How can we prevent the spread of SARS-CoV-2 in children?

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The rise in cases of COVID-19 among children in the U.S. is primarily linked to the Delta variant. Cases are rising especially quickly in communities with low rates of COVID-19 vaccinations.

Although the Centers for Disease Control and Prevention (CDC)Trusted Source recommend universal indoor masking and physical distancing in schools, mask-wearing is optional in North Dakota and Ohio.

Rapidly increasing infection rates among children and teachers have forced many schools in the U.S. to halt in-person learning and turn to hybrid models of education. This comes despite 175 pediatric disease experts agreeing earlier this year that elementary schools could open full-time for in-person instruction.

Although children generally have milder COVID-19 symptomsTrusted Source than adults, the fact that few studies have investigated how the disease affects children means that many questions remain unanswered. For example, why are so many children being hospitalized with COVID-19? Which children are most at risk? And what can parents and authorities do so that children can return to school safely?

To answer these questions and more, Medical News Today spoke with seven doctors and researchers who specialize in pediatrics and infectious diseases and have worked directly with children with COVID-19.

Why are COVID-19 hospitalizations among children increasing?
The Delta variant of COVID-19 is more than two timesTrusted Source as contagious as previous variants. Alongside school reopenings, this may partially explain the increase in pediatric hospitalizations due to COVID-19.

“The Delta variant that is circulating widely is more contagious, and children are getting infected more often than previously during the pandemic,” Michael L. Chang, M.D., director of pediatric antimicrobial stewardship for McGovern Medical School and Children’s Memorial Hermann Hospital in Texas, told MNT. “Also, across the country, mitigation measures such as masks, reduced occupancy indoors, physical distancing, etc., all ended around the same time.”

“Now, you have a more contagious variant with fewer mitigation measures in place. With the rising number of cases, unfortunately, you will see more hospitalizations. As an example, if 2% of children need hospitalization, then it’s a big difference between 2% of 10,000 cases vs. 2% of 100,000 cases,” he added.

Another reason for rising COVID-19 hospitalizations among children may be that those under the age of 12 years cannot get the vaccination yet.

“Vaccines remain effective at preventing severe illness, hospitalization, and death from [SARS-CoV-2] infection, even Delta strain infection,” Kristin Moffitt, M.D., an infectious disease expert at Boston Children’s Hospital, MA, told MNT. “This is consistent with reports that the overwhelming majority of hospitalizations and deaths during the recent surge are occurring in unvaccinated individuals.”

“Since children under 12 aren’t yet able to be vaccinated, and many adolescents and young adults remain unvaccinated relative to older individuals, this age group is making up a bigger proportion of those at risk for severe illness based on their unvaccinated status,” she added.

Dr. Karen Ravin, M.D., chief of infectious diseases at Nemours Children’s Hospital in Delaware, agreed. “Children under 12 years of age make up a substantial proportion of the unvaccinated population in the U.S., so they are the population at highest risk,” she said. “Early in the pandemic, schools were closed, and children had a lower risk of exposure in the community. Contrast this to now, schools are open for in-person instruction […] so children are at greater risk for being exposed, becoming infected, and, unfortunately, being hospitalized.”

“Early in the pandemic, those over 65 accounted for more severe disease and hospitalization. Now that this age group has a higher percentage of vaccinated persons, the disease burden will be seen in the younger, unvaccinated population,” noted Dr. Adriana Cadilla, an infectious diseases pediatric specialist at Nemours Children’s Hospital in Orlando, FL. “[In Florida,] there has been over a four-fold increase in child [SARS-CoV-2] infections in the past month,” Dr. Cadilla added.

Top Reason for Teen Spine Injuries: Not Wearing Seat Belts

Two-thirds of spinal fractures suffered by American children and teens occur in car crashes when they aren’t wearing seat belts, a new study finds.

Researchers analyzed data on more than 34,500 U.S. patients younger than 18 who suffered spinal fractures between 2009 and 2014. Teens aged 15 to 17 accounted for about 63% of the spinal fractures, two-thirds of which occurred in motor vehicle accidents.

