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Should schools be open or closed during COVID?

By Dr. John Maddox, Pediatrician
Pentucket Medical/ Haverhill

School staff and families are experiencing tremendous fatigue from the heroic work to maintain in-person education during the COVID pandemic. Millions of hours and millions of dollars have gone into mitigation efforts (like masks and distancing and ventilation).

Most schools use a hybrid model, with each student only in the building 2 days per week. Furthermore, close contacts are quarantined. These modifications significantly reduce the likelihood of COVID spread.

Given the benefits of in-person education and the health risks of COVID, decisions about if and when to temporarily shut schools are very complex — requiring wise judgment. It’s important to avoid being reactionary, when fear clouds fact. The fundamental question should be: “is having our school open right now making the pandemic here now worse?”

Massachusetts has its system of red, yellow and green communities, which marks the degree of caution each district should be using in its decisions. This is a particular challenge for urban cities, where both the rates of COVID and the harms of remote education are highest.

To use a baseball analogy, closing a school is like shifting the infield to double play depth when a runner is in scoring position with one out. It’s a tool that gets you out of a pinch. If this school year were a game, we’d be in the top of the 3rd inning. We need to encourage and reward good managers, who keep an eye on the long view and the final outcome.

Mask Mythbusters: Five Common Misconceptions about Kids & Cloth Face Coverings

Submitted by Dr. John Maddox, Pediatrician, Pentucket Medical/ Haverhill

1.        Can wearing a mask make it harder for my child to breathe?

Recommended cloth face coverings do not block the exchange of oxygen or carbon dioxide.  The vast majority of children age 2 or older can safely wear a cloth face covering for extended periods of time; this includes children with many medical conditions.  Begin now having your child wear masks at home.  Start with short periods, when they are doing their favorite activities, and gradually increase the length of time, so they get used to it.  All schools will offer mask breaks.

2.       Can masks themselves spread germs?

Masks get damp over time, from the same respiratory droplets that spread COVID, flu and other germs, so face coverings should washed regularly.  It is important to have cloth face coverings that fit a child’s face well, so that they are not tampering with the mask.  You should perform hand hygiene before and after touching your face covering.

3.       Can a child with special health care needs, like the autism spectrum, wear a mask?

Some children will need extra attention to the way a mask feels and fits and smells.  Some kids will benefit from strategies like Social Story (see below), which help explain new situations with both descriptions and directives.  Schools are prepared for some students with special needs to be unable to wear masks full-time right away.  Occupational therapists and applied behavior therapists will work with students to teach them new and important skills.

4.      Should a kid wear a mask during sports?

Cloth face coverings help young athletes protect their teammates and themselves.  They also help protect the sports season.  Whenever safe and possible, athletes should wear a cloth face covering.  This includes on the sideline bench, in team chats and going to and from the field.  Exceptions include when they are actively exercising.

5.       Do masks really prevent the spread of COVID-19?

Cloth face coverings are one of the most effective ways to prevent the spread of COVID, flu and other germs.  Very early on in the pandemic, there was concern about having enough masks for health care workers, so widespread mask use was discouraged.  However, it is very clear now that states, communities, and schools that have contained COVID— despite imperfect social distancing, ventilation and hand hygiene— have used cloth face coverings to prevent spread, even in asymptomatic people.

 

https://www.healthychildren.org/English/health-issues/conditions/COVID-19/Pages/Cloth-Face-Coverings-for-Children-During-COVID-19.aspx

https://www.healthychildren.org/spanish/health-issues/conditions/covid-19/paginas/cloth-face-coverings-for-children-during-covid-19.aspx

https://drive.google.com/file/d/1R1lSbfZ8TRchbHCiK_4svK7WLH62lS

https://vkc.mc.vanderbilt.edu/assets/files/tipsheets/socialstoriestips.pdf

https://www.nytimes.com/interactive/2020/08/19/well/childrens-face-masks-comfort.html

Recognizing the Importance of Foster Parents

Dr. John Maddox, Pediatrician/ Pentucket Medical/ Haverhill

In my work as a pediatrician, few things are as inspirational and selfless as foster families that agree to take on the responsibilities of caring a child with nowhere else to go. (We should not lose sight of the substance abuse problems in our society: the primary root of neglect and mistreatment.)

Foster parents often have their own biological children, whose needs are being juggled, but — with amazing dexterity and balance — these homes, enriched with family love, are wonderful environments for the newly arrived foster child. Like a repotted plant that was once wilting, one can see a child in foster care begin to flourish in a matter of days. Furthermore, the foster parents go to extraordinary lengths to help DCF maintain children’s connections to their biological families. I realize that not every foster situation is a happy one, but many are and should be celebrated and exalted.

For more information visit:
https://www.healthychildren.org/…/Pag…/Foster-Parenting.aspx

The Facts about Flu Shots

 

Seasonal flu activity typically occurs between October and May. The CDC recommends getting vaccinated as soon as the vaccine is available.

The American Academy of Pediatrics recommends that everyone six months of age and older get a flu shot for the 2019-2020 season as soon as it is available (which is now).

Influenza is dangerous – much more dangerous than the common cold. It can lead to hospitalization, ICU admission or even death. In the 2018-2019 flu season, 116 kids died. Of those children, 70 percent did not receive that year’s flu vaccine, and 50 percent were healthy before they got the flu. That is why getting the vaccine is so important.

Seasonal flu activity typically occurs between October and May. The CDC recommends getting vaccinated as soon as the vaccine is available, if possible by October. However, getting vaccinated later can still be beneficial.

What is the difference between a cold and the flu?

Influenza (the flu) is a contagious respiratory illness caused by influenza viruses. Viruses also cause colds but generally; do not make the patient as ill. Your health care provider may make the diagnosis based on symptoms and exam or can do a flu swab in the nose. Since viruses cause both types of illness, antibiotics won’t help.

