Transcription:

Melanie Cole: This is St. Louis Children's Hospital Podcast on COVID-19 dated April 8th, 2020.

Dr. Orscheln: Hi, I'm Rachel Orscheln. I am a Washington University Infectious Disease Pediatrician with St. Louis Children's Hospital and I'm a Mom Doc

Host: Hey, welcome to Mom Docs, the podcast from St. Louis Children's Hospital and today we're talking about the Coronavirus. Dr. Orscheln, it's a pleasure to have you here in these unprecedented times. Tell us, what do we know about COVID-19 and children? Is it affecting them as much? What are you seeing right now?

Dr. Orscheln: Well, thank you so much for having me today. We do know that the novel Coronavirus can infect children. What has been the silver lining in this epidemic is that children do seem to have less severe infection when they are infected with the novel Coronavirus. So it is possible that kids can have very mild symptoms and they are much less likely to become hospitalized or severely ill with COVID-19.

Host: I think every parent's biggest fear right now and question, you know, it's also seasonal allergies time and people get colds or even the flu. How does a parent know? How do we know if our child starts coughing or comes up with a fever or just really has a runny nose? How do we know what's going on?

Dr. Orscheln: Well, one of the benefits of our social distancing policies has been that we've seen a really steep decline in influenza, so we are not seeing a lot of community influenza right now. Many children have seasonal allergies that can present with a runny nose or a slight cough. And if your child is having their typical symptoms and it's most likely represents allergies we do know that the novel Coronavirus infection is less likely to present with things like sneezing and runny nose and more likely to present with things like fever, a dry cough, difficulty breathing. Although again, those symptoms can be different in children. Truthfully, children can become very mildly symptomatic and we won't even know it. And the problem is if they transmit this to people who will be more susceptible for a severe infection. And that's why we're asking families not to visit their elderly or vulnerable relatives or friends at this particular moment in time.

Host: Before we get into social distancing for a minute, what fever would warrant a call to the pediatrician? You're an infectious disease specialist. What fever would we worry about? And now with telemedicine really coming into play, tell us how St. Louis Children's Hospital is using that to reach out to patients that are nervous right now?

Dr. Orscheln: Well certainly we are offering telehealth visits now, which is something new and I think something transformative for our practice. We can now make visits both new and return visits through a telehealth mechanism. And so that allows us to connect with families review histories talk about plans for patients. So that's great. I think families can reach out to their pediatrician in the way they always have. If there is fever for your very young infants, we typically consider a temperature above 100.4 to be something to contact your pediatrician about because that can represent a serious bacterial infection in a very young infant for older children, a temperature over 101 might be a reason to call the pediatrician if you have concerns. Now I think in the current era we can almost assume that children who have a fever and a respiratory illness might have a novel Coronavirus infection. And again, they are unlikely to become severely ill from this and they should follow the recommendations that we've made for really everybody in the community, which is to stay home to isolate from people who might be at risk to control the respiratory secretions, to wash hands frequently to avoid spreading the infection to other individuals.

Host: So social distancing, which could be its own podcast to explain to our teens why this is so important. And even our little kids who want to have play dates and such. If one of our children is sick exhibiting symptoms, Dr. Orscheln, as a parent, our natural inclination is to obviously care for that child. And we're being told that whoever is sick should be in one room. Can you give us some tips for caring for our children if they do have symptoms of this or really any illness at this time?

Dr. Orscheln: Well, I think, you know, it depends on the susceptibility for the parents. So if a parent has underlying health conditions, they might need to take a more aggressive approach in terms of isolating themselves, maybe even protecting themselves with a mask. For most parents, you know, the good news is we have been on this social distancing recommendations for some time. So our children largely haven't had exposure to other people in the community, the most people that they've been exposed to is family members. That's one of the benefits of closing the schools early. And so if a child has an infection, it may be that they contracted it from their own parents. And so they're the parents. And the child may share the same viral infection and thus any individual parent is less likely to become ill from their child. So I do think that that is one of the benefits. I think anytime someone in the family has a respiratory virus and we'd like to prevent ourselves from getting that infection and if it was new in the household is to do some very practical things. Certainly you know, teaching the child about proper respiratory hygiene, that would mean coughing into your elbow rather than coughing into your hands. It would mean washing your hands frequently, especially after doing such things as or blowing your nose. And again, it might be appropriate not to sit, you know, cuddled up together. Especially if the parent doesn't think that they have had the infection that the child has had or to use a mask if possible in certain circumstances.

