Dr. Karl Neumann's KidsTravelDoc
A pediatrician's guide to travel and outdoor recreational activities
When will your child be vaccinated against coronavirus?
December 3, 2020. Vaccinating your children against the COVID-19 virus will not take place “anytime soon,” says Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases.
1. The COVID-19 vaccine has yet to undergo trials in children. “Only after there is sufficient safety and efficacy information regarding COVID-19 vaccines in adults will trials begin in children.” Barring unforeseen events, such trials will commence in a few weeks. Hopefully, having a vaccine for children “anytime soon” means that it will be readily available by the onset of the 2021 fall schoolyear. Generally, trials in children start with children ages twelve and older. Experiences with previous vaccines show that children react well to vaccines that have been proven successful in adults, sometimes with lifelong immunity.
2. The vaccine trials in adults show “almost ideal” results. Because of new technology and know-how, trials in adults have been successful in a matter of months instead of years. Some COVID-19 vaccines produce protection in about 95% of recipients, have few and only mild side effects, and appear to be effective in older adults, a group in whom many vaccines produce poor immunity. Additional COVID-19 vaccines are in the pipeline. One vaccine may not only protect but also prevent asymptomatic carriers from spreading the infection. Asymptomatic carriers, some of them children, appear to be a significant conduit for spread.
3. If children are not added to research trials very soon, there will be a significant delay in when they are able to access a potentially life-saving vaccine. A million-plus American children have been infected since the onset of the pandemic. Moreover, children have suffered in numerous ways: disruptions to their education, harms to their mental and emotional health, and diminished access to critical medical services, for example. Still unknown are possible long-range effects. Already there have been a small number of cases of catastrophic multi-organ failures in children. Such cases may occur months after the COVID-19 infection.
4. Generally, vaccine trials with children take longer than with adults. Issues needing answers include the lower age limit where vaccines become safe and effective. That age can vary from infancy to teenagers. Adult doses may require adjustments for children’s age and weight. And numbers of doses and intervals between doses may affect optimal immunity more in children than adults. Trials typically start with older children and work their way down to infants.
5. The positive experience with adult COVID-19 vaccines trials bodes well for trials with children. Technology and know-how are similar. Vaccines safe in one age group are generally safe in others. Also, the excellent safety record in adult trials plus the terrible toll of illness and deaths from the virus will encourage parents to volunteer their children. The larger the number of volunteers, the sooner necessary data are assembled.
6. COVID-19 cannot be defeated without vaccinating children, says the US Centers for Disease Control (CDC). Even in the midst of the COVID-19 pandemic, only half of adults say they will “probably” or “definitely’’ take the vaccine. Less than half of adults take other CDC-recommended vaccines. Experience has shown that the number of adult cases of a vaccine-preventable disease drops significantly only when the vaccine is included in pediatric vaccination programs. Children are a “captive audience.” Generally, they need vaccines for school entry.
7. Hopefully, most parents will accept yet another childhood vaccine. Present vaccine schedules require children to have dozens of doses of various vaccines by school entry. A small but growing number of parents are “anti-vaxxers.” They believe that vaccines are unnecessary or harmful, that diseases disappear spontaneously or are only minor inconveniences, that too many vaccines overpower children’s immune systems making children vulnerable to other illnesses, or that vaccines are plots from rogue government agencies to control children’s minds.
8. In fact, worldwide, vaccines save millions of lives annually with virtually no known downside. The World Health Organization (WHO) has named “vaccine hesitancy” as a top threat to global health. (Some years ago, health experts named “vaccines” as a top advancement in modern medicine.) There is no evidence to substantiate anti-vaxxers theories. Moreover, parents who don’t vaccinate their children benefit from those that do; the fewer unvaccinated children there are, the lower the risk that anti-vaxxer’s children will become infected.
9. Anti-vaxxer’s computers are revved up to sow doubt about COVID-19 vaccines. On social media, the number of pages opposing vaccines far outnumbers pages promoting them. The message: COVID-19 vaccines are based on science never used before and need further study, but is being “green-lighted” for political reasons. Not so, says Dr Fauci. Fast-tracking is not skimming. The technology that made the COVID-19 vaccines available in record time also enables government oversight agencies and peer review committees to better oversee vaccine development.
