The rising number of COVID-19 cases in North Texas is due to the delta variant, which is more contagious than other strains of COVID-19, and a significant number of unvaccinated people. With Texas doing away with virtual learning this school year and the COVID-19 vaccine not yet available for those under 12, many parents and children are understandably feeling anxious.

Amanda Jordan, Psy.D., a licensed psychologist at Cook Children’s Alliance, can relate. She has a child starting kindergarten in the fall and is experiencing similar feelings.

“I want parents to understand you can’t take care of others if you don’t take care of yourself first,” Dr. Jordan said. “You have to check in with yourself first to see how you’re feeling because you don’t want your children to pick up on your negative energy.”

As for parents, Dr. Jordan says it is important to engage with other parents, make sure to create and maintain their own schedule, talk with their partner/spouse and seek professional help when necessary.

Dr. Jordan says once parents have worked through their anxiety, it is good to start preparing children for their ‘new normal’ as early as possible. She says it’s important to pose open-ended questions such as, “I wonder what your first day will be like?” or “I wonder who your teacher will be this year?” These types of questions allow your child to open up about how they’re feeling and can lead to other questions or concerns they may have.

Dr. Jordan also stresses the importance of establishing a routine as school beings again because many children have been off of their schedule for more than a year. This routine includes bedtimes, meal times, changing eating habits, etc.

“There has been so much flexibility with virtual learning,” Dr. Jordan said. “Children have been going to bed and waking up later than normal, and could do their work at their own pace.”

She says starting a ‘school year’ routine before school officially starts can help ease some of the anxiety on the parents and children.

Another technique Dr. Jordan recommends to parents is called ‘Name it to tame it.’

“It is important to help children put a name on their feelings,” she said. “As parents, we want to fix things and say things like ‘don’t be scared’ or ‘you’re going to be fine,’ but you must validate their feelings.”

Dr. Jordan says to respond to children by validating their feelings and letting them know you understand how they feel and let them know they always have a safe space to express their feelings.

Along with the anxiety of returning to school, medical professionals at Cook Children’s are also getting questions about children wearing masks in the classrooms. Alice Phillips, M.D., a Cook Children’s pediatrician at Cook Children’s Cityview says she stands behind the recent recommendations from the American Association of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC), that all children K-12 should wear masks in classrooms this school year.

“I believe children need to be in school for their social skills, mental health, and other key personal connections,” Dr. Phillips said. “I recognize it’s a hot topic, but for students to stay in school without shutdowns or quarantines, we must do it safely.”

Dr. Phillips says the new delta variant is spreading rapidly in our unvaccinated population. At Cook Children’s we have seen a rise in the number of children testing positive for COVID as well as an increase in the number of children being hospitalized. For this reason, she believes it is even more important to make sure all children have masks on in the classroom, no matter their vaccination status.

“Parents have to begin modeling mask-wearing behavior at home, and support their children if they feel pressured to do otherwise by their peers,” Dr. Phillips said.

To prepare children to wear masks in the classroom, she says it’s important to explain to children the reality of doing ‘hard things,’  for our friends and communities. Equally important is providing encouragement to children when they're doing the right thing.

“I understand that it’s hard to be brave sometimes,” Dr. Phillips said. “The best we can do is encourage, support, and validate children’s feelings and let them know the ‘why’ behind masking and the importance of keeping themselves and others safe.”

Dr. Phillips says her advice to all adults is to get vaccinated and be an example. She advises all adults to wear a mask when they are in the grocery store and other public settings as recommended by the current CDC guidelines, 

“If parents are vaccinated and their children are not, I still advise the entire family to mask up to support the child and protect them,” she said.

If you have any questions about preparing for your children to head back to the classroom or need guidance for masking, contact your child’s pediatrician.

Read more about preparing for the upcoming school year here:

Cook Children's 10-Point Guide for Safely Reopening Schools

Should My Child Wear a Mask to School this Fall? 

1. Make sure all children are up to date on the routine childhood vaccinations needed for school entry. Access to medical offices, fear of leaving home and of waiting room exposures, and closed schedules of weary medical providers taking long-awaited vacations could result in a drop in vaccination rates against measles, mumps, rubella, pertussis, and the bacteria causing meningitis. A slight drop in vaccine coverage for measles, pertussis, and mumps translates quickly to a loss of herd immunity and outbreaks of serious, vaccine-preventable illnesses.