Host: And what about home care? Cause we're hearing more about ibuprofen and not to use that, but more acetaminophen. Do you want if since it's respiratory warm, moist air, cool mist, humidity, what can we do to help our child if they are ill?

Dr. Orscheln: Well there are, you know, very practical things like making sure that your child is getting plenty to drink lots of fluids. I think that the jury is still out on the issue of the ibuprofen. That was some initial concern that emerged from France. I think. I don't know that that concern has been validated going forward. In general the need to give a child Tylenol or ibuprofen or I'm sorry, acetaminophen or ibuprofen really just relates to the child's level of discomfort. There's no need to treat a fever per se, except for to keep a child comfortable. So I think that's a really important point for families is that really a fever can be helpful in fighting off an infection. And so we really only need to give medications to control fever in so much as it helps the child feel more comfortable. So I don't think families should feel pushed to go out and buy any particular medication. And again really the most important thing for a child who is ill is that they get plenty of rest. They get plenty of fluids. And there's no real need for medication.

Host: So as we're doing all of this home care and self care and we're cleaning and we're doing all this great advice that you've been giving us today, how long if we feel like we were exposed or our children were exposed, how long do we self isolate social distance before we can sort of breathe a sigh of relief? I think that's every parent's question right now, Dr. Orscheln is can we breathe a sigh of relief if we've been in our home for a certain number of days and had no exposure to anything in the outside world?

Dr. Orscheln: I think it's very likely that if you've been self isolating at home, kind of the long end of what we call the incubation period for this particular virus and an incubation period is the time from an exposure to the onset of symptoms is about at the long end, about 14 days. So if you've been home and really haven't had any exposure with the outside world for about 14 days is very unlikely that you will then subsequently come down with symptoms of COVID-19 or infection with the novel Coronavirus. So I think, you know, on average it's probably about a week after an exposure that people develop symptoms. So I think for families that have been home for one to two weeks, it's very unlikely that new symptoms will emerge.

Host: This is so important. Such great information, Dr. Orscheln, wrap it up for us. Give us your best advice as the expert that you are in this COVID-19 pandemic that we're seeing unprecedented, scary times for parents, for children who really don't understand what's going on. Speak to us about the stress that all families are feeling. It's sort of worldwide. We're kind of all feeling this worldwide stress and how we can take care of our mental health as well as our physical health for our children at this time.

Dr. Orscheln: Well, I think you bring up a really good point. I think one of the significant risks during this time is that children will feel stressed. They may be seeing their parents act, you know, and talk about and listen to newscast regarding this particular outbreak. That can be scary. So I think it's really important for us to take this time when we're all home together to really you know, talk about this issue in a way that's developmentally appropriate for a child to reassure children that they are safe and they are going to be cared for, and to really potentially highlight the blessings in this particular situation, which do include being home more together, having the opportunity to play games. Many of the other previous stresses of our life, like going to school or running around in the evening to various activities have now been removed so we can take that time to do things we maybe didn't have the time to do before. Like play games together, talk, you know, watch a show together. So really trying to call out the really the benefits of the situation and the opportunities to slow down while it's at the same time emphasizing that the children are safe and that if they do need to talk or feel particular anxieties, parents and families are always there to hear those concerns.

Host: Well, it's so important and at this time as families, it's really a time to come together and as you say, discuss it, listen to our children's questions and their fears and answer them as best and honestly as we can. Thank you so much, Dr. Orscheln for coming on and sharing your incredible expertise today. That concludes another episode of Mom Docs with St. Louis Children's Hospital. For more advice and articles on COVID-19, please visit the Mom Docs website at childrensmd.org. You can also get great information COVID-19 at StLouischildrens.org. Until next time, I'm Melanie Cole.