10. For your information. Vaccinating children against COVID -19 may be further delayed if children receive low priority for vaccination. Other groups, health care workers and the elderly, for example, are more vulnerable to serious consequences from the virus. Early shortages of the vaccine may cause additional delays. Also, children may require more than one dose given a month or more apart to acquire optimum immunity. And immunity may not occur until several weeks after the final dose.
Note: You may find a related artcle of interest; schooling during the COVID-19 pandemic
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Schooling during the COVID-19 pandemic: The facts
(November 18, 2020. Hi Reader: We’re devoting this edition of KidsTravelDoc to help you cope with an important aspect of the COVID-19 pandemic: elementary schooling. Hopefully, we’ll soon return to our main – and more pleasurable – topic: helping you to keep families healthy, safe, and comfortable for travel and fresh air activities. )
1. When reading about COVID-19, note the date and source of the material. Also note the frequent use of words such as “likely” and “probably.” We don’t know as much as we would like to know about this pandemic. And what we do “know” can be outdated overnight. Moreover, some “experts” lack “expertise,” with opinions based on emotions and politics, rather than on science. (All our information comes from the US Centers for Disease Control, the World Health Organization, the American Academy of Pediatrics – accepted “best sources available.”)
2. Transmission of COVID-19 in schools may be less common than initially feared. That thinking was largely based on data concerning the influenza virus. Experience is showing that school-based transmission of COVID-19 is far less common than with influenza. Each virus has its own “personality.”
3. School closures may not have to be a foregone conclusion. This is particularly true for elementary school-aged children who appear to be at low risk of infection. Closures alone may be insufficient to halt epidemic spread and have only a modest overall impact on infection rates compared with broader, community-wide physical distancing measures. However, traditional schooling may not be an appropriate option in communities where the virus is spreading rapidly. Local public health professionals must make decisions.
4. As of November 12, 2020, in the US, just over one million children tested positive for COVID-19 since the onset of the pandemic. In the one-week period ending Nov. 12th, there were 111,946 new cases in children, which is substantially larger than in any previous week. However, these numbers are not necessarily alarming. They are mainly due to an increase in the number of children being tested. (In the US, the definition of a “child” in regard to COVID-19 varies state by state, from 0-14 years to 0-20 years.)
5. Children are infected far less often than adults. More important comparisons are the percentage of infected children that require hospitalization (only about 2% of adult admissions), rate of admissions to intensive care units (one in three hospitalized children), and deaths (extremely rare in children and usually only in children with serious underlying conditions). Overall, the risk is low, but not negligible.
6. Children most frequently acquire COVID-19 from adults, rather than transmitting it to them. And children are generally not the individuals who bring the virus into households; adults generally do. Limited information indicates that teachers are unlikely to become infected by young children. However, this may not be the case for teachers with predisposing health issues.
7. The consensus among educators and parents is that remote learning is a poor substitute for in-person schooling. This is especially true for children in the early elementary school grades. Remote learning seems to slow the development of social and emotional skills, eliminates schools as safe places while parents are working, and keeps many children from having healthy meals and access to the internet, to mention just a few.
8. A COVID-19 vaccine for children is NOT “just around the corner.” The vaccine most advanced in development is being studied only in adults, not in children. Likely, this vaccine, in adults, will require two doses given several weeks apart, and then require more weeks until it provides optimal immunity. Only then will it be considered for children and probably only after more testing, to establish lower age limits of effectiveness, for example. Furthermore, the most promising drug to treat COVID-19 infections has a tentative lower age limit of 12 years.
9. The risk of infection for children in school settings can be reduced with simple measures. Improving air circulation, for example, by keeping windows and doors open. And placing desks all facing in the same direction rather than sitting children around tables. Three feet (one meter) of separation of desks may be sufficient to minimize spread. Other measures include having teachers, not children, move from classroom to classroom to avoid crowding halls and stairways, and having children eat lunch at their desks.
