Dr. Matt Birnholz:
Coming to you from the ReachMD studios, this is COVID-19: On the Frontlines. I’m Dr. Matt Birnholz, and on today’s program, we caught up with Dr. Jennifer Shu, staff pediatrician at Children’s Medical Group in Atlanta, Georgia,, who shared her perspective on how the COVID-19 pandemic has been affecting children physically, mentally, and emotionally.
Here’s Dr. Shu now.
So, there’s a newly recognized condition, which is now called MISC, or multisystem inflammatory syndrome in children, which shares some similarities with Kawasaki Disease but also has some important differences. What’s being reported is that MISC has symptoms such as fever, shock, GI distress, such as abdominal pain, diarrhea, sometimes vomiting, in addition to conjunctivitis, oral findings such as a strawberry tongue, a rash, particularly on the extremities, as well as laboratory abnormalities including an elevated CRP and ESR, increased neutrophils, low platelets, and lymphocytes. There’s also an association with COVID-19 in that the patient might have a positive PCR or antigen study, positive antibody, or simply exposure to somebody who had COVID-19 or suspected COVID-19 within the past several weeks. Another difference between MISC and Kawasaki Disease is that MISC tends to affect older children, whereas Kawasaki tends to be under about 5 years of age. And there seems to be more of a predominance in African American children for MISC, whereas Kawasaki may be more likely to affect children of Asian descent.
On the plus side, I’ve seen a lot of my patients, especially teenagers who have really actually done better from an emotional standpoint once the pandemic started. One of the reasons for that is some of the pressures they had with really intensive school schedules or after-school extracurricular activities were wearing them out. And so all the sudden having to slow down and do virtual learning kind of took some of those time pressures off of them. So many teenagers, at first at least, were saying that this is much, much easier for them. They were getting much more sleep, they enjoyed being home with their families; these are things that they weren’t doing enough of beforehand. The younger kids have also seemed to like having their parents home, but unfortunately what I’m finding is that a lot of these parents are also trying to work at the same time as taking care of children, meeting their basic needs, such as feeding and cleaning the kids, but also needing to supervise them and making sure that these children are safe. And so, all the sudden parents are in a dual role at home where they’re having to both work and care for the children at the same time. I do notice that some of these children, preschoolers mostly, have become more clingy and don’t want the parents to leave. They are so used to having a parent around that some parents report to me that even if they’ll leave one room to go to the next room, the child may be anxious. And I’m noticing more kids with some sleep problems where they don’t want to sleep by themselves, either. So there’s definitely some anxiety that we’re seeing at all ages, but for my patients in particular it seems to be the preschool set. Fortunately, our patients’ pediatricians are always available to counsel as needed. And, in addition, at least in my area, we have psychologists who are doing virtual visits and able to –help consult with these families virtually to get the help that their children need emotionally and mentally. Regarding immunizations, there are studies recently that have shown that since the beginning of the year, immunization rates for children have gone down. The problem with this is that if we go below a certain level and lose the protective herd immunity that we’ve had for vaccine-preventable illnesses, then some of these illnesses will start to come back, especially once kids start returning to school, daycare, camps, etcetera. And these include things like measles, mumps, pertussis, and then in the future we have the challenge of what’s going to happen once flu season starts back up again. So, the American Academy of Pediatrics has a campaign encouraging patients to keep up with their well-child visits and keep up to date with their immunizations because of the importance of maintaining our children’s health. The AAP also has a new campaign called “#callyourpediatrician,” just to remind families that our pediatricians are still open and available to patients, whether that be in person or virtually.
Dr. Matt Birnholz:
That was Dr. Jennifer Shu explaining the physical, mental, and emotional tolls of the COVID-19 pandemic on our younger patients.
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