The COVID-19 pandemic forced many child care centers to change their operations. Many of them suspended their operations to prevent the risk of COVID-19 spread. In Pennsylvania, child care centers remained open for the families of essential workers.
As states across the country are reopening, daycare centers are reopening as well. Child care businesses in Pennsylvania counties that are deemed “yellow” or “green” by Gov. Tom Wolf can admit children.
However, there remains some question about the risk of COVID-19 spread in child care settings. Because of that, parents might wonder if it’s the right decision to bring their children in for care.
“What we’re hearing from the field is there’s a lot of fear from parents and child care providers,” says Timothy Shope, MD, professor of pediatrics at UPMC Children’s Hospital of Pittsburgh.
“They want to know how they can keep themselves safe. They obviously want to keep their children safe.”
Here’s what you should know about COVID-19 in children and daycare.
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How Does COVID-19 Affect Kids?
According to available evidence, COVID-19 appears to affect children less severely than adults. Adults make up most of the reported cases, hospitalizations, and deaths.
A small number of children with COVID-19 have developed a serious condition known as multi-system inflammatory syndrome.
“We know that children are less likely to have severe disease, and often have asymptomatic infection,” says John Williams, MD, chief, Division of Pediatric Infectious Diseases at UPMC Children’s Hospital of Pittsburgh. “More recent data suggest that kids are actually less frequently infected by the virus. This may mean they are less likely to transmit.”
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COVID-19 and Daycare
“The biggest concerns for COVID in schools or daycare are the fact that when children are infected, they are often asymptomatic, and the risk of transmission to older daycare workers, teachers, or family members,” Dr. Williams says. “The risk is to these other people more than the children themselves, since kids rarely have severe disease.”
Child care settings can exacerbate the spread of many infectious respiratory conditions, such as the common cold or influenza. Children can acquire an infection from another child in a child care setting and then spread that infection to family members and the greater community.
However, current evidence suggests that COVID-19 may be different. According to a report by the American Academy of Pediatrics, children are less frequently transmitting COVID-19 to other children or to adults.
“We don’t have really firm data so far, but out of the entire world, there are no reports from group child care that show child-to-child transmission at high rates,” Dr. Shope says. “Almost all the cases that have occurred in child care centers have come from infected adults. That sort of flips the entire script.
“However, there are COVID-19 outbreaks occurring in child care centers in Texas right now. It will be important to learn whether the cases originated from infected adult caregivers or whether children were involved in transmission.”
Even with those positive signs, there is no guarantee that children won’t transmit COVID-19 to other children or to adults.
How Can Daycares Prevent COVID-19 Spread?
As daycare and other childcare businesses reopen, their employees should try to take steps to prevent the spread of COVID-19.
Dr. Shope and other researchers conducted a survey of child care center directors to determine preparedness for pandemic influenza in 2008 and 2016. The survey analyzed child care centers’ readiness for pandemic influenza by taking into account several factors:
- General infection control
- Seasonal influenza control
- Use of health consultants
- Quality of child care
- Perceived barriers
According to the report published by the American Academy of Pediatrics, preparedness for pandemic influenza was low and needed to improve.
COVID-19 is a novel disease, different than the flu. However, daycare centers can take several steps to try to prevent COVID-19 spread.
The Centers for Disease Control and Prevention (CDC) has published guidelines for daycare centers to follow. While they do not supersede any federal, state, or local laws, they do provide guidelines to limit COVID-19 spread. Pennsylvania’s Office of Child Development and Early Learning also released guidelines, based on information from the CDC and Pennsylvania Department of Health.
Staff members should wash their hands frequently with soap and water, scrubbing for 20 seconds before rinsing. If soap and water are unavailable, they should use a hand sanitizer with at least 60 percent alcohol. They should avoid touching their mouth, nose, or eyes with unwashed hands.
It may be difficult to enforce frequent handwashing among children. Workers should do their best to supervise children’s hand hygiene.
Child care facilities should consider setting up hand hygiene stations at their entrance to allow children, staff, and parents to clean their hands. If a sink with soap and water is unavailable, facilities should provide hand sanitizer with at least 60% alcohol next to parent sign-in sheets.
Facilities also should post signs about proper handwashing habits in visible locations (i.e. on doors, in lobbies, and in restrooms).
Cleaning and sanitizing
Although COVID-19 generally spreads through airborne droplets, it also can spread through infected surfaces. Child care workers should regularly clean and sanitize frequently touched surfaces.
Facilities should set up a schedule for cleaning and sanitizing. Toys that children can put in their mouth should be cleaned and sanitized. Surfaces like diaper changing stations, doorknobs, and floors should be disinfected.
- Staff should routinely clean, sanitize, and disinfect frequently touched surfaces. They should pay special attention to toys and games.
- Only toys that can be cleaned or sanitized should be used.
- Toys that have been placed in children’s mouths or have been otherwise contaminated by bodily fluids should be set aside until cleaned and sanitized. A person wearing gloves should clean them with water and detergent, rinse them thoroughly, sanitize them with an EPA-approved disinfectant, rinse them again, and allow them to air-dry.
- Cloth toys should be used by one individual at a time and should be put in the laundry before the next use.
- Toys should not be shared by groups until they are washed or sanitized.
- Set aside toys that need to be cleaned in between use. Warm soapy water can be used. Keep these toys out of reach of children.
