Fort Worth, Texas,
15:07 PM

A Pediatrician Answers Your Questions about Going Back To School Or Online Learning

Recently, I wrote a post titled, “Is Going Back to School or Online Learning Best for Your Child?” A Pediatrician Shares what Parents Should Consider?”

Following that initial article, we received a lot of questions from you all. I wanted to take this opportunity to answer them all at once.

Let’s get started.

For families with multiple school-age children, is it counter-productive to send some children and keep the others home? I think one of my kids can thrive with online schooling, but it would be much harder for the other two (due to dyslexia, age, socialization needs, etc.).

Not necessarily. While the child at school could contract the virus and bring it home, the fewer children and contacts, the less likely the family is to be exposed. I can easily see a family weighing the risks versus benefits and making different decisions for each child.

When looking at a child as a whole and not just at the physical, can you talk about what repercussions we could be looking at from keeping kids home from school. As a nurse, one of our core principles is looking at the entire patient and not just the patient's body. I think we should have a discussion about the mental health, emotional health, educational health, and even social health repercussions of keeping kids home. This won't be the often very successful home schooling that people do.

Yes, I think it is very important for families to consider both the medical risk of COVID on children and household contacts in the context of how being home from school would affect their child educationally, socially and emotionally. It should definitely be a whole child conversation.

Is it worth sending kiddos with special health needs to public school this year? We had hoped to send our youngest who has cystic fibrosis back to public school for his high school years starting this year.

And ...

Hi Dr. Smith, My soon to be 1st grader is on methotrexate for Crohn’s disease. How worried should I be about sending him to in person school? I’m worried the medication will make it harder for him to recover from Covid. Thank you for your insight!

This decision will be different for every child and every family depending upon the needs and risks for an individual child. These decisions would be best made with the pediatrician or specialist who knows the child's history the best.

If our kids go back to school, are we basically giving up seeing grandparents and anyone high risk? We’ve been very careful all summer in order to be able to spend time with my mom.

This is probably one of the worst parts about this decision for families. Based on the best information available currently, once our kids go back to school, I think we will have to use extreme caution with grandparents and other at risk contacts. Hopefully we will learn more over time what it looks like to protect grandparents and maintain connection.

My oldest is entering kinder, and it just seems/feels like such a big year for him. He loves school, and excels, but is also shy and sensitive to new things and transitions. We also have a grandparent that we see often who has cancer, so sending him would mean that we couldn’t see family. We are leaning towards homeschooling for the year, but don’t want him to miss out on such a big and important year. Is kinder a good year to homeschool or would it be more important to send him for the socialization and such?

Transitional years seem like the one that most families are struggling with. Kindergarten, 6th grade, 9th well as the obvious 12th grade. Unfortunately, I don't think that there is a straightforward answer but I am trying to remind families that everyone is facing the same decision and your child wouldn't be the only one who stays home...all that to say, there will be several kids starting first grade the next year who also home schooled.

For me it’s, if we as a family decide to send him back to school, how do we protect the rest of the family from germs he may bring home? Is it even possible? And at 13 is social interaction crucial for his mental state (he’s kind of a home-body anyways)?

I think I would be extra cautious about hand washing, perhaps even showering and changing clothes once they get home. Is it possible to keep them completely sterile? Probably not but it might make me feel better to make sure I was doing everything I could. Is social interaction crucial? It definitely depends on the kid. But it might not be as simple as thinking introverts don't need to go but extroverts do-perhaps it's our introverts who have the most to learn from being in a social environment. It's hard to say.

One of my two children has already tested positive. My youngest has not. Is it safe to send the one who has tested Positive back to school? Is there such a thing as immunity?

This is something I truly don't know if we have the answer to. Can a child who has had it get it again? Can they still bring it home even if they are immune? I don’t know the final answer to these questions.

What about the nonverbal language skills kids will lose by not being able to see their teachers and peers facial expressions behind a mask.

I think it’s safe to say that even being at school will not be normal and there will be some downsides and missed opportunities for learning. Even things as simple as not having lunch in the larger community and skipping recess (if a school chooses to do those things) will be something we need to consider.

Guilt. Am I a bad parent if I send my kids because I think they need in school learning? The spring at home was minimally successful and I do not think we have the capacity to do the teaching from home. How do I NOT feel like a bad parent?

I think this one will affect everyone. Trying to make the right decision with limited information and two options directly in front of you is a huge challenge. Dealing with the downfall when things go wrong or there are challenges down the road will inevitably lead this towards you wondering if you made the best decisions.

It’s the Bachelor phenomenon-how can an individual get to the end with two competitors and choose one-completely forgetting that the first was an option and not wondering if they made the right call? It’s probably why it seems to fail more than work out. (Except Sean and Catherine and a few others…)

And it’s not just the decision to send them that will have parents feeling guilty…parents choosing to keep kids home will have similar struggles.