How does the flu spread?

The flu spreads through droplets – sneezing, coughing, blowing your nose – and can stay on surfaces for a period of time. If someone with the flu touches a surface and you touch it a short time after them, you could get it. That’s why hand washing and covering your/your child’s mouth when you/they sneeze or cough is so important.

What are the symptoms of the flu?

Many symptoms of the flu are similar to other viruses. You can have fever, chills, sore throat, cough, runny/stuffy nose, headache, stomachache and body aches. The flu is more of a respiratory virus, not so much a vomiting/diarrhea one. Symptoms can last for up to a week. You can also get complications from the flu, such as pneumonia, sinus infections, ear infections, and even blood infections.

My child was tested and has the flu. What now?

The most important thing you can do is keep them comfortable and hydrated. If they don’t want to eat, that is okay – most of us don’t want to eat when we’re sick. However, it is important to stay hydrated. Be sure to push fluids – Pedialyte is a good choice for children and even comes in popsicles. With kids two years and older, ensure they are peeing at least three times in 24 hours. In kids who are two years and younger, ensure they are peeing at least four times in 24 hours.

Why do we have to get a flu shot every season?

The flu viruses are constantly changing to get around our defenses and make us sick. The CDC works year round collecting data to figure out which strains of flu will be most prevalent year to year.

I heard the flu shot does not really work. Why should I get it?

There are many misconceptions about the flu shot. Is it 100% effective at preventing the flu? No. Scientists do their best to create a vaccine each year based on the research they have done on the previous year’s flu strains. Although effectiveness does vary from year to year, the CDC estimates the flu vaccine reduces your risk of getting the flu by 40-60% when the vaccine is well matched to circulating viruses. A bigger point is that the flu vaccine has been shown to significantly reduce the risk of death in children. A study published in Pediatrics in 2017 showed that between 2010 and 2014, the flu vaccine reduced the risk of flu-related death by 51% (half!) among children with other high-risk medical conditions. It also reduced the risk of death in healthy children by 65%.  It is also important to note that if you get the flu shot and still end up getting the flu, symptoms will last for a shorter period and will not be as severe.

Which kids have to get two doses of the flu shot and why?

If it is your child’s first flu season receiving the vaccine and they are nine years old or younger, they will receive two doses of the vaccine four weeks apart. This helps prime their immune system. The first shot shows their body what the flu viruses looks like and the second shot is a reminder to make antibodies that are even more protective.  Once they get two doses of the flu shot their first season, they only need one dose each season after that.

My baby is under six months old. How can I protect them from getting sick?

The best things you can do is have everyone else in the house (or who will be around your baby) vaccinated and practice good hand washing. If you have older kids in the house, teach them about hand washing, sneezing/coughing into their arm, and avoid kissing the baby if they are sick.

My child is healthy. Do they still need the flu shot?

Unfortunately, every year there are healthy kids and adults who die from influenza. Getting a flu shot reduces the risk of your child being hospitalized due to the flu and/or its complications. Additionally, it protects those around them – older adults who have weakened immune systems, people with cancer, and babies who are too young to be vaccinated.

I get sick every time I get the flu shot. Why should I get it?

If you feel crummy after you get a shot that can be a good thing! It means your immune system is up and running, working to create antibodies to protect you in the future. When you get a shot, it triggers an inflammatory response in your body, a very similar type of response that is triggered when you get an infection. It is the same reason kids sometimes get a fever after their childhood immunizations – their immune system is getting to work.

Sometimes you may feel feverish or achy after getting a shot, but it is a small price to pay for how sick you could get the flu. The most common complaint we hear after giving a flu shot is some soreness around the area where the shot was given.

I heard the flu nasal spray is back again this year. Can we do that instead of the flu shot?

Yes – as long as your child does not have a history of asthma/wheezing/respiratory problems and is two years or older. Last year, we still recommended the injections over the nasal vaccine since it was the first year back on the market after being removed in the 2017-2018 season. Based on data from the 2018-2019 season, the American Academy of Pediatrics now recommends either the injection or the mist.

If you have more questions, please talk to your child’s pediatrician. Remember, it takes about two weeks for your body to build up an antibody response, so the earlier you get the  vaccine, the better.

To schedule an appointment call 888-227-3762.  

How to Prevent Sport Injuries in Children

Sports may be fun for kids and parents, but accidents happen. Around one in three children in the US who participate in sports will miss a game this year due to a sports-related injury. How can you minimize your child’s risk of injury at the next game? Here are some ideas to keep in mind:

Continue reading “How to Prevent Sport Injuries in Children”

Mass General Brigham community practices are here for you during these challenging times, and our staff are available in the office for most appointment types. Virtual visits by smartphone, computer, with webcam, or telephone are now available for urgent appointments.

View Appointment Instructions

If you are unable to reach your Mass General Brigham provider or do not have a primary care provider, you can call the Mass General Brigham COVID-19 Nurse Line at 617-724-7000.

Available from 8 a.m. to 4:30 p.m. 7 days a week (Monday through Sunday), nurses can respond to general or specific questions about COVID-19 for those who have symptoms, believe they may have been exposed, or are looking to learn more.

If testing or treatment is needed, the nurses will guide you through next steps. Interpreters can be added to calls for patients who need it. The nurse hotline is available to anyone that is a Mass General Brigham patient, regardless of immigration status or insurance.

Please note the Nurse Hotline is not able to schedule or answer questions about elective testing, such as testing for travel or do not have symptoms.

UPDATE: COVID-19 Latest Information

COVID 19 information from Mass General Brigham. COVID-19 information from CDC.