These findings show that around the time teens get their drivers’ licenses, young drivers and passengers are at highest risk for spinal fractures in car crashes, according to the authors of the study published online recently in the journal Spine.

The investigators also found a strong link between not buckling up while in the car and increased risk of spinal fractures.

“Nearly two-thirds of pediatric spinal fractures sustained in [motor vehicle accidents] occurred in children who did not use belts,” Dr. Vishal Sarwahi, from Cohen Children’s Medical Center, in New Hyde Park, N.Y., and colleagues wrote in a journal news release.

Spinal fractures in children and teens were associated with a 3% death rate, with many deaths occurring in unrestrained drivers and passengers, the researchers noted.

Another study finding was that the risk of severe or multiple injuries and death was more than twice as high (nearly 71%) when children and teens didn’t wear seat belts than when they did (29%).

Wearing seat belts was associated with lower rates of multiple vertebral fractures, other types of fractures in addition to spinal fracture, head and brain injuries, and a more than 20% lower risk of death in car crashes.

The researchers also found that 58% of the young spinal fracture patients were male, and that spinal fractures were most common in the South (38%), likely because a lack of public transportation results in more vehicles on the road.

The percentage of U.S. drivers wearing seat belts has risen steadily over the years, but teens and young adults remain less likely to use them, the study authors noted.

The findings highlight the need to take steps to increase seat belt use by younger drivers and passengers, such as targeted approaches using technology and media awareness campaigns, the researchers suggested.

“Ensuring our new, young drivers wear protective devices can greatly reduce morbidity/mortality associated with [motor vehicle accidents] and can help save lives, and spines,” the research team concluded.

Number of Gender-Diverse Teens Grows

The number of American children who identify as a gender other than male or female appears to be increasing, a new study in the journal Pediatrics reports.

In 2017, a CDC survey asked high school students if they considered themselves to be transgender and found 1.8% said yes. But a doctor at the University of Pittsburg Medical Center wondered if the way the CDC survey was structured didn’t capture all kids who were “gender diverse.”

Kacie Kidd, MD, instead turned to a diverse Pittsburg public high school and asked more than 3,000 students two questions:

“What is your sex (or, your sex assigned at birth, on your birth certificate)?”
“Which of the following best describes you (select all that apply)?”
The available options were “girl,” “boy,” “trans girl,” “trans boy,” genderqueer,” “nonbinary,” and “another identity.”

The study says 9.2% of kids responded that they were gender diverse in some way.

The results of the study come as singer Demi Lovato came out as nonbinary and uses the pronouns “they” and “them.”

“This has come after a lot of healing & self-reflective work,” Lovato said on Twitter. “I’m still learning & coming into myself & I don’t claim to be an expert or a spokesperson.”

Finding people on and off the binary definition of gender is not difficult in any society, Jules Gill-Peterson, PhD, associate professor of English and gender, sexuality, and women’s studies at the University of Pittsburgh, told CNN.

“Regardless of what kind of sex and gender system existed in a particular society at a given time, there are pretty much consistently always folks who stray from those norms,” Gill-Peterson said. In many of those cultures, “It’s culturally sanctioned and celebrated for certain people to live lives differently than what we might call the gender they were assigned at birth.”

Slideshow: Quick Tips for Feeding a Picky Eater

Problem: One-Food Wonder

Your child may happily eat some foods and toss others on the floor. Is it just a phase, and how long will it last? What do you do in the meantime: Give them what they want, or hold your ground?

Solution: Don’t Fight It

Don’t turn mealtime into a battle of wills. Keep offering a variety of good-for-you foods, even if your kid rejects it at first. Many kids take their sweet time before deciding they like a new food after all, so keep trying. Offer fruit, vegetables, and even “grown-up” food, without pressure. Your child may surprise you with what they like.