10. For your information: Becoming infected with COVID-19 by touching virus-contaminated objects and then placing ones’ fingers in ones’ mouth/nose – common habits among children – are uncommon means of spreading the virus… The necessity of storing and transporting the vaccine currently furthest in development at extremely low temperatures will likely delay the widespread availability of that vaccine… Children, like adults, should be isolated for two weeks after being in close contact with individuals testing COVID–19 positive – regardless whether that contact individual has symptoms… Close contact is generally defined as being within six feet (two meters) of such a person for at least 15 minutes, whether or not that person was wearing a mask.
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Keeping the “amusement” in children’s amusement park rides
Family visits to amusement parks, fairs, and carnivals sometimes include an unanticipated ride – to an ER. In the US, ERs see about 25,000 such visitors yearly, with young children accounting for more than a quarter of them. About one percent of these kids require hospitalization. Moreover, space-age rollercoasters injuries may have serious after-effects.
1. Parents are the ultimate safety inspectors. Most accidents are preventable. While you’re there to “please”’ your children, never let them “please, please” you into letting them on rides not suited for them. In the US and many other countries there are no federal mandatory safety standards for rides. And the oversight from local government often is murky. Be especially cautious of rides at small, seasonal parks, more so for rides that are frequently dissembled and moved.
2. Obey posted restrictions. Operators of rides base safety regulations on standard height and weight tables, not considering the great variability in size of children at a given age, and not considering children’s maturity and impulsivity. Children younger or smaller than posted limits can slip out of restraints; those older or bigger can overload rides. On rides that use single lap bars for multiple riders, the bars fit closely only against the largest passenger in the car, allowing smaller riders to stand up or slip out under the bar.
3. Match rides to your child’s temperament. Don’t coax children to try rides if they are reluctant to do so. Children who have queasy stomachs may become ill on merry-go-rounds and rollercoasters. Children have been injured when falling leaving rides that made them dizzy and nauseous. Vomiting ruins the day. Instruct children to sit down on the ground when feeling unsteady and to wait for assistance. Excessive darkness and scary scenes may frighten children, causing them to act irrationally, placing themselves and others in danger.
4. Observe rides before allowing children on them. And allow olderchildren to do so. If rides are not visible, check if there are posted descriptions and safety instructions, or ask operators. Are there sudden sharp curves or ups and downs? Can the ride be stopped if a child becomes unruly or overly frightened? Are the children exiting the ride content or staggering? Are operators friendly, attentive and helping children on and off?
5. Check “kiddie” rides. These rides move slowly, have no ups and downs or sharp curves, and are safe for seated, cooperative toddlers. However, many rides have inadequate safety restraints. Some toddlers are unpredictable and impulsive, and may become “spooked’ for no apparent reason. They may get up during the ride, fall out, or become entangled in inappropriate safety devices.
6. Instruct children in safety. Tell them not to clown, to keep arms and legs inside, to hold on tightly with both hands, and not to stand up until instructed, never before reaching the unloading platform. If they become frightened, they should stay seated, close their eyes, hold on tight, and, if they wish, scream out loud. They should not attempt to retrieve objects they drop.
Children having fun on trampoline 7. Be wary of trampolines, “bounce houses” and inflatable slides. The numbers of injuries on such rides would be labeled an epidemic were they illnesses, says the American Academy of Pediatrics. Falling off, crashing into other children, or jumping incorrectly can result in strains, sprains, and potentially serious head and neck injuries. Trampolines should only be used in supervised programs, with safety guidelines strictly followed. Also, zip lines are soaring in popularity, resulting in several thousand ER visits yearly, with children younger than 10 years of age accounting for almost half of injuries.
8. Know your rollercoasters. Many recently built ones reach speeds in excess of 100 miles (160 kilometers) per hour, have precipitous drops of more than 300 feet (91 meters), accelerate from top speeds to near standing in seconds, make hairpin turns, and include stretches where riders are suspended with heads dangling downward. (Currently, the world’s fastest rollercoaster is in Dubai, United Arab Emirates, reaching speeds of 149 miles (239 kilometers) with sheer drops of 400 feet (121 meters). The fastest rollercoasters in the US go about 120 miles (194 kilometers) per hour with sheer drops greater than 300 feet (91 meters).
