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Q&A: Is in-home child care safe during COVID-19 pandemic?

Nusheen Ameenuddin

With children home from school and many parents teleworking during the COVID-19 pandemic, is in-home child care a safe option?

Infectious Diseases in Children spoke with Nusheen Ameenuddin, MD, MPH, MPA, chair of the AAP’s council of communication and media and assistant professor of pediatrics at the Mayo Clinic, regarding recommendations for in-home care for children while families self-quarantine. – by Ken Downey Jr.

Q: As a practicing pediatrician, and a member of the AAP, would you recommend in-home child care for children?

A: Regarding in-home child care, if it’s not possible for a parent or guardian to stay home with a child, a safer option than a large child care center could be an in-home child care provided by one person.

There’s no way to guarantee that a person coming into the home is not an asymptomatic carrier of the coronavirus, short of massive testing of the entire population, but this is a less risky option than putting a large group of children together in a common space, which is why schools are closed in the first place.

If there is an elderly person in the home or someone who is immunocompromised, one would have to weigh the risks and benefits of having one person come into the home to care for children vs. the children being exposed to the virus in a larger setting outside and possibly bringing the virus home.

Q: If a child becomes sick in quarantine, is it safe to take them to a pediatrician?

A: So, if a child were ill, I would definitely recommend keeping them at home. This includes any sort of febrile illness or even something that may seem like a common cold. The reason for that is that this novel coronavirus also has other variants that can present normally as a cold. And so far, we're finding that most of the kids who've been infected — and again, it's limited data — but for most of the kids who've been infected, they're actually doing pretty well.

Because they are exposed to so many other types of coronaviruses, that might function as a little bit of immunity, almost like a vaccine. But if kids are sick, we recommend that they stay at home and that contact is limited with the outside world because even if kids do OK with this, they can potentially be able to spread that to more vulnerable populations.

What we're learning about the novel coronavirus that causes COVID-19 is that even healthy people who don't have any symptoms can transmit the disease to others.

Q: What if a parent has a fear of bringing someone in their home who could potentially have the virus or could be a carrier of the virus and the parent does not want to risk in-home care?

A: Obviously, you can’t really quarantine if you are a primary caregiver, but what we would recommend is really good hand washing, in between wiping down shared surfaces. If it is possible — and I do acknowledge that this is not possible for all families — but if there's any way they could do sort of a semi-quarantine, even within the home, that can potentially be helpful.

This is true particularly if there's like a newborn in the home, or someone who is compromised, for whatever reason, or if there's an elderly or otherwise chronically ill person in the home. For families who are able, sometimes this means keeping the sick child mostly confined to their room, or to a couple of rooms, while having other parts of the home or apartment, sort of designated as clean areas. I realize that that is not 100% realistic. But as much as people can do to try to limit that spread and cross-contamination could be helpful.

Q: Is there anything else regarding in-home care that you think is relevant?

A: We know that this is a really stressful time. Families are facing a number of challenges — job-related — and then kids potentially being home from school could be a financial hurdle, as well.

We know that during these stressful times, it's easy to sort of turn on the TV, or use an electronic device in part to keep everyone’s sanity. But we do recommend trying to maintain some sort of a routine, having variety built in, doing activities that are still maintaining the whole social distancing principles that allow kids to essentially not just be cooped up at home and sitting in front of the screens all day. So, have family time using technology to potentially connect to relatives like grandparents who might be isolated because either they're in living facilities, or just because of their age, they might be trying to socially distance, which we strongly recommend for everybody.

That's a good way to use technology positively and productively to be able to maintain social connections with people who might not have the ability to be as mobile. Also, just for kids who aren't sick, use the time together to do family learning activities, dance parties, just whatever you do the sort of let the kids burn off a little bit of energy, while still doing it in a safe way.

I also recommend ensuring more than one layer of protection that includes social distancing as much as possible in addition to good hand hygiene, avoiding contact with any clearly ill people and doing the best people can under difficult circumstances.