2. Revisit the latest masking decisions in light of the recent surge in COVID-19 cases. The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) advocate for masking in schools, especially in areas with moderate to high transmission of COVID-19. Follow guidance from your local health department which will be in line with the current state of the pandemic and regional community health recommendations.  We have learned during the pandemic that most children, 2 years of age and older, can wear a mask.

3. Encourage COVID-19 vaccination of all eligible children and adults. COVID-19 efficiently spreads from adults and teenagers to younger children, not often the reverse. The key to keeping schools open during the COVID-19 pandemic is getting unimmunized parents and all eligible family members vaccinated.

4. Arrange for mobile COVID-19 vaccination units to be present during orientation and events such as 'meet–the-teacher' nights. Gains in U.S. vaccine acceptance are likely to come amidst the group of people who don’t have a solid reason to avoid vaccination. Surveys reveal that most of these people were hoping that the pandemic was wrapping up and that they would not have to take a risk by taking an “untested” vaccine. They are reasonable people who describe themselves as cautious, slow adopters of things that are new. Most are not necessarily opposed to vaccination philosophically. They were just hoping to wait out the pandemic while relying on social distancing, masking, and herd immunity to keep them from having to getting a vaccine. With the loosening of restrictions and the surge in cases due to the Delta variant, many are now ready to stop holding out.

5. Continue to utilize strategies promoting social distancing in the classroom (by using partitions, separating desks, and cohorting of student groups), during passing periods (by keeping them short to discourage standing around in small groups and conversing), and during meal times (by moving meals outside in the fresh air, limiting line length for meal service, and by observing social distancing).

6. Re-enforce good hand-hygiene practices and cleaning of shared workstation areas with demonstrations that highlight effective hand hygiene and disinfection techniques.

7. Quarantine unvaccinated children and school staff members exposed to COVID-19 per CDC guidance. Vaccinated exposed persons may still get sick with COVID-19 and could be contagious, though their risk of hospitalization and severe disease is extremely low. Quarantine exposed, vaccinated persons if they develop symptoms of COVID-19 until testing results are available.

8. Provide interactive and technologically sound, distance-learning alternatives for immunocompromised students who should not be in the classroom during the pandemic.

9. Encourage precautions for bus riders like masking and opening windows to promote adequate ventilation and reduce the transmission of COVID-19 while traveling to and from school.

10. Above all, send recurring reminders to parents not to send ill children to daycare and to school. Many parents are returning to the workplace for the first time in over a year. They may be experiencing pressures to be physically present, rather than staying home with an ill child. Memories are short when pressures are high. However, we are still in the midst of a global COVID-19 pandemic that has already claimed the lives of more than 600,000 people in the U.S.

In an interview with WFAA, pediatric infectious diseases physician Nicholas Rister, M.D. said, “We are seeing more numbers, which means we're seeing more sick kids, and the expectation over the next coming weeks and months is that we'll likely see more of that.” 

Dr. Rister advises parents to watch out for the typical symptoms of COVID-19, including fever, cough and shortness of breath, as well as gastrointestinal or abdominal symptoms, which “can be pretty prominent.” 

“It's not that adults can't have that, but we do have a fair number of kids who primarily present with like, 'my stomach hurts or I have diarrhea,'” Dr. Rister explained.

North Texas medical experts continue to encourage people to get vaccinated.

“For the kids that are old enough to get the vaccine, we're highly recommending that. We're asking people to be aware that COVID still exists,” Dr. Rister said.

According to the DFW Hospital Council, there are currently 605 COVID-19 hospitalizations in the 19 county region known as TSA-E. 

The highest numbers are as follows: 

• TARRANT = 222
• DALLAS = 173
• COLLIN = 96
• DENTON = 25

Read the entire story here.

Dr. Terk routinely addresses questions and concerns about the vaccination, which the Centers for Disease Control and Prevention (CDC) recommends for everyone ages 12 and older. He wants parents to understand the vaccine is safe and effective against the virus that causes COVID-19. 

