low-priority strategies are provided for distancing and cloth face coverings by age. High-priority strategies include the following:
- For pre-kindergarten students, cohort classes, spend time outdoors, and limit visitors to the building. The impact of physical distancing is small and difficult to implement in this age group.
- Elementary students should wear face coverings if the risk of touching their mouth or nose is not greater than the benefit of reducing the spread of COVID-19. When possible, spacing desks 3 to 6 feet apart and using cohort classes and outdoor space, is recommended
- Physical distancing may have a bigger impact on reducing the risk of COVID-19 among secondary school students. When feasible, use face coverings when closer than 6 feet apart, avoid close proximity (and go outdoors if possible and spread out) during activities like singing and exercising, and consider cohorting classes.
- Pediatricians can work with families and schools to identify and develop accommodations for children with unique needs.
During the school day, students also must navigate physical distancing in enclosed spaces, such as buses, hallways, playgrounds, and cafeterias. Other distancing measures include:
- Assign seats to bus riders by cohort, use face coverings if distancing is not possible, and minimize the number of riders within reason. Encourage students who have other options to use alternative transportation.
- Reduce congestion inside the building with one-way hallways (tape arrows on floors), rotate teachers instead of students, stagger class periods, and assign lockers by cohort or eliminate lockers.
- Group students by cohort for meals. Students could eat in their classroom or use outdoor spaces when possible. The guidance stresses that care should be taken to protect students with food allergies from potential exposure. Decisions about how to serve meals also should take into consideration food security and the possible increase in students eligible for free or reduced meals. Emphasize the importance of physical distancing to adults with staggered drop-offs and pickups, limiting parents from entering the building, installing plexiglass in reception areas, and discouraging shared lounges.
Other considerations
In addition to having plans in place to keep students safe, there are other factors that school communities need to address:
- Pressure to catch up.Students may not have gained as much from distance learning. Some students may not have had access to computers and WiFi. Schools should be prepared to adjust curricula and not expect to make up all lost progress. It is important to balance core subjects with physical education and other learning experiences.
- Students with disabilities.The impact of schools being closed may be greater for students with disabilities. They may have a difficult time transitioning back to school after missing out on instruction time as well as school-based services such as occupational, physical and speech-language therapy and mental health support counseling. The AAP recommends reviewing the needs of each child with an Individual Education Program before they return to school, and starting services even if they are done virtually.
- Annual physicals.The AAP encourages families to continue to see their pediatrician for checkups. Immunizations should be top priority, and all students should get an influenza vaccine. Preparticipation physical examinations also should take place.
- Mental health.Mental health support should be available to all students to help them cope with stress from the pandemic and and recognize students who show signs of anxiety or distress. Schools also can help students with suicidal thoughts or behavior get needed support.
- Many students receive healthy meals through school meal programs More students might be able to get free or reduced meals than before the pandemic. Schools should provide children participating in free and reduced meal programs even if the school closes or the student is sick and stays home from school.
Sources:
https://www.healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/Is-it-safe-to-send-my-child-to-child-care-during-COVID-19.aspx
https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-planning-considerations-return-to-in-person-education-in-schools/
Author
Alison Heffernan, MD
Board Certified Pediatrician and Fellow of the American Academy of Pediatrics
