Pediatricians on COVID-19's Impact on Kids

They may not be in the direct path of contracting coronavirus but adolescents are plagued with other hard-hitting issues during this ever-changing time. Disrupted routines, high anxiety, moodiness and social isolation are just a few of the daily battles children face now that they’re stuck at home with fewer ways to exert energy and vying for attention from remote-work parents. Three pediatricians, who graduated from Ross University School of Medicine—Omar Jaber, MD, MPH, FAAP; Amada Costa MD; and Nicole Molinos, MD MPH—recount what they’re experiencing in their respective COVID-19 hot zones and urge parents to keep some sort of semblance of normal.

Omar Jaber, MD, MPH, FAAP—Washington, D.C.

“In a world that’s now so hyper-sanitary and children being the antithesis of that, it’s tough for pediatrics. We are a socially oriented field and the impact of COVID—while it may not be significant from a mortality standpoint because the disease is targeting adults—still has an impact on kids. We’re social human beings—we learn better when we’re amongst classmates and we thrive in routine and social interactions. We are trying to juggle childcare and work done virtually, and we don’t know what kind of long-term consequences there will be with the continued quarantine.”

Omar’s pediatric office changed its waiting-room policies a few months ago and fortunately has two offices—one to treat sick patients and the other for well visits. The doctors have been able to screen potential COVID-positive patients through telehealth appointments and immediately divert them to the hospital. But even for patients coming into the office, it’s difficult to follow COVID-19 protocols. “Children don’t social distance; they run to others, play close to each other. Any child under four years old can’t wear masks; they won’t cooperate. They won’t be able to cover their mouth when they cough, and they won’t sneeze the right way. Or what happens if they vomit? And babies will drool.”

Following in his parents’ footsteps, Omar envied the interaction his mom, a fellow pediatrician, had with patients and their families. “I saw the bond she had with the whole family. There were patients in their 20s who she had cared for since they were babies. I knew that’s what I wanted—to follow children throughout their lives and see them graduate school and maybe see their kids in the future. There’s an innocence in treating a child—they are not responsible for what’s happening to them and they don’t understand. It’s important for them to have an advocate.” Omar’s father is an obstetrics and gynecology physician. Chuckling at the irony of his parents’ specialties, Omar said, “It’s a great set up in our family—we’re with the patient from start to finish.”

How COVID Affects the Family

Omar said the pandemic has impacted not just children but the entire family dynamic:

• For single parents who are infected and require hospitalization, a child may now have to also stay in the hospital because child-based organizations won’t accept someone who’s been exposed.

• Children who rely on school meals must now find daily nutrition through other means.

• Hallmark moments such as graduation have gone virtual or been canceled and those heading into the working world are entering a less-than-ideal economy.

• Kids of all ages are exposed to more screen time and the blue-light effect is disrupting sleep patterns.

• Younger children who aren’t getting as much physical activity and social time with friends are becoming hyperactive, moody and clingy.

• Adolescents may not prioritize school the same in a remote setting and that can cause a cascading effect of worrying about grades and college applications.

• Those in high school thrive on acceptance from peers and without socialization, they may become rebellious—ignore social distancing—when they feel overwhelmed with authoritative direction.

• Children with underlying learning disorders like attention-deficit/hyperactivity disorder (ADHD) and autism are challenged by virtual instruction and crave learning in a classroom with a more adaptive environment. “Parents are now burdened with being a parent and a teacher while trying to have a personal life and get their jobs done at the same time.”

Originally from New York, Omar now resides in Virginia with his wife, whom he met during medical school, and their toddler son. “He’s taught me more in the two years of his existence than I learned in all of my medical training.” For fun, Omar watches movies, exercises, reads and roots for New York sports teams.

Amanda Costa, MD and Nicole Molinos, MD, MPH—Florida

At a children’s hospital in Broward County, Amanda and Nicole are treating patients who are admitted for one ailment and then sometimes also presenting with COVID-19. “They turn out positive but it’s because of an incidental finding,” Amanda explained, adding that many children are asymptomatic or experiencing gastrointestinal symptoms such as vomiting, diarrhea and abdominal pain instead of the traditional respiratory issues. 

The pair is also treating patients who, after having COVID-19, are showing symptoms of a new severe inflammatory immune response referred to as Multisystem Inflammatory Syndrome in Children (MIS-C), which can present similarly to another known inflammatory condition called Kawasaki Disease. Nicole said some kids have had prolonged fevers, red eyes, red tongue, cracked or dry lips as well as a rash on their hands and genital area. “There are some overlapping features between MIS-C and Kawasaki Disease,” which has led doctors at their hospital to treat the two diseases similarly by using an intravenous therapy (IV) solution of antibodies to alter the immune response. “Just like we don’t know why certain healthy 20- or 30-year-olds get severe COVID-19 infection where others their age have mild or asymptomatic infections, we also don’t know which children will get MIS-C and which won’t after a COVID-19 infection.” 

Both doctors understand their patients are fearful of going out during this time, but they reiterate the importance of keeping on track with vaccines. “People are so afraid to go to doctors and they are not going to wellness exams. We are in danger of having outbreaks of preventable diseases,” Amanda explained.

Keeping Vaccines in the Forefront

Nicole suggests pediatric teams strategize with families to find ways to minimize exposure but still stay on schedule. “We are doing whatever we can to keep families safe because the first year of life is so critical. The immune system is building itself in the first six months of life when infants are starting to lose antibodies from their mom. The health organizations are not recommending a delay in vaccines. Keeping them on schedule through two years old is what produces the best immunity.”

Now in Florida, Nicole enjoys the same amenities she had in her home state of California—swimming at the beach and enjoying outdoor activities. After years in education, teaching children with special needs, Nicole dabbled in public health positions before becoming a physician. “I knew I loved learning how the body worked and the disease process. I wasn’t sure medicine was my path so I worked in public health for a while and still left with that curiosity. Thankfully, Ross Med gave me the opportunity I wouldn’t have been given otherwise. And I knew I wanted to work with children. With kids, you are constantly reminded about the best in humanity. They show themselves easily and when they’re sick, you know they’re sick. They’re not as complex to read as adults.”

Amanda grew up in Brazil and moved to Florida during her last year of high school. Losing a cousin to cancer during her childhood spurred her interest in medicine. “It was such a big loss and I wanted to learn more about it so I just went for it. Pediatrics makes me happy except that you can’t save everyone, which is the only downside of this profession. I never thought it would be an easy field but it’s a rewarding career. Ross Med gave me the opportunity to achieve my dream.” When the restrictions relax, Amanda and her husband hope to explore Greece.

Silver Linings

Despite all the challenges for adolescents, Omar prefers to focus on the positive. He is thankful the preliminary data shows the transmission of COVID-19 between children is relatively low, though he still recommends interaction only with family members. He also encourages kids to go outside as much as possible and recommends that everyone take pause and enjoy this unique setting. “A lot of parents miss out on terrific milestones. The pandemic has created a great home environment where families are together and experiencing great interaction. They need to appreciate this time because all kids grow up. As challenging as it may be at the time—like when your two-year-old son is screaming his head off—remind yourself that you are lucky to have time with him because it could be limited.”

Appreciative and Thankful 

We appreciate your commitment to the continued well-being of our Ross Med community and support during this unprecedented time. Please visit the Ross Med website for the latest updates regarding COVID-19.