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How do I talk to my child about the vaccine? How effective is a mask on a five-year old?
Those were among the questions child health and wellness experts answered at an AL.com COVID-19 town hall on Wednesday.
The town hall was the first in a series of five Facebook Live segments, presented by AARP of Alabama and AL.com, that aim to answer audience questions about the coronavirus and its impact on different aspects of Alabamians’ lives.
In the first installment, Alabama Department of Public Health Assistant State Health Officer Dr. Karen Landers, Midfield Schools Mental Health Services Coordinator Camille Underwood and child and adolescent psychiatrist Dr. Amin Gilani fielded questions about the psychological and physical effects of COVID-19 on children.
Currently, children ages 0-18 represent about 25% of COVID-19 cases statewide, with child cases toppling 9,000 — an all-time high.
“This virus this year is not last year’s virus,” Landers told viewers Wednesday, echoing pleas from health experts across the state to get vaccinated and to mask inside and outside of school settings.
Here are their answers to common questions about children and COVID-19:
Do guardians have to approve vaccinations for their children? How should kids who want to get vaccinated approach the topic with their parents who might be against vaccinations?
The clinical trials for both the Pfizer and the Moderna vaccines in younger children are still ongoing. Any vaccines administered by ADPH or off-site clinics require parental permission for children 12 and above, Landers said.
[Editor’s note: It was not clear at press time whether this was a departure from previous guidance; some districts, such as Huntsville, have previously required parental consent for some, but not all, students. Alabama law allows people 14 and older to make some medical decisions for themselves.]
“We need to respect one another’s decisions and help people make health decisions based on the science,” Landers said. “When children are brought into something that’s unfortunately more political than it should be, we need to have open dialogue.”
Gilani said open communication is key for productive conversations, and that health decisions shouldn’t feel forced. Landers reminded viewers that they can always come back to get vaccinated if they need more time to weigh their options.
“If you’re not going to vaccinate, please mitigate,” Landers said. “Because we absolutely need to shut this virus down.”
How should parents and schools talk to kids about preventative measures?
Public health discussions can teach children valuable skills, like social responsibility, social awareness and self-management, Underwood said. She encouraged schools to facilitate small-group discussions about how students feel about the vaccine, which also can provide an outlet for staff to quell misinformation.
“It’s an opportunity to stay connected and stay informed about things that impact them on a daily basis,” she said.
Gilani said that in order for parents to have productive conversations, they need to sit down as a family and ask their children what they know about the vaccine. Listen to family members’ opinions without interrupting or judging them, he said, and then help them find reputable sources that will help them make their own informed decisions.
“Once you’ve heard them completely, then figure out if there is misinformation and where the source of that misinformation is,” Gilani said. “Social media has created this notion that [the vaccine is] completely unsafe or that they have negative side effects, which just has not been proven right.”
Gilani said that children are less likely to feel any negative mental health effects if they feel like they have a role in masking and school choices.
“Instead of telling them what to do, ask them, ‘Are you going to wear a mask because you want to save lives?’” he said. “Let them make the decision.”
What is the likelihood of a 5-year-old catching the virus or spreading it to others?
Landers said she and other health experts previously thought children under 12 couldn’t spread COVID-19 as efficiently, but that has changed as the delta variant continues to infect more and more children across the state.
“[Kids are] just as efficient at spreading COVID as adults are,” Landers said. “So I don’t think that we need to have a false sense of security about children’s ability to spread COVID because they absolutely can contract COVID and they absolutely can spread COVID to other people.”
More children are hospitalized now with COVID-19, and the state has seen more than 100 cases of MIS-C, a rare inflammatory syndrome associated with child COVID-19 cases that has landed at least a handful of children in the hospital over the past weekend, Landers said. Between 6 to 10% of children can develop long COVID symptoms — including chronic headache, fatigue and inability to concentrate – which could affect their ability to perform in an academic setting, she said.
What does the research say about mask effectiveness? Is there a negative psychological outcome of expecting children to wear masks?
There’s a growing body of data, experts say, that shows the efficacy of masking in schools. Landers pointed to a Duke University study, which showed that universal masking in schools limited in-school secondary cases.
A month ago, about one-third of Alabama school districts had adopted mask mandates. Now, more than 90% of districts require universal masking. Dr. Landers said that those efforts, along with social distancing, routine cleanings and testing, can help mitigate the spread.
“It’s very important to support our schools for doing everything that they’re doing to keep kids safe,” she said.
Gilani said that even in very young children, there’s no evidence that suggests universal mask wearing can present negative mental health outcomes. Social outcasting, which is more likely to affect masked children in districts that don’t have mask mandates, has a more harmful effect, Gilani said.
“If they see that everyone else is wearing masks, it becomes their normal.” he said. “Simple measures can save lives. Why should we not do it?”
How are children handling changing guidance?
Midfield schools stayed virtual for several months last year and many parents and students have been anxious about this year’s in-person learning. Underwood said that’s taken a toll on student and staff mental health.
A system of support, she said, can be “a saving grace” for students and staff, and she urged schools to keep lines of communication open to students and parents.
“Kids are a lot more flexible than we are, and it’s easier for them to pivot,” she said, noting that younger children tend to want to socialize more. The ability to stay in school, she noticed, was a motivator for students to stay safe.
When will school nurses be able to give COVID-19 tests at school?
Weekly testing, in addition to mitigation standards such as masks, social distancing, environmental cleaning and good respiratory hygiene is key to keeping kids in school, Landers said.
But the state doesn’t mandate mass testing, so it’s up to schools to work with providers to conduct surveillance tests. The University of Alabama at Birmingham has been coordinating a grant to conduct in-school weekly testing, and several schools have already signed up, Landers said.
Why am I not getting notified when my child’s classmate has coronavirus?
State health officials recommend schools notify families to slow the spread of COVID, but it is not required. ADPH recommends that close contacts who were at least 3 feet away from a student who tested positive don’t need to quarantine as long as both people were masked and they remain asymptomatic.
“It’s important for parents to consistently be aware that COVID is out there, that COVID is in the community,” Landers said. “Now, if a school is universally masking and following mitigation guidelines, then you markedly reduce the numbers of kids in the classroom that would be considered contacts.”
Will COVID-19 become a required vaccine in schools?
No. Alabama law specifically bars schools and universities from requiring the vaccine. Landers encouraged eligible groups to get vaccinated.