“What’s school going to look like in the fall?” “Should I send my child or keep them at home?”

These are the questions that every parent is probably already asking as school districts roll out their plans for re-opening school in the context of continued COVID-19 cases in our communities. Many schools may present the option for all in person, all online or some blended method. And parents will have to consider what works best for their children.

There have been many stressful decisions in regards to COVID, but this might be the most anxiety inducing one for parents so far. School districts realize how stressful this is for parents and are taking steps to protect their students and your kids.

 “We understand that some of our families are anxious about the new school year so we are implementing strict new cleaning protocols for every campus. That means that schools will be cleaned multiple times during the daytime hours rather than in the evening as has been the practice for many years,” said FWISD Superintendent Kent P. Scribner. “We are also making a significant investment in both Personal Protective Equipment--for both adults and children—as well as cleaning supplies for campuses and other FWISD facilities. The good health and safety of our students and employees remains our top priority.”

The Texas Education Agency released these guidelines for school reopening on July 7, 2020:

• Daily on campus learning will be available to all parents who choose that option for their children
• Parents may be asked to commit to remote instruction for a full grading period but will not have to commit until 2 weeks ahead
• Health and safety procedures should be in place for student and teacher safety

In normal times, making a decision about what your child will do for school in the middle of July would seem way too late, but this year it feels way too early.

Each parent will have to make their own decision but here are some things that it would help to consider:

Childcare and Other Resources

First and foremost, it’s important to consider that children attending school is an important part of allowing parents to work and function in society. Parent’s jobs help secure food, shelter and in many cases provide health care insurance that allow children to receive care when needed. Not all parents can work from home, stay productive and keep a job. In addition, many of our children receive their most nutritious and guaranteed meal during the school year through their school lunch. Schools provide many resources to our communities and children beyond education.

Medical

Healthy children, for the most part, are considered to be safe in the school environment. Children have been more or less spared from severe illness but, as with most illnesses, children with chronic medical conditions are at higher risk for severe illness. Parents of children with medical conditions may learn toward keeping their child in the online environment in order to protect them from exposure. In addition to the child, considerations must be made for other household members and extended family members with whom the child might have contact. If the child will have contact with family members who have weakened immune systems, they could bring the virus home despite not having significant symptoms.

School

Examining the policies and procedures of the school will be another important decision point for families. Is the school district taking the recommendations for safety seriously and attempting to implement them consistently? With kids involved, there will be a learning curve but districts should be considering policies in regards to social distancing, mask use and movement throughout schools at a minimum. The evidence suggests that most schools are taking the threat of COVID very seriously but each parent should make that assessment for themselves.

Educational

April and May taught us a lot about how capable our students were of learning in an online environment. While the school districts will be significantly more prepared for teaching online, there are certain kids for whom it was obvious that the online environment was not going to be the right choice for them. Children who receive services and support at school might have a more difficult time adjusting to life at home without that extra help. For others, they struggle to learn online and in-person teaching might be a better fit. In addition to the child’s learning needs, families must consider their ability to support their learner with their existing responsibilities. Teachers and school staff can help, but students at home will often require some, if not significant, guidance from someone in the home. This is especially true for younger students and those with special learning needs.

Social and Emotional Needs

Some kids have thrived in regards to their mental health with the online learning environment. Many children with anxiety in regards to school or formalized testing had significant improvement in their symptoms as they transitioned to at-home learning. Other students and families needed the structure and activity of school in order to maintain a sense of normalcy. The lack of contact with friends, teachers and other school staff affected them in very negative ways. Another consideration should be the child’s level of concern about COVID-19. Children with significant anxiety regarding the virus could anxiety, depression and other severe health and mental health issues.

Decisions regarding going back to school in the fall are complex. Each parent should consider how the effects of being at school or at home would affect their children and consider that as part of their decision.

For more information on this topic, read the recommendations of more than 50 Cook Children’s pediatricians, led by Medical Director of Infection Prevention, who worked to create guidelines for returning back to school. The AAP released similar guidelines that support opening of schools for in person instruction.

It’s likely the plans for each school will continue to change throughout the rest of the summer. Parents should consider the best option for their children and be prepared for disruptions to occur based on local case numbers.