“It’s an exciting time to be able to provide protection against the pandemic virus for the younger population,” said Dr. Terk, who treats patients at Cook Children’s Pediatrics at Keller Parkway. “I’m encouraging my families to get that done as soon as possible.”

The U.S. Food and Drug Administration has authorized the Pfizer-BioNTech vaccination for children as young as 12 years old, who receive the same dosage as adults -- in two shots, three weeks apart. Potential side effects include pain at the site of the injection, tiredness and headache.

Cook Children’s has teamed up with Texas Health Community Clinics to provide the Pfizer vaccines at clinic locations throughout the North Texas region. Appointments may be made but aren’t necessary. There is no cost.

Dr. Terk, who is also the chair of the Texas Public Health Coalition, pointed out that some families in 2020 delayed their children’s scheduled checkups. The summer break from school provides a good opportunity to receive not only the COVID-19 vaccine but any overdue vaccinations, such as Tdap (tetanus, diphtheria, pertussis). The COVID-19 vaccination may be given along with other vaccines that adolescents need.

“We have a backlog of people who didn’t come to the doctor because of the initial concerns about safety at the beginning part of the COVID-19 pandemic, and so we’re still in the process of catching people up,” he said. “We want to try to leverage this time to get these things done.”

Some children who are infected with the coronavirus show symptoms at all. Others can experience fever, cough, nausea, sore throat and body aches. While children generally do not get as sick from COVID-19 as adults, in rare cases some kids become severely ill or even die. Recent news reports have also zeroed in on the Delta variant of COVID-19, which was first detected in India. According to the CDC, it now accounts for 6% of all infections in the United States. The Delta variant is highly transmissible and may be associated with more severe disease.

At Cook Children's, the seven-day rolling average of COVID-positive tests has fallen from 170 daily in January to fewer than 20 per day, or 1%. Dr. Terk called the trend good news across the United States but subject to new variants that seem to spread easier and cause more severe symptoms in younger people.

In a report released June 4, the CDC noted a rise of adolescents hospitalized primarily for COVID-19 in April – lower than the peak in January, but higher than in March. Risks in these severe cases include the need for intensive care admission and mechanical ventilation. “Highly effective COVID-19 vaccines are now available to adolescents as an additional evidence-based prevention measure,” according to the CDC.

Dr. Terk discusses the vaccine with all of his patients who are eligible for the immunization, and with the parents of every child who comes to his office. He urges teens and adults alike to get vaccinated soon. The responses vary.

“I just saw someone today who is a 12-year-old who affirmatively said on the very first day that the authorization came out ‘I want to get this done. I want to do my part.’ She was motivated,” he said. “Then you have other 12-year-olds and 13-year-olds who look at it as another shot to try to avoid just because it’s a shot.”

For those who respond with hesitancy or objection, Dr. Terk explains what he described as the appropriate development and testing of the vaccines. His message: Vaccine manufacturers proceeded rapidly but cautiously without cutting corners. Dr. Terk also shares the data on the vaccine’s track record of success against the spread of coronavirus and severe cases of COVID-19.

These conversations take place at the pediatrician’s office because Dr. Terk wants families to make informed decisions. A parent’s choice to receive the COVID-19 vaccination helps protect young children in the home, he tells them. Sometimes, he said, a reluctant or undecided candidate for the vaccine just needs a little nudge.

“Most people who have not gotten the vaccination and don’t intend to are not militantly anti-vaccine people. They simply have real concerns and questions,” Dr. Terk said.

More than 170 million Americans have received at least one dose of the COVID-19 vaccine, according to the CDC. In rare instances, the Vaccine Adverse Event Reporting System has received reports of myocarditis (inflammation of the heart muscle) particularly in adolescents and young adults. But to Dr. Terk and other promoters, the overall benefit from the vaccine far outweighs the risks, which he called “infinitesimal.”

Plans are underway to pilot a COVID-19 vaccine clinic at two Cook Children's pediatrician offices later this month. Dr. Terk encourages his teenage and 12-year-old patients to access the vaccine at pharmacies, clinics or wherever it’s most convenient.

“We are seeing wonderful rates of protection,” Dr. Terk said. “We now are millions of doses down the road and seeing a very, very good safety record.”