HCN News & Notes

Baystate Pediatrics Chief Offers Back-to-school Tips in the COVID-19 Era

SPRINGFIELD — Time is running out to schedule back-to-school checkups and sports physicals, said Dr. John O’Reilly, chief of General Pediatrics at Baystate Children’s Hospital.

“Pediatrician offices face an influx of calls to schedule appointments and get the proper paperwork completed before the school year begins,” he added. “As pediatricians, we want to partner with parents to help their children be successful students. Are they generally healthy? Will they have any problem seeing the board? Is their hearing okay, so they don’t miss what the teacher is saying? Do they have any attention issues? We want to address all these issues before they enter the classroom.”

As children begin the new school year once again amidst the coronavirus pandemic, most of the country’s schools this year will reopen for fully in-person schooling, but not without a number of safety concerns and questions from parents.

In updated guidance for the 2021-22 school year, the American Academy of Pediatrics (AAP) strongly recommends in-person learning and urges all who are eligible to be vaccinated to protect against COVID-19. Vaccines have yet to be approved for children younger than age 12 and may not be until the end of the year.

For public schools, vaccine requirements are largely left up to states, but none have yet required children to receive the COVID-19 vaccine to re-enter school, according to the National Conference of State Legislatures.

In addition to vaccinations, the AAP recommends a layered approach to make school safe for all students, teachers, and staff. That includes a recommendation that everyone older than age 2 wear masks, regardless of vaccination status.

The AAP recommends universal masking because a significant portion of the student population is not yet eligible for vaccines, and masking is proven to reduce transmission of the virus and to protect those who are not vaccinated. Many schools will not have a system to monitor vaccine status of students, teachers, and staff, and some communities overall have low vaccination uptake where the virus may be circulating more prominently.

“We are starting to see an increase of positive COVID-19 tests, so, based on Centers for Disease Control and Prevention (CDC) data, we can assume that the Delta variant has made it to Western Massachusetts,” O’Reilly said. “This variant is attacking younger patients, and it is making them sicker much faster than the original COVID-19 virus. Studies are showing that the amount of Delta variant in the nasopharynx of an infected individual is up 1,000 times what we saw originally in the pandemic. That means that the cough or sneeze from that infected individual is much more likely to spread the illness to anyone around them. Because of that, we really need to work harder to protect children in school and in our community.”

For young people over age 12, he went on, “vaccination is the best defense, since our current vaccines still protect against the Delta variant. Mask wearing is our best second line of defense, since that sneeze or cough may not leave the infected person’s mask, and if a few Delta particles sneak around the mask, people in the area are protected when they are wearing a mask.”

Dr. O’Reilly continued to note that schools should be using a “layered defense” to protect students. Schools should have in place policies for mask wearing, hand washing, social distancing, cohorting students to avoid large crowds, ventilation systems for indoor spaces, and protocols for testing and removing symptomatic individuals. Parents should contact their school officials to find out what they are doing to protect their child.

The AAP also urges families to call their pediatrician and have children caught up on all vaccines they may have missed during the pandemic. This includes getting a vaccine to protect against influenza, which, like COVID-19, can cause severe illness and death. O’Reilly suggested that parents should check with their child’s doctor, school, or the local health department to learn about the immunization requirements in their state or county.

By state law, children must be up to date on their required immunizations in order to start school. The 2021-22 immunization requirements as listed by the Massachusetts Department of Public Health (DPH) include:

• Two prior doses of measles, mumps, and rubella (MMR) vaccine for entry into any grade level ranging from kindergarten through college graduate studies (including health-sciences students), unless one has documented evidence of immunity to all three infections;

• Two doses of varicella (chickenpox) vaccine for entry into any grade level ranging from kindergarten through college graduate studies (including health-sciences students), unless one has documented evidence of immunity or a history of varicella confirmed by a physician; and

• One dose of Tdap for entry into any grade level ranging from grade 7 through college graduate studies (including health-science students).

The Tdap booster dose — recommended by the CDC for preteens at age 11 or 12 — provides protection against tetanus, diphtheria, and pertussis (whooping cough). Children initially receive protection against these bacteria with the DTaP vaccine, which loses its protective effectiveness over time. As a result, preteens and teens need to get a Tdap booster dose. This is important not only to protect them, but also to protect those around them, especially babies and the elderly.

According to the CDC, all preteens 11 or 12 years old need one dose of Tdap vaccine, one dose of meningococcal vaccine (to help prevent against bacterial meningitis), and two doses of HPV vaccine (for those who get their first dose of HPV vaccine between ages 9 and 14) to be fully protected against these serious diseases. A second dose of meningococcal vaccine is also necessary at age 16. The DPH (via the Massachusetts HPV Initiative) and the CDC continue to urge healthcare professionals to give a strong recommendation for all adolescent vaccines recommended for boys and girls ages 11 or 12, and to recommend HPV vaccine as they would Tdap and meningococcal vaccines.

The AAP and Dr. O’Reilly also offer these tips for the new school year:

• Establish rules and expectations with a built-in routine for each day. Keep bedtimes the same, and limit use of digital devices an hour before bedtime.

• Provide multiple cloth face coverings for your child, and label them so they are not confused with another child’s. Practice putting on and taking off cloth face masks with your child while avoiding touching the cloth portions. Remind your child that they should clean their hands before and after touching their mask.

• Help children take responsibility for their learning. Becoming independent takes lots of practice and developing good habits. Help them create an environment at home that promotes learning and schoolwork. Check in with them and coach them, but they need to do the work and learn how to persevere to accomplish difficult tasks. That is a skill that will help them throughout their life.

• Talk with your child or teen and watch for any signs they need additional mental-health support. Call your pediatrician and school if you suspect your child is having trouble adjusting to new routine or struggling academically.

• Parents will need to be on the lookout for any signs that a child is struggling academically or has learning differences. Contact your pediatrician, who can help evaluate if a child has a learning disability or something else is going on.

Finally, “if your child has asthma or a peanut allergy, or any other chronic condition, we will need to develop an action plan to share with the school nurse,” O’Reilly said. “Paperwork must also be completed for any prescription medications your child may need to take while at school. And make sure the school has an updated list of emergency contacts.”