For more on this topic:

• Cook Children's Physicians Create Guide to Help Kids Safely Return to School amid COVID-19 pandemic
• COVID-19 Planning Considerations: Guidance for School Re-entry (AAP)
• Young Athletes and COVID-19: 'When Can My Child Start Playing Sports Again?'
• TEA Issues Comprehensive Guidelines for a Safe Return to On-Campus Instruction for the 2020-21 School Year

The policy statement from the AAP “provides 5 evidence-based recommendations for best practices to optimize safety in passenger vehicles for all children, from birth through adolescence.”

The policy statement from the AAP gives these five recommendations:

1. All infants and toddlers should ride in a rear-facing car safety seat (CSS) as long as possible, until they reach the highest weight or height allowed by their CSS’s manufacturer. Most convertible seats have limits that will permit children to ride rear-facing for 2 years or more.
2. All children who have outgrown the rear-facing weight or height limit for their CSS should use a forward-facing CSS with a harness for as long as possible, up to the highest weight or height allowed by their CSS’s manufacturer.
3. All children whose weight or height is above the forward-facing limit for their CSS should use a belt-positioning booster seat until the vehicle lap and shoulder seat belt fits properly, typically when they have reached 4 feet, 9 inches in height and are between 8 and 12 years of age.
4. When children are old enough and large enough to use the vehicle seat belt alone, they should always use lap and shoulder seat belts for optimal protection.
5. All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection.

Resources For Parents

• Child Passenger Safety Guidelines from AAP
• Vehicle/Car Safety
• The Ultimate Car Seat Guide
• Road Rules for Little Passengers
• Child Passenger Safety Considerations For Organizations Transporting Children

Make sure they get enough sleep.

A new study, published in the Journal of Obesity, found that routines for preschool-aged children are tied to better emotional health and may lower the chances of obesity later.

The American Academy of Sleep, supported by the American Academy of Pediatrics, has released the following recommendations for how much sleep kids, from infants to teens, need based on their age:

• Infants 4 to 12 months – 12 to 16 hours of sleep every 24 hours (including naps).
• Children 1 to 2 years – 11 to 14 hours of sleep every 24 hours (including naps).
• Children 3 to 5 years – 10 to 13 hours of sleep every 24 hours (including naps).
• Children 6 to 12 years -9 to 12 hours of sleep every 24 hours.
• Teens 13 to 18 years – 8 to 10 hours of sleep every 24 hours.

The AAP found that adequate sleep duration for age on a regular basis leads to improved attention, behavior, learning, memory, emotional regulation, quality of life and mental and physical health. Not getting enough sleep each night could mean an increase in injuries, hypertension, obesity and depression, "especially for teens who may experience increased risk of self-harm or suicidal thoughts."

Hilary Pearson, M.D., medical director of the sleep laboratory at Cook Children’s, said parents often set the tone for their child’s sleep patterns.

“One way of protecting your kids’ sleep is protecting your own sleep,” Dr. Pearson said. “Parents should think about how much sleep they get and then recognize how much sleep their children are actually getting. That alone can be very helpful.”

If your child is not sleeping well, Dr. Pearson says most of the time there are simple things that parents can do to make a difference in their kids’ sleep.

“I’m a firm believer in establishing a bedtime and sticking to it. Children who have not reached puberty should be in bed before 9 p.m. Studies show they will sleep better overnight, wake up more easily in the morning and have fewer behavioral problems. A routine that simple could make the difference in whether a child receives good grades at school,” Dr. Pearson said.

At best, the mom is rolling her eyes and pulling her phone out to hand to her screaming child.

“Children under 2 years of age should have no screen time and after 2 years, we should limit screen time to 2 hours per day.”

There is the common summary statement that can be taken out of the AAP Policy Statement on Children, Adolescents and the Media.

Is this realistic?

Is this practical?

Is anyone listening to anything we say?

In May, a meeting of the best minds in the use of media in pediatrics set out to answer these questions as well as look at recent research on the use of screens in children and teenagers.

In order to get information about the meeting out quickly, AAP News released a summary of some of the thoughts that came out of the meeting.

If you read the headlines that were generated as a result of the statement, you might have heard:

“Pediatricians think all screen time is OK. Go for it!”

“Pediatricians finally admit that they were dead wrong and outdated when they said toddlers shouldn’t use screens.”

“Pediatric guidelines now changed to allow for more screen time, at earlier ages.”

Unfortunately, we don’t always get the time to fully explain our message and the media doesn’t always get it right.