Problem: Won’t Eat Their Veggies

Does your child say they hate asparagus, even though they’ve never tried it? It happens a lot. Many vegetables have a strong smell and taste, especially when cooked. Be patient. They may want to see it and smell it before they’ll taste it, and even then they may spit it right back out. Take a breath and try it again another day.

Solution: Give Them Choices

Many children warm up to veggies when they’ve helped pick them out, whether at the store or at meals. If green veggies turn them off, try orange or red ones instead. Or offer them raw with a dip like ranch dressing or hummus. Although hiding vegetable purées in foods like baked goods or pasta sauce is a short-term fix, it doesn’t teach them to like those veggies when they are out in the open.

Problem: Drinks Their Calories

Does your child drink so much milk or juice during the day that they are not hungry at mealtimes? It can be a problem if they drink so much it makes them miss meals.

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Slideshow: A Day of Healthful Choices for the Whole Family

6:30 a.m. Fuel Up First Thing

If you’re just waking up, you probably haven’t eaten in at least 10 hours. Don’t head out before fueling up! A healthy breakfast can give you and your kids a sharper mind, more energy, and better total nutrition for the day. A balanced breakfast includes protein, carbs, and fiber. Try spreading peanut butter or melted low-fat cheese on a whole-wheat English muffin.

7 a.m. Get Moving

Before heading out for the day, take a brisk 30-minute walk around your neighborhood. You’ll feel invigorated, and you’ll chip away at the 150 minutes of moderate-intensity activity that we need every week. Morning exercise may help you lower your blood pressure and daily levels of triglycerides (unhealthy fats) in your system. As a bonus, you may sleep better at night, too.

7:30 a.m. Protect Your Skin

Don’t leave home without it — sunscreen, that is. Sunscreen isn’t just for the beach and the summer. Even in winter — and even when it’s cloudy — UV rays can penetrate and sear your skin, particularly exposed areas like faces, ears, and the backs of the hands. Those are the areas dermatologists treat most for skin cancer.

7:45 a.m. Travel Light

Overloaded backpacks and purses can strain or injure muscles in the neck, shoulders, and back. Backpacks shouldn’t contain more than 10% to 15% of the wearer’s weight. Look for one with wide padded straps. Wear it on both shoulders to distribute weight evenly. Look for lightweight purses, briefcases, and totes, and pack only what you need. Alternate shoulders or the hand you carry it in. You can also try a wheeled bag and roll it on the ground.

8 a.m. Get More from Your Commute

Do you live within a couple of miles of work or school? Then ditch the car and try a walking commute. You’ll save on gas, keep the environment cleaner, and start your day with a healthy glow. Be sure to wear supportive walking shoes. If you have to use a car, drivers and passengers — even kids in school buses — should buckle up or use an appropriate car seat, no matter how short the trip.

10:30 a.m. Snack Smart

Dump the doughnut tray before your next office meeting! Instead, serve healthier options like fresh fruit platters, mini muffins, whole-grain bagels, or yogurt. Maybe you don’t need to serve food at your meeting at all. Maybe you can motivate your colleagues to attend by another method.

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How to Handle a Temper Tantrum

You’re standing in the snack aisle of the supermarket. Lying at your feet is your toddler, who has just been informed (by you) that, no, they cannot have the Cinderella fruit snacks. Their face has turned a shade somewhere between red and purple. Their fists are pounding the floor in fury as they emit a shriek that can be heard in the farthest reaches of the parking lot. The other shoppers are gaping at this spectacle as you wish desperately for a hole to open in the floor and swallow you up.

Many a parent has been through a scenario like this, although the tantrum might have taken a slightly different form; crying, hitting, kicking, stomping, throwing things, and breath holding are all popular tantrum techniques.

Temper tantrums are exceedingly common in children, especially between ages 1 and 4 — the early part of which is sometimes called the “terrible 2s” — when kids are still learning how to communicate effectively. More than half of young children will have one or more tantrums a week as they vent their frustrations and protest their lack of control.

Although they are a normal part of the toddler repertoire, temper tantrums can be distressing to parents. When they occur infrequently, tantrums aren’t a big deal and are best ignored. It’s when they become regular or intense that parents need to look into what’s causing them and find ways to stop them.