9. Can modern roller coasters cause lingering brain injuries? Possibly, say neurologists. There are about a dozen reports of individuals, including children, experiencing stroke-like symptoms soon after such rides. The rollercoaster’s maneuvers create gravitational forces sufficiently vigorous to vibrate brains back and forth against skulls, possibly causing bleeding into the brain. Posted minimal height limits for rollercoasters generally allow four-year-olds to go on tamer rides and children of eight or nine years to ride on the “thrillers.”
10. Additional Tips. Prepare children for getting lost. See http://kidstraveldoc.com/preparing-your-children-to-becoming-lost… Scarves and other loose clothing may get caught in safety equipment… Tie down very long hair… Avoid footwear that can fall off… Large meals before rides favor vomiting… Chewing gum and sucking candies can cause choking… Are older siblings and grandparents sufficiently safety conscious to chaperone your younger children?
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Preparing your children for becoming lost
Chances are, it will happen – possibly at a mall, airport, “amusement” park, or during an outdoor excursion. While virtually always you and your child will be reunited, usually in a matter of minutes, being lost is an extremely frightening experience for all involved, remembered for a lifetime.
1. Prepare children for what to do if they lose sight of you. Avoid the word “lost”; it seems to scare them. Children tend to panic when they don’t see you while in unfamiliar surroundings. And they usually run as fast as they can in whatever direction they happen to be facing, complicating your retrieving them.
2. Teach them to remain where they are. Tell them that you will be right back. Suggest that they hug a tree or lamppost or sit down on the ground, enabling you to retrace your steps. Teach them “Freeze,” a game in which children run about until a designated caller yells, “Freeze!” The children stop in their tracks and remain in place until someone gives the all-clear signal, in this case you reappearing.
3. Or tell them to approach “another mommy” (a woman with a young child). Mommies are easily identifiable and relatable. Approaching security personnel, lifeguards and police officers is obviously OK, but such people may be more difficult for them to feel comfortable with.
4. Try not to frighten children when speaking about “becoming separated.” Intermingle your message with mentioning the fun they’ll be having wherever you are going. Tell them that sometimes you, the parent, can become separated from them, and that if that happens you will return promptly. Don’t scold them when you find them. Use the situation as a teaching opportunity. Discuss what you and they did wrong to have created the predicament.
5. Envision situations where separations can occur. Elevators are one example. Children run into elevators as soon as doors open, and the doors may close before you get in. Children should hold your hand when entering. Should they find themselves riding alone, they should remain in the elevator until it returns to your floor. Otherwise, they usually get off as soon as the door reopens, often on another floor. You pressing the elevator button will return the elevator to your floor eventually.
6. Pin identification tags with your cell phone number to the child’s outer clothing. Law enforcement officials say such identification speeds reunions and in no way encourages abduction. Random abduction of children from public places is an extremely rare occurrence, says the FBI, and is nearly always committed by a disgruntled family member. Stories that abductions commonly happen in crowded venues are untrue.
7. Place a leash on toddlers. You may get disapproving stares and sarcastic remarks from strangers. Leashes are especially helpful for controlling active children or when you have multiple toddlers in your care. See KidsTravelDoc/Leashes. Said one mother, “I became a ‘leasher’ when seeing terror in the eyes of my three-year-old when the police reunited us, at JFK Airport in New York. It put a serious damper on our Italian vacation.”
8. For older children, check that they understand where you will meet them. They may not be listening when you tell them, especially if they are excited about the place you are visiting. Write down the meeting point and see that they put the paper into their pocket. Check out the meeting point. Stores and arenas may have more than one exit. Landmarks change from one visit to the next. Many amusement park rides and restrooms have exits not in view from the entrance. Cell phones are invaluable for helping older kids reunite after becoming separated.