Here are my takeaways from the statement that I hope better reflect the intent of the authors:

1. What you might have heard: “Pediatricians think all screen time is OK. Go for it!”

What it should have said: “We need to continue to be careful about the amount of time children are on screens. Guiding them toward quality apps and games that are more than just watching a video is important. Watching and playing alongside your children helps to enrich the experience for the family as a whole.”

2. What you might have heard: “Pediatricians finally admit that they were dead wrong and outdated when they said toddlers shouldn’t use screens.”

What it should have said: “The benefit of screen time for toddlers is an ongoing topic of research but it is clear that children continue to learn best from interacting with and talking to other humans. One of the major risk of screen time is the time take away from rich interaction with parents and other caregivers.”

3. What you might have heard: “Pediatric guidelines now changed to allow for more screen time, at earlier ages.”

What it should have said: “While this statement is not a new guideline, it does highlight the AAP commitment to following new research in regards to screen use and helping to relay that information to parents as soon as possible. As more information comes available, we will update our guidelines to reflect current studies in the context of practical media use for children.

Do continue to follow this debate because the guidelines are likely to change over time. (P.S. That’s what guidelines should do in a new and heavily researched field.)

Don’t go out and buy your 1 year old her own iPad.

Even skilled physicians may not be on the lookout for something as uncommon as CHI in newborns, which could be the difference in preventing irreversible damage and improving the quality of a child’s life.

That may all change following an article published in the Journal of Pediatrics titled, “Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants and Children.”

Paul Thornton, M.D., medical director of Cook Children’s Congenital Hyperinsulinism Center and Endocrine and Diabetes program and an Endowed Chair, led the team of experts from around the world in creating new screening for physicians to recognize and manage neonates at increased risk for a persistent hypoglycemia disorder.

“Infants with uncontrolled hypoglycemia caused by CHI are at risk for seizures or permanent brain damage without early identification and screening,” Dr. Thornton said. “These new guidelines will help physicians who recognize these symptoms shortly after birth and then provide the specialty care which may make the difference on whether this child has a productive and fulfilling life.”

The article states that “failure to investigate a neonate, infant, or child with suspected hypoglycemia increases the risk of delaying a definitive diagnosis and instituting effective treatment.”

But quickly identifying the specific cause of hypoglycemia allows for timely and appropriate treatment to begin and decreases the risk of permanent brain injury from persistent and recurrent severe hyperglycemia.

Dr. Thornton was chosen as the principal author of the article because he’s internationally known in the field of CHI. He leads a highly skilled team of specialized physicians and supporting specialists to treat hyperinsulinism.

Cook Children’s Hyperinsulinism Center is the only one of its kind in the Southern U.S. and the second in the country.

Davelyn Hood, M.D., president of the CHI Board of Directors said her organization “is thrilled beyond words” that long-awaited hypoglycemia guidelines have been published this month in the Journal of Pediatrics.

“We consider this a sentinel moment in time for the entire congenital hyperinsulinism community,” Dr. Hood said. “Many patients born with this congenital HI are discharged from newborn nurseries without adequate study of their hypoglycemia, often with tragic consequences. These guidelines give us hope.”

Dr. Hood said she believes the guidelines will save countless lives and improve the well-being of HI children everywhere. She also praised Dr. Thornton for all of his work for CHI patients.

“He cares for children across Texas and the U.S. with one of only two dedicated Hyperinsulinism Centers in the country,” Dr. Hood said. “He speaks to clinicians around the globe about the proper management of hypoglycemia and leads HI research to better understanding of the disease and best treatment options. Most importantly, Dr. Thornton, brought the HI research community together, took all of their collective knowledge regarding hypoglycemia and its underlying causes, and articulated that into clear guidelines for clinicians of all types that care for neonates, infants and children. Dr. Thornton is a definitely a ‘CHI Super Hero.’”

More about Cook Children's Hyperinsulinism Center

One of only two such programs in the nation Cook Children's Hyperinsulinism Center uses a specialized team approach to treat this rare disease. Hyperinsulinism affects many areas of the body, so to truly treat the disease, each child is seen by top physicians, nurses, researchers and specialists in the field. These medical professionals have spent additional years of intense study and have dedicated their practice to focusing on hyperinsulinism so that your child will has access to the medical care that treats all the symptoms. It is this level of treatment that has helped earn our program a distinguished international reputation for extraordinary care and achieving positive results.