As schools start their fall semesters or plan their reopenings, parents who send their kids to daycare may have their own distinct worries when it comes to protecting babies, toddlers, and preschoolers from the coronavirus.
Six months into the COVID-19 pandemic, childcare centers may be ahead of schools in the level of protection they’re able to offer.
“Unlike many teachers in public schools, early childhood professionals are trained in the physical care of children,” says Cindy Lehnhoff, director of the National Child Care Association. “Because of the age of these children and state regulations, there’s always been an emphasis on the health and safety side.”
Diane Glassy, MD, a pediatrician in Seattle and a spokesperson for the American Academy of Pediatrics (AAP), says that many daycares are already accustomed to new coronavirus safety protocols because they’ve stayed open through the summer.
“I think parents of school-aged kids are wringing their hands more,” says Dr. Glassy. “Childcare has still kept going on for the last six months and they have already worked through a lot of issues.”
A new study supports the idea that, in states where coronavirus levels are relatively low, childcare centers can operate with minimal risk. The Centers for Disease Control and Prevention (CDC) published a report of August 21 showing that, during June and July, 666 Rhode Island daycare centers authorized to watch almost 19,000 children recorded only 52 confirmed and probable COVID-19 cases — 30 kids, 22 adults.
Researchers noted that, during 127 unannounced visits, health-department assessors observed high compliance with safety requirements such as mask wearing, daily symptom screening, and deep cleaning and disinfecting per CDC guidelines.
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Local Infection Rates Matter
Jennifer Shu, MD, the medical editor for HealthyChildren.org, the parenting site for the American Academy of Pediatrics (AAP), emphasizes that sending kids to daycare or preschool is a “an individual and local consideration.”
The “local” part of the decision starts with checking an area’s positivity rate — the percent of coronavirus tests that come back positive. “The positivity rate is now roughly 1 percent where I am,” says Thomas McDonagh, MD, a pediatrician with Northwell Health’s Huntington Hospital in Long Island, New York. “Most experts would say if you have a positivity rate that is below 5 percent, that it’s relatively safe to operate in a school environment.”
Over the past week, for instance, the positivity rate in Rhode Island was about 1.4 percent, according to data from the Johns Hopkins Coronavirus Resource Center.
By comparison, the Resource Center found that the positivity rate in Texas over the past week was over 14 percent.
This difference may explain why childcare centers in Texas appear to be experiencing higher rates of coronavirus infection. The state shut down daycares early in the pandemic, then reopened them in mid-May, according to a July 9 article in The Texas Tribune. By early July the state health agency reported a total of 1,695 positive cases at 1,078 childcare facilities — about 8.8 percent of all open centers, according to The Tribune. The data showed that 555 of those cases were children.
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Complications Are Rare but Real
No one is immune to the coronavirus, including children. The AAP estimates that as of August 13, children (ages 0 to 20) represented about 9 percent of all COVID-19 cases in states reporting cases by age.
The majority of kids and babies infected with the coronavirus experience only mild symptoms resembling those of a cold, according to the Mayo Clinic, such as fever, stuffy or runny nose, cough, fatigue, muscle aches, vomiting, diarrhea, and poor feeding or poor appetite. Many have no symptoms at all.
Still, sometimes even the very young can become seriously ill with COVID-19. “Although it’s rare, babies under age 1 can have more complications of illness than older children,” warns Dr. Shu.
This is likely due to their immature immune systems and smaller airways, which may cause some infants to develop serious breathing issues if they develop a respiratory infection, according to the Mayo Clinic.
In very rare cases, children may develop an illness associated with COVID-19 called multisystem inflammatory syndrome in children (MIS-C). As of August 20, the CDC has received reports of 694 confirmed cases of MIS-C. In addition to fever, children with MIS-C may experience abdominal (gut) pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes, or extreme fatigue. According to the CDC, 11 children have died from the illness.
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Daycares Need to Follow Safety Measures
The CDC offers a number of COVID-19 safety protocols for daycare centers:
Children age 2 and older should wear a mask. KidsHealth.org offers suggestions on how to get kids to comply with this rule. Adults can gently demonstrate how to properly wear a mask, help children decorate face coverings, or encourage them to pretend to be doctors and nurses. They can also lead by example: Daycare staff should always wear masks.
Note that the youngest children and babies should not wear a mask, as it can cause difficulty breathing and pose a suffocation risk. “They can’t necessarily get it off if it’s pinching, obstructing, or choking them in any way,” says Glassy.
Children should be kept at least six feet from others. With toddlers, this can be especially tricky, since they want to touch each other, share toys, and offer food to each other. In a July 5 iinterview with NPR, Lucy Mullen Davis with Denver’s Early Childhood Council says that teachers have to get creative and try to come up with activities that engage kids as a group but keep them physically apart, such as setting up an obstacle course with furniture.
Or adults may have to create cubby-like play areas that can separate toddlers from one another. (As seen on Twitter, some children in China have been wearing hats with long horizontal plumes to help them stay apart.)
Glassy says that some facilities with more limited room may need to place kids head to toe during nap time as a measure to create distancing.
Children should clean their hands often. Adults may need to assist toddlers with hand-washing and sometimes use wipes to clean them. The CDC offers guidance on how and why to help kids develop these skills. The agency says, “You can find ways to make it fun, like making up your own hand-washing song or turning it into a game.”
Lehnhoff adds that daycare professionals are pros at cleaning hands. “Hand-washing for 20 seconds has long been a part of our routine in early childhood education,” she says. “Plus, infants and toddlers love to wash their hands and they love playing in water, in comparison to fourth graders who don’t like it.”
Staff should also frequently wash their own hands, she says, and wear gloves for certain tasks, such as changing diapers.
Lehnoff recommends that parents considering sending their children back to daycare check that the facility is licensed. Licensing indicates that a center is regulated and visited periodically by health authorities to see that it is in compliance with standard safety practices.
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Parents Need to Stay Informed
With many childcare centers closing during the early months of the pandemic, more people working remotely, and rising unemployment rates putting financial strain on families, many parents took their kids out of daycare and began tending to them at home. ABC News reported June 22 that many facilities have been pushed to the brink of collapse. A July survey from the National Association for the Education of Young Children showed that 18 percent of childcare centers have remained closed.
But as lockdowns ease in many parts of the country, working parents are finding themselves in dire need of help with their children.
Glassy believes parents can proceed — with caution — to place their kids in daycare, but should always keep themselves informed about coronavirus risk as new data and research becomes available.
“We’re giving the best advice we can based on the information we have now, but as science marches on and we learn more, we’ll keep adjusting,” she says.
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