Tantrum Triggers
Some children are more prone to tantrums, particularly kids who are intense, hyperactive, or moody, or kids who don’t adapt well to new environments. For most toddlers, tantrums are simply a way of getting out their frustration and testing limits (Will mommy buy me that toy if I scream really loud?).

The smallest things, from asking them to take a bath while they’re in the middle of watching Sesame Street to requesting that they share a favorite stuffed animal with a younger sibling, can set off young children. Any situation that involves change may spawn a tantrum. Add fatigue or hunger to the equation and children, their threshold for tolerance even lower, are even more likely to throw a tantrum.

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The Power of Play: How Time Outside Helps Kids

For millennia, parents have told their rowdy kids to “Go out and play!” In doing so, most hadn’t a clue they were nurturing the emotional, cognitive, language, and self-regulation skills that build executive function and social aptitude in children, all while enhancing critical brain structures that support pursuing goals and ignoring distractions.

In other words, play is needed for healthy development. So says a recent report published in the journal Pediatrics, which outlines how play advances such skills even as it manages toxic stress. What’s more, playing is shown to support the formation of stable and nurturing relationships with caregivers that kids need to thrive.

While the definition of play is not clear-cut, the researchers agree that play is naturally motivated, uses active engagement, and results in joyful discovery. It’s also voluntary, fun, and spontaneous, with no extrinsic goals.

There are different types of play, says Eileen Kennedy-Moore, PhD, a child psychologist and the author of Growing Friendships: A Kids’ Guide to Making and Keeping Friends. “Some play is child-directed; it’s about exploring,” she says. “A toddler puts everything in her mouth — she’s curious about the world. Physical play is rough-and-tumble, with kids running and moving their bodies. Social play may involve a child watching another kid, playing alongside him, which becomes cooperative play with shared goals as they interact. Pretend play is when children take on adult roles. Interestingly, this happens cross-culturally at specific developmental times, primarily during the preschool years.”

Free play enables children to understand their own preferences and interests, the report states. But play guided by an adult, where the child does her own actions, better promotes learning with a specific goal in mind.
Kennedy-Moore agrees: “Adult-guided play is not about an adult lecturing, but rather modeling for children by asking questions. For example, if a parent and a child are doing a puzzle, the adult might say, ‘I notice the color yellow is running through here. Do you see a yellow piece?’ Asking questions instead of giving the answers.” This allows a child to figure it out — and succeed — independently.

Play and stress are closely linked, with high levels of play associated with low levels of cortisol. Play may be especially important for children in high-stress family situations, the report says.

4 Game Changers
Use these play tips from Kennedy-Moore in your kids’ downtime to boost social, emotional, and mental development.

Ditch the device. There’s no “right” number of hours for kids to play — but do monitor screen time, Kennedy-Moore says: “Playing a video game virtually with a friend is not the same as a game of tag, where kids negotiate the rules, cooperate, and compete to catch each other.”

Solo play is good — to a point. “Alone play can be wonderful, and it builds imagination,” Kennedy-Moore says. “For instance, kids love playing alone with Legos.” But if your child always plays solo, it can be a red flag for social isolation.

Embrace unstructured play time. “Kids say, ‘I’m bored!’ and parents leap to the rescue,” Kennedy-Moore says. “If they can resist, the child moans and groans — and, then, something wonderful happens: Kids think of something to do. It’s a life skill to follow their own curiosity, entertain themselves, and manage their emotions.”

The play’s the thing. “Play is important and valuable, in and of itself,” Kennedy-Moore says, “even if it doesn’t always encourage development every time. Play is like art — to be appreciated.”

Can Gluten-Free Foods Fuel Your Kids?

When it comes to food trends, “gluten-free” (GF) is at the top of the heap. Some people claim that the meal plan has helped them lose weight, have more energy, and just feel better. But is it better fuel for your kids?