9. Report missing children to security officials immediately. Don’t spend time searching alone. Alert strangers to your predicament; it instantaneously increases the size of your search party. Most public places have protocols for missing children alerts, including security personnel with two-way radios and surveillance cameras. Report back to security when you find your child. Dressing children in items that stand out in crowds helps find them. Once they are dressed for the day’s outing, take a picture of them to show security personnel.
10. Additional tips. Simple-to-use electronic surveillance systems to monitor children are available at many amusement parks, on cruise ships and at large resorts… Supply children with whistles, where appropriate… Waterfronts are especially important locations for vigilance… Question whether teenagers are sufficiently mature before letting them chaperone younger ones… Make it a memorable, festive occasion when you become reunited with your child.
Getting kids to walk and hike: A primer
Hey parents. While you already know that family walks and hikes make your family healthier and help build closer relationships, do you know how far, how fast, and for how long you can expect kids at various ages to go – without choruses of “I’m tired” or “This is boring”? And how to motivate them to go farther? Or how much backpacks should weigh in proportion to a child’s weight?
1. Start kids walking before they can walk. Carry them on your back, so that you can hike and get them used to the outdoors. Start when they are about six months of age, a time when they can hold their heads up. Check that you have an infant carrier comfortable for you and appropriate for the infant’s age and size. When walking, watch for branches and bushes. Protect their eyes from the sun, especially in snow country.
2. For toddlers, don’t bother trying to predict what they will do. (Toddlers are defined as being between one and three years of age, after which they become preschoolers.) Let them walk as long as they like; no need to limit them. Let them set the pace and direction – which may be slow and in circles. The first few times you go “hiking,” stay close to your house or car. You may hear, “Carry me!” at any time and, possibly, repeatedly. Don’t go farther than you can easily carry them back.
3. Get toddlers out of their strollers and away from their screens. Many young children in strollers watch screens, get no exercise, don’t interact with the family, and are unaware of their surroundings. Current recommendations: no screen time for children less than two years of age and one to two hours a day, preferably quality programming, for children older than two.
4. Most four-year-olds will walk one mile (1.6 kilometers). A rule of thumb: motivated kids will walk/hike one additional mile for each year over four, i.e., three miles (4.8 kilometers) for a six-year-old. However, factor in their physical fitness, past experience in walking/hiking, the difficulty of the terrain, and weather. Compliment them on their achievements.
5. Keep them motivated. Let them help you pick out snacks for the walk/hike and tell them about what they will see en route. Call for rest stops when you see them dragging and losing interest. Do so before they complain. Let them lead the family. Alternate leaders if there is more than one child. Plan a picnic en route.
6. Choose interesting, age-appropriate routes. Kids are rarely impressed by historical sites and scenic landscapes and prefer picking flowers to viewing them. They tend to like waterfalls, lakes (especially ones with ducks in them or into which they can throw stones), and rocks on which they can climb (safely). Ideally, choose routes with attractions close together so you can entice them on with something interesting just ahead. Point out animal tracks and burrowing holes, anthills, and birds’ nests, for example.
7. Provide young kids with backpacks. Wearing backpacks makes them feel part of the group. For toddlers, it doesn’t matter what they carry – a light toy, a small water bottle, their favorite snack, or nothing. For older children on serious hikes, backpacks should weigh no more than fifteen percent of body weight, less for tough terrain, first time hikers, and extremes in temperatures. (This limit applies to school backpacks too.)
8. Keep kids well hydrated and well fed. Loss of stamina occurs before thirst sets in and drinking is especially important in hot and humid environments. Encourage them to drink. Carry drinks they like. For children of all ages, even on fairly strenuous hikes, plain water is adequate. Energy drinks and electrolyte solutions are unnecessary. “Trail mixes” consisting of dried fruits, nuts, grains and chocolate are popular and readily available. Such mixtures provide energy, taste good, are lightweight, and are easy to carry, store, and eat.
9. Teach young children to “hug-a-tree” if they lose sight of you. (Don’t use the word “lost.” It scares them.) If children lose sight of you, typically they start running in the direction they happen to be facing, greatly complicating reuniting. Supply preschoolers with whistles, when appropriate. Check into the many electronic gadgets now available to keep track of children.