How do you help with the guilt:

  1. Remember that you’re not in this alone. Everyone else is having to make the same decisions.
  2. Remember that kids are resilient. If they have a parent who loves them and is agonizing over this choice. They are likely to be ok in the long run.
  3. Remember that no choice is forever. It feels like you’re making a decision that could have effects on your child for the rest of their life, but we will have options over time. None of them may be great options but we can make changes as we go and modify based on how it’s going.

What should performing arts classes do for safety? Is it safe for a bunch of teenagers to be singing, playing instruments, performing plays and musicals together in one room? 

Yes, I believe that most school will have to forego performing arts classes for the near future due to the risk that these activities could increase the risk of spreading droplets and disease.

How do we keep 2600 high school students from passing this like wildfire when we can’t easily keep them in 1 or 2 classrooms all day? Are teenagers being affected symptomatically similar to “kids” or more like “adults”?

I think secondary schools are going to present the biggest challenge to keeping infections at bay due to their mobility throughout the school day. We may see schools make decisions to keep kids cohorted for core classes and limiting electives or presenting electives in an alternative way. It does appear that adolescents appear to be presenting with more symptomatic disease-which may help monitoring infections and spread easier than in kids who are asymptomatic.

If one child in a classroom is positive will the entire class need to quarantine/virtual school for a 14 day time period?

It does not appear that the class will be shut down if a classmate tests positive for COVID. According to the TEA and local health departments, notification will be provided to families should a person on campus test positive but it is not clear how much information will be provided.

What are the thoughts on preschool. If we have the option is keeping them home worth the reduced risk of Covid despite it keeping the children from other children and a classroom? Will our preschoolers be behind come Kinder?

Keep in mind that many children start their first formal schooling experience with kindergarten and do well. Parents may still make a decision to send their child to preschool but I don’t think it should be out of fear for their education.

My heart breaks for my kindergartener who will start his public school experience looking SO different than his older sister. How much should I allow a 5 year old to endure. What are the “new rules” that are too much to expect (an active) 5 year old to adhere to?

I think they should be prepared that things will be a little different than their preschool years. Masks, recess, PE, lunch-everything will look a little bit different. Reassure them that all of the changes are to help them be safe. But also keep in mind that they probably don’t know what Kindergarten is supposed to look like. So, what does that mean? There’s no point in having significant discussions with them about what they are missing out on. Focus on the positives. The way we frame these discussions with our kids is going to mean a lot to them. Are masks going to be required? Don’t say it’s stupid but we’re going to do it anyway, just say, it’s part of life. Recess with just your class? Think of how much more room you’ll have on the playground. You’ll get so many more turns!

What happens when our 4 yo inevitably picks up another cold of virus at school with the same symptoms. Will we need to get her tested for Covid every time to rule it out? I also have a 6 month old so worried about him getting it from her. Just can’t wrap my head around how this will work when she does get sick with something.

This is going to be one of the biggest challenges of the fall. Because the list of COVID symptoms are so broad, we’re going to have to learn quickly what symptoms require testing and what can be monitored. Early on, I expect we’ll be doing a lot of tests out of precaution until we get better guidance. We’ll all be doing the best we can to minimize unnecessary visits but also to keep everyone as safe as possible.

I’m choosing to start my son out at home this year. How do I approach the decision with him? What is appropriate for elementary aged kids to know about why I made the decision and how do I make sure to address the missing of friends?

I think informing them of your thought process to the level of their development is an important part of how you transition them towards thinking about doing school at home. Finding ways for them to connect with peers will be something that you need to focus on-through technology or finding ways for them to participate in extracurricular activities that are following COVID guidelines are two thoughts that come to min.

Is it ok for a 3rd grader to wear a mask for 8 hours a day at school?

Yes! It will be a learning curve for sure but kids in schools all over the world have adjusted to wearing masks both now and in flu seasons throughout the years. Start practicing now. Explain to them the importance at their level. It’s just like covering your cough, washing your hands and not picking your boogers. Just another thing that we have to teach them in order to keep the environment safe for themselves and their classmates.

Should I have my child tested for antibodies to COVID if I think they had it earlier in the year? If they have antibodies will this help protect them when they go back to school? One of my children has special needs and gets sick very easily. I am fearful for him to go back to school but also fearful that lack of socialization for him will be detrimental.

Unfortunately, the accuracy of antibody testing has not been consistently good-some studies have shown that have shown false positive and negatives at a rate of 50%. In addition, we are not sure what antibodies actually confer immunity.

Get to know Justin Smith, M.D.

Justin Smith, M.D., is a pediatrician in Trophy Club  and the Medical Advisor for Digital Health for Cook Children's in Fort Worth, Texas. Dr. Smith is an experienced keynote speaker for a variety of topics including pediatric/parenting topics, healthcare social media and physician leadership. If you are interested in having Dr. Smith present to your conference or meeting, please contact him at

He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” open now. Click to learn more. To make an appointment, call 817-347-8100.

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Kimberly Sheppard
Thank you Dr. Smith for sharing these questions of concern and taking the time to give such honest guidance. I found this very helpful for myself as a parent, as well as very helpful to use with the families I see for counseling. It will be a great reference to use. Thanks again! Kimberly , H/O clinical therapist