Unless your child has a specific medical reason to avoid gluten, there’s little proof that a GF meal plan is better than the healthy, balanced foods that all kids need. Before you start planning GF meals, it’s important to understand the basics of this approach to eating.

What It Means to Go Gluten-Free
Gluten is a protein found in some grains. If your child goes on a GF diet, they’ll avoid all food and drinks that have:

Wheat
Rye
Barley
Triticale (a cross between wheat and barley)
Instead, they’ll focus on foods that are naturally gluten-free. These include fruits, vegetables, meat, poultry, fish, beans, legumes, and most dairy products.

Some grains and starches are OK on a gluten-free diet, like:
Buckwheat
Corn and cornmeal
Rice
Soy
Quinoa
Tapioca
Special GF flours are also made from many of these grains.

Is a Gluten-Free Diet a Healthy Choice for Kids?
The only people who need to stick to a gluten-free diet are those with celiac disease, a condition in which gluten can damage the small intestine. Kids who are allergic to gluten, like those who have a wheat allergy, should avoid it, too.

For everyone else, gluten is not unhealthy. Avoiding it won’t make your kids “feel better” or have more energy. In fact, trying to cut it out of your child’s diet may make it harder for him to get enough key nutrients, like iron, zinc, calcium, vitamin B, and folate. Plus, since so many grains are off-limits, a GF diet can mean he’ll have a tough time getting enough fiber.

It’s still the overall quality of the foods your child eats that makes the biggest difference in how he feels. Focus on helping him choose a variety of whole, healthy foods and cutting out processed ones. (Packages of gluten-free cookies or potato chips aren’t any healthier than the regular kinds.)

Artificial pancreas effectively controls type 1 diabetes in children age 6 and up

A clinical trial at four pediatric diabetes centers in the United States has found that a new artificial pancreas system — which automatically monitors and regulates blood glucose levels — is safe and effective at managing blood glucose levels in children as young as age six with type 1 diabetes. The trial was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. Results from the trial were published August 26 in the New England Journal of Medicine.

“Fewer than 1 in 5 children with type 1 diabetes are able to successfully keep their blood glucose in a healthy range with current treatment, which may have serious consequences on their long-term health and quality of life,” said Guillermo Arreaza-Rubín, M.D., director of NIDDK’s Diabetes Technology Program and project scientist for the study. “Earlier research showed that the system tested in this study was safe and effective for people ages 14 and older. This trial now shows us this system works in a real-world setting with younger children.”

The artificial pancreas, also known as closed-loop control, is an “all-in-one” diabetes management system that tracks blood glucose levels using a continuous glucose monitor (CGM) and automatically delivers the insulin when needed using an insulin pump. The system replaces reliance on testing by fingerstick or CGM with delivery of insulin by multiple daily injections or a pump controlled by the patient or caregiver.

The study enrolled 101 children between ages 6 and 13 and assigned them to either the experimental group, which used the new artificial pancreas system or to the control group which used a standard CGM and separate insulin pump. Check-ins and data collection were conducted every other week for four months.

Study participants were instructed to continue about their daily lives so that the researchers could best understand how the system works in the typical routines of the children.

The study found that youth using the artificial pancreas system had 7% improvement in keeping blood glucose in range during the daytime, and a 26% improvement in nighttime control compared to the control group. Nighttime control is of particular importance for people with type 1 diabetes, as severe, unchecked hypoglycemia can lead to seizure, coma or even death. The overall time-in-range goal for the artificial pancreas reflected a nearly 11% improvement, which translated to 2.6 more hours per day in range.

“The improvement in blood glucose control in this study was impressive, especially during the overnight hours, letting parents and caregivers sleep better at night knowing their kids are safer,” said protocol chair R. Paul Wadwa, M.D., professor of pediatrics at the Barbara Davis Center for Childhood Diabetes at the University of Colorado, Aurora (CU). “Artificial pancreas technology can mean fewer times children and their families have to stop everything to take care of their diabetes. Instead, kids can focus on being kids.”

