Parents in pandemic: how to keep children healthy and happy

We sat with Dr Michael Loubser, a very popular pediatrician, clinical immunologist and allergist practicing in Dubai, to discuss ways to keep children healthy and happy during COVID-19. The interview turned out well in covering quite an extensive range of topics including children's mental health during social distancing, emerging pediatric cases during pandemic, and wearing facial masks. 

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Dr. Michael Loubser

Specialist Pediatrician, Clinical Immunologist, Allergist
Genesis Healthcare Center

What is the best way to explain current situation to children?

There probably isn’t a single best way because obviously in children, there is such a big age group. On one hand, we see six-week old babies who come to the clinic for vaccines, or eight-week old babies who this may be their first time out. Now they are in a situation where everybody’s faces are covered; whereas at home they never were and that’s terrifying for them.

You get toddlers who are quite articulate, who’ve spoken to their parents and they come in my office and say: Daddy, is the virus in this office? The little ones have a problem with the abstraction. To them, the virus must look like an elephant or a tiger or it must look dangerous. So, we have tried to show them what the electron microscope images are and say: 'This is the virus but you can’t see it. That’s why you mustn’t touch the surfaces don’t lick the back of chairs'.

Then there’s the bigger kids, some of them are actually quite insightful. I look after a population of children with respiratory illnesses and they are actually saying to their parents, they are scared of dying! We have to spend a lot of time, explaining that, first of all, it doesn’t appear that asthma puts you in a particularly higher risk, interestingly. And we’ll talk about that as long as you are properly isolated, your risk of getting the disease is pretty low, and as a child, your risk of getting a severe disease is even lower.

And we’ve actually seen, sort of depression or anxiety amongst the kids, perhaps from 10 upwards. There is definitely a worry.

How you educate kids, it’s difficult. I mean there are people that created story cards, there are videos. It is very difficult because it’s an abstract concept. A lot of people, adults don’t even get the fact and say: “Why should we isolate” or “This thing doesn’t appear to be a big problem”. So it’s very hard.

I think 'openness', 'bringing it to the child’s level', 'not being too scared' is important. I also think parent’s fear is projected to their children. So, if parents are absolutely paranoid, and they’re terrified, that’s only going to reflect in their children who are then going to have nightmares and difficulty sleeping.

Any emerging pediatric cases now that kids are stuck at home? 

So, this is change of season. Typically in change of season, you get increase in infectious diseases. As the summer months come, we typically get more chickenpox, gastrointestinal diseases. We are not seeing that at the moment. Everybody is isolated and those sorts of infectious diseases are gone. All the little nursery school illnesses, hand foot and mouth disease, all of the kids with the congestion and ear infections are much much less, because these kids just aren’t getting the regular day-to-day viruses.

Perhaps, one of the biggest things we have been seeing more recently is accidents. We’ve been seeing kids jumping on beds, and falling and cracking their lips and banging their heads, and breaking their arms and getting burned. They’re all getting cabin fever and they’re doing crazy things. If I reflect in the last month, we’ve probably seen more children with accidents than we would normally see in a six-month period.

We also see some mental illness because the children don’t understand why they can’t see their friends. Why they can’t go out and they are asking questions now. They don’t present with profound mental illness but they present with anxiety. So we are seeing a different spectrum.

Would social distancing negatively affect children's mental health?

If everybody is functioning in a normal family setting, where people talk to each other and parents interact with their children, I don’t think there should be regression. In fact, in a way, children today have the most wonderful situation in that they have both parents with them at all time and that’s great.

There will be issues with relationships and teenagers are having issues because they are social creatures and they like to interact with their friends. But fortunately with social media and with Zoom and those type of things, they can actually interact. I am generally not a huge advocate of social media in teenagers in the normal course of events because I believe they should sit in front of each other and actually look each other in the eyes and talk to each other, but I think social media is saving the day at the moment especially amongst the teens.

How can I tell whether my child is going through emotional difficulties?

Normally in small child psychology, we see how children play, and we look at what they are saying when they are playing. So if your child is playing with their dolls and all of a sudden setting up funeral parlors, I would actually take that as a negative cue. Whereas, if they are playing healthy play then that’s ok. So, the way parents can look at their children is to play. With little boys and little girls, they can use action figures and dolls and children can project their fears onto their toys. That way the parents can get a feel for where their children’s head space is. Play therapy is very important with the semi-verbal child.

Test shows my child is COVID-19 positive, but shows no symptom, what shall I do?

The first problem is how does the child get to be diagnosed in this town asymptomatically because it is very difficult to get a test if you’re asymptomatic. Typically it is the other way around where you have an index adult who gets tested, and then as part of contact tracing, you pick the child up. But the tricky part of course is that you’ve got a person who got the infection and very likely not to get sick, is being cared for by people who have a much greater likelihood of getting sick. Your tougher question could’ve been: 'the asymptomatic child who is been looked after by the hypertensive diabetic mother', because you’ve got an exceedingly higher risk adult. What should you do?

So in such cases, you have to think, and you have to break it into smaller pieces: firstly, you have to put the welfare of the child at front. How do you look after the child physically, emotionally, mentally? And you can’t separate children from their caregivers easily.

Then the other thing you have to do is to cocoon the family in some way to make sure that those at highest risk are put in an environment that is relatively safe and those at slightly lower risk can perhaps continue their care-giving role. But it is exceedingly difficult. Once you’ve got care-givers that are not sick amongst patients who are sick, there are going to be casualties unfortunately.

Why is it so important to wear facial mask?

Early on in this illness, there was a push even by the WHO, to say this is not a respiratory illness. That this is not an airborne disease. 

What they were trying to say was that the large droplets either coughed or spoken that land on surfaces contain more viruses than if I just cough into the air. Therefore be very worried about surfaces. And I completely agree with that. But it is ludicrous to say that this not airborne since it comes out of somebody’s airway.

So, we must think of this as airborne and if we protect the airborne part of us, we’re going to stop those big particles coming out, so masks and airborne control is critically important part.

The other thing I’d like to stress is that wearing gloves does not make you safer. In fact, I’ve seen a lot of people wearing gloves who are putting themselves at risk because they think ‘I’m wearing gloves, I’m safe’, 'I can touch my face'. Well actually, the gloves are just another skin, and they need cleaning and washing just the same as your skin does.

So, my advice is that if you’re wearing gloves, think of them as your own skin. Yes, maybe instead of washing them with soap, you can peel them off and put a new pair on. But don’t believe those gloves make you safe. There is no evidence really to show in day to day life that very good hand washing with soap and water is not as good as any of the other methods.

Day-to-day healthcare has not changed!

I think the most important thing for us to remember is that our a day-to-day healthcare hasn’t changed. We are dealing with Corona. But babies need to have their developmental checks. Babies need to be vaccinated. People with acute illnesses need to seek medical care. It’s an absolute tragedy if we are so worried about Corona that children die from Polio, Measles, and Rotavirus; and people have heart attacks and strokes because they didn’t get their blood pressure medications.

So, we must remember there are vulnerable people who still need to be cared for in a normal way whilst we cope with the pandemic. 

*Disclaimer: Please consider the information in this video/article most recent as per date and medical recommendations towards COVID-19 may change as the situation evolves.