Disclosure: Ameenuddin reports no relevant financial disclosures.
Nusheen Ameenuddin

With children home from school and many parents teleworking during the COVID-19 pandemic, is in-home child care a safe option?

Infectious Diseases in Children spoke with Nusheen Ameenuddin, MD, MPH, MPA, chair of the AAP’s council of communication and media and assistant professor of pediatrics at the Mayo Clinic, regarding recommendations for in-home care for children while families self-quarantine. – by Ken Downey Jr.

Q: As a practicing pediatrician, and a member of the AAP, would you recommend in-home child care for children?

A: Regarding in-home child care, if it’s not possible for a parent or guardian to stay home with a child, a safer option than a large child care center could be an in-home child care provided by one person.

There’s no way to guarantee that a person coming into the home is not an asymptomatic carrier of the coronavirus, short of massive testing of the entire population, but this is a less risky option than putting a large group of children together in a common space, which is why schools are closed in the first place.

If there is an elderly person in the home or someone who is immunocompromised, one would have to weigh the risks and benefits of having one person come into the home to care for children vs. the children being exposed to the virus in a larger setting outside and possibly bringing the virus home.

Q: If a child becomes sick in quarantine, is it safe to take them to a pediatrician?

A: So, if a child were ill, I would definitely recommend keeping them at home. This includes any sort of febrile illness or even something that may seem like a common cold. The reason for that is that this novel coronavirus also has other variants that can present normally as a cold. And so far, we're finding that most of the kids who've been infected — and again, it's limited data — but for most of the kids who've been infected, they're actually doing pretty well.

Because they are exposed to so many other types of coronaviruses, that might function as a little bit of immunity, almost like a vaccine. But if kids are sick, we recommend that they stay at home and that contact is limited with the outside world because even if kids do OK with this, they can potentially be able to spread that to more vulnerable populations.

What we're learning about the novel coronavirus that causes COVID-19 is that even healthy people who don't have any symptoms can transmit the disease to others.

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Q: What if a parent has a fear of bringing someone in their home who could potentially have the virus or could be a carrier of the virus and the parent does not want to risk in-home care?

A: Obviously, you can’t really quarantine if you are a primary caregiver, but what we would recommend is really good hand washing, in between wiping down shared surfaces. If it is possible — and I do acknowledge that this is not possible for all families — but if there's any way they could do sort of a semi-quarantine, even within the home, that can potentially be helpful.

This is true particularly if there's like a newborn in the home, or someone who is compromised, for whatever reason, or if there's an elderly or otherwise chronically ill person in the home. For families who are able, sometimes this means keeping the sick child mostly confined to their room, or to a couple of rooms, while having other parts of the home or apartment, sort of designated as clean areas. I realize that that is not 100% realistic. But as much as people can do to try to limit that spread and cross-contamination could be helpful.

Q: Is there anything else regarding in-home care that you think is relevant?

A: We know that this is a really stressful time. Families are facing a number of challenges — job-related — and then kids potentially being home from school could be a financial hurdle, as well.

We know that during these stressful times, it's easy to sort of turn on the TV, or use an electronic device in part to keep everyone’s sanity. But we do recommend trying to maintain some sort of a routine, having variety built in, doing activities that are still maintaining the whole social distancing principles that allow kids to essentially not just be cooped up at home and sitting in front of the screens all day. So, have family time using technology to potentially connect to relatives like grandparents who might be isolated because either they're in living facilities, or just because of their age, they might be trying to socially distance, which we strongly recommend for everybody.

That's a good way to use technology positively and productively to be able to maintain social connections with people who might not have the ability to be as mobile. Also, just for kids who aren't sick, use the time together to do family learning activities, dance parties, just whatever you do the sort of let the kids burn off a little bit of energy, while still doing it in a safe way.

I also recommend ensuring more than one layer of protection that includes social distancing as much as possible in addition to good hand hygiene, avoiding contact with any clearly ill people and doing the best people can under difficult circumstances.

Disclosure: Ameenuddin reports no relevant financial disclosures.

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