Sixteen adverse events, all classified as minor, occurred in the artificial pancreas group during the study, with most due to problems with the insulin pump equipment. Three events occurred in the control group. No cases of severe hypoglycemia or diabetic ketoacidosis occurred during the study.

“For decades, NIDDK has funded research and technology development to create a user-friendly automated device that could ease the constant burden of type 1 diabetes, from the finger sticks and insulin injections, to the insulin dose calculations and constant monitoring while improving diabetes control outcomes and preventing both short- and long-term complications of the disease,” said Arreaza-Rubín.

“The artificial pancreas is a culmination of these years of effort, and it’s exciting to see how this technology may benefit children with type 1 diabetes and their families, and hopefully benefit everyone with diabetes in the future.”

The artificial pancreas technology used in this study, the Control-IQ system, has an insulin pump that is programmed with advanced control algorithms based on a mathematical model using the person’s glucose monitoring information to automatically adjust the insulin dose. This technology was derived from a system originally developed at the University of Virginia (UVA), Charlottesville, with funding support from NIDDK.

This four-month study was part of a series of trials conducted in the International Diabetes Closed-Loop (iDCL) Study. In addition to CU and UVA, study sites included Stanford University School of Medicine, Palo Alto, California; and Yale University School of Medicine, New Haven, Connecticut. Jaeb Center for Health Research served as the data coordinating center.

Based on data from the iDCL trials, Tandem Diabetes Care has received clearance from the U.S. Food and Drug Administration for use of the Control-IQ system in children as young as age six years.

“As we continue to search for a cure for type 1 diabetes, making artificial pancreas technology that is safe and effective, such as the technology used in this study, available to children with type 1 diabetes is a major step in improving the quality of life and disease management in these youth,” said NIDDK Director Dr. Griffin P. Rodgers.

The iDCL Study is one of four major research efforts funded by NIDDK through the Special Statutory Funding Program for Type 1 Diabetes to test and refine advanced artificial pancreas systems. The studies, with additional results forthcoming, are looking at factors including safety, efficacy, user-friendliness, physical and emotional health of participants, and cost.

This study was funded by NIDDK and Tandem Diabetes, Inc. Tandem provided the experimental closed-loop systems used in the trial, system-related supplies including the Dexcom CGM and Roche glucometer, and technical expertise.

Remedies for Nausea and Vomiting

Nausea and Vomiting: What’s Wrong?

Your child’s nausea has turned to vomiting, and you want to help him fast. Luckily, bouts of vomiting in kids aren’t usually harmful, and they pass quickly. Common causes are stomach viruses and sometimes food poisoning. Check in with your doctor if your child is less than 12 weeks old, acts sick, or if you are worried.

Signs of Dehydration

One of the best things you can do is watch for dehydration. Kids get dehydrated more quickly than adults. Watch your child for: acting tired or cranky, dry mouth, fewer tears when crying, cool skin, sunken-looking eyes, not urinating as often as normal, and when he does go, not peeing very much or urine that is darker yellow.

Treating Dehydration

To prevent and relieve dehydration, try to get your child to drink in very small amounts. Even if vomiting continues, she’s still absorbing some of what you give her. Try ice chips, sips of water, sports drinks, or oral rehydration solutions like CeraLyte, Enfalyte, or Pedialyte. After she vomits, start with a small amount: a few tablespoons every few minutes. Over time, give her more as she is able to hold it down. Make sure she urinates regularly.

What About Flat Soda?

For many years, parents used flat lemon/lime soda and ginger ale to help kids replace fluids, and many doctors still recommend those. But research has begun to show that oral rehydration solutions are better for kids. These drinks offer the right amounts of sugar and salt. An alternative can be a sports drink mixed with an equal amount of water.

Liquid Diet

When it’s been several hours since your child last vomited, you can begin a clear liquid diet beyond just water, electrolyte drinks, or oral rehydration solutions. Stick with liquids you can see through. They are easier to digest, yet they offer nutrients to give your child energy. Think clear broth, cranberry juice, apple juice. Popsicles and Jell-O can work well, too.

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