- Objects not ordinarily cleaned frequently — including doorknobs, light switches, classroom sink handles, countertops, nap pads, toilet training potties, desks, chairs, cubbies, and playground structures — should be cleaned routinely.
- Staff can use cleaning products typically used at the facility. They should use products according to directions. Most common EPA-registered, fragrance-free household disinfectants can be used to disinfect surfaces. Staff should clean dirty surfaces with detergent or soap and water before disinfecting. Cleaning materials must be locked away or out of reach of children, and they should not be used near children.
- Staff should ensure adequate ventilation when using cleaning products.
- Only bedding that can be washed should be used. Each child’s bedding should be kept separate, and possibly in individualized, labeled containers. Bedding that touches a child’s skin should be laundered weekly, or before it’s used by another child.
Attempt to set guidelines for social distancing.
- Try to keep the groups of children as consistent as possible; avoid mixing children from different groups. The child care providers also should be consistent.
- Consider separate groups for children of health care workers.
- Avoid holding events or activities with large numbers of participants.
- Limit mixing of children for playground time and activities like art, music, etc.
- If you have nap time, space cribs or sleeping mats at least 6 feet apart and consider placing children head to toe.
Because COVID-19 can spread through airborne droplets, face coverings may help prevent the spread. Staff should wear facemasks, especially indoors. Children are not required to wear cloth face coverings, but they are still recommended by the CDC, especially for older children and especially while indoors or in crowded locations.
Children under 2 should not wear facemasks. Also, children who cannot remove the facemask without assistance and children who cannot tolerate a facemask for developmental, medical, or behavioral reasons should not wear a mask.
States and local municipalities may have their own laws or guidelines about the use of facemasks.
Pick-up and drop-off
Facilities should post signage in pick-up and drop-off areas to remind people that 6 feet of social distancing is needed.
To avoid large numbers of congregating families, consider staggering drop-off and pick-up times. Have workers outside to greet children as they arrive, and try to limit contact between parents and staff.
The same parent or guardian should pick up and drop off children each day, if possible. Individuals in high-risk groups should not be the designated pick-up/drop-off person.
Designate one staff member to handle pick-up and drop-off, and to walk children to their parent or guardian’s vehicle at the end of the day. Infants should be transported in their car seats.
COVID-19 daily screening
If possible, daycare centers should conduct daily screening for COVID-19 exposure and symptoms in staff, children, parents, and all others before they can enter the building.
Children or staff should not be admitted if they:
- Have tested positive for COVID-19 or are showing symptoms like fever, cough, or shortness of breath
- Have a fever of 100.0 degrees Fahrenheit or higher
- Had known exposure to someone with COVID-19 within the past 14 days. This means being in close contact (within 6 feet) of someone with confirmed or suspected COVID-19 for at least 15 minutes.
Parents should be told to stay alert for signs that their children is ill. If children are ill, they should be kept at home.
Staff should monitor the health of children and other workers throughout the day.
If a staff member or child develops fever, chills, shortness of breath, new cough, or new loss of taste or smell, that person should be isolated from the group.
- The sick person should be isolated until he or she and any family members can be sent home.
- If the sick individual is a child, a parent or guardian should be contacted immediately.
- A staff member should stay with the child in isolation away from others. If the child is showing symptoms, the caregiver should attempt to remain as far away as possible while still supervising the child, preferably 6 feet. The caregiver should wear a cloth face covering.
- If the sick child is over 2 years old and can tolerate a face covering, he or she should wear one.
If COVID-19 is confirmed, the facility should be cleaned and disinfected. Anyone who had contact with the sick person should self-isolate for 14 days.
Is It Safe to Return to Daycare?
Doctors and researchers continue to learn more about COVID-19.
Currently, there is no evidence that says children are at greater risk of infection or transmission of COVID-19 in daycare.
However, it’s a decision parents will need to make on their own.
Dr. Williams says parents should consider whether there’s a risk to other family members if a child inadvertently brings home COVID-19 after attending daycare. The risk may be low enough if a child has no contact with individuals in high-risk groups (older adults, people with underlying health conditions, or people who are immune-compromised). However, if a child lives in the same house as someone in a higher-risk group, the risk of that child attending daycare may be too high.
“Everybody has to make their own choices,” Dr. Shope says. “Nothing is a zero-risk game in this world we’re living in right now, and I think we’re all realizing that. Your child would be safer at home than in groups of other children, but I think the risk is probably very low, based on what we know so far about kids aggregating in groups in child care settings. We have to weigh all those factors. Everyone has to make their own individual choice.”
For more information on COVID-19 in children, visit www.chp.edu.
Centers for Disease Control and Prevention, Guidance for Child Care Programs That Remain Open. https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/guidance-for-childcare.html
Centers for Disease Control and Prevention, Help Stop the Spread of COVID-19 in Children. https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/children/protect-children.html
Benjamin Lee, MD and William V. Raszka Jr., MD, Pediatrics, COVID-19 Transmission and Children: The Child is Not to Blame. https://pediatrics.aappublications.org/content/pediatrics/early/2020/05/22/peds.2020-004879.full.pdf
Timothy R. Shope, MD, Benjamin H. Walker, MS, Laura D. Aird, MS, Linda Southward, PhD, John S. McCown, MS, Judith M. Martin, MD, Pediatrics, Pandemic Influenza Preparedness Among Child Care Center Directors in 2008 and 2016. https://pediatrics.aappublications.org/content/pediatrics/139/6/e20163690.full.pdf
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