10. “Green” outdoors may be the best outdoors. While you should walk/hike wherever you can, doing so around trees, grass and plants may be more beneficial than doing so amid buildings, concrete and traffic. Wilderness is the ultimate outdoors.
Additional tips. Allow kids to bring a friend along. (Adults are boring, friends are cool.) Expensive and sophisticated footwear and clothing add little to the kind of walking/hiking that young children do. Keep a list of supplies to carry: insect repellent, sunglasses, sunscreens, sun hats, extra clothing, a small first aid kit, and a cellular phone that works where you will be hiking.
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Placing leashes on children: Wise or other-than-wise?
To leash or not to leash children is an oft-raised question. Is it truly nobler to spurn leashes and, perchance, your child will do no wrong? Or is it far wiser to leash them, and avoid a sea of troubles, but suffer the scorn of outraged strangers and the humiliations parental guilt is capable of self-inflicting? – William Shakespeare (updated and misquoted)
While the use of leashes on children seems to be declining, the subject continues to be of great interest. Type “children-leashes” into Google and up come 48 million responses, mostly from parents, educators, pediatricians and psychologists. Many responses are detailed and passionate. Here are some representative ones:
Don’t use the word ‘leash’. Call it a harness, halter, tether – or even an umbilical cord. These sound more humane.”
“Expect strangers to elbow their companions, point a finger in your direction and smile. Expect other strangers to frown in disbelief, with an occasional one telling you, ‘I leash my dog, you leash your kid’ or ‘Next, you’ll teach your child, sit, stay, roll over.’ Say ‘thank you for your advice’ – and do what you think best.”
Likely, children are more comfortable on a leash than walking with their arms yanked above their shoulder and their hands tightly held. Ditto for being shackled into a stroller.”
“Leashes are just what the doctor ordered for children with hyperactivity and sensory issues. Leashes allow them to move about safely while also allowing them to exercise.’
“Leashes save lives – mine. I have a bad back. My daughter is overweight. I am tall and must bend to the side to hold her hand. It hurts. My back hurts even more when she wants to be carried. Fortunately, she loves her leash. Go figure!”
“Leashes are no-brainers for parents with two toddlers. Most such parents have experienced the nightmare of both kids suddenly bolting in different directions with you only able to chase one at a time! Leashes are available that attach two kids to one leash, freeing one hand for other purposes.”
“Our world is not built for toddlers. Even places that are supposedly “for kids,” like zoos or amusement parks are so overstimulating and crowded that a visit there with a toddler is overwhelming. The leash allows you take a wiggly, impulsive firecracker of a human out into a big world that’s designed for predictable adults. But to those who leash: I salute you.”
“I lost my toddler at an airport. When we reunited, the terror in his eyes made me a ‘leasher.’”
“What kind of people are we that we put leashes on our kids? Dogs get more respect. I don’t care how uncontrollable children are. Haven’t these parents heard of books on improving their parenting skills? I feel like running up to these parents and slapping them. Leashes convey an inappropriate message by using physical force instead of words to keep children under control.”
“Leashing approaches child abuse, stunting curiosity, making children objects of ridicule, destroying their self-esteem…”
“Many types of leashes are available. Some can be extended and retracted. Leashes attach to children’s’ wrists, special vests, or backpacks. Some backpacks are shaped as cartoon characters. Check the internet.”
“Parents should ask themselves whether they have well-thought-out motives for leashing. Is it because their children are excessively impulsive or have special needs? Or is it because the parents have anxieties and don’t trust themselves to keep their child safe?”
“Does the leash ‘respect’ the fact that a toddler’s impulse control is not well-developed? Or does the leash ‘disrespect’ the toddler – and emphasizes the child’s subordinate status in the world?”
“My pediatrician suggested I get a leash. I dislocated my son’s arm twice. Dislocation occurs at the elbow when children twist a tightly held arm to go in a different direction.”
——————
My conclusion: All “opinions” on leashing young children are hearsay; I could not find a scholarly study. Using leashes occasionally for short periods of time, to “prevent a sea of troubles” is a reasonable strategy.
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