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We Know Kids

The Willows Pediatrics Blog

Willows Baby Group Thrives Outside

The intrepid members of our baby group don’t let the winter chill slow them down! On a recent Tuesday, with temperatures above 40 degrees, many of our new moms (and dads too!) met outside to discuss questions about newborn care and enjoy each other’s company. On top of the support and knowledge the group provides, our baby group is a great opportunity to meet new parents with similar age infants. The shared baby group experience has led to bonding and networking among the parents who join us, including finding time for outdoor walks and socially distanced outdoor get-togethers other days of the week.

Our baby group met outside here at Willows Pediatrics due to the pandemic and covid-19
Led by Heather Buccigross, PA-C and certified lactation consultant, our baby group meets by the picnic tables behind our office, weather permitting (no rain and temperature above 40 degrees) every Tuesday at 11 am. Babies are bundled up and are part of the team. In case of rain or temperatures below 40 degrees the group meets over Zoom. Please check our Instagram the day before for an update on the group’s location.

College Students Returning for Holiday Break: Covid-19 Guidance

College student bumper stickers - advice for returning home during coronavirusWe are all aware of the rising COVID cases around the country. Many college campuses are facing similar outbreaks. If you have a college student returning from campus, here is some guidance on how to handle their return.

Of course, these cases can be complicated and there may be questions specific to your family. Please feel free to call your doctor, PA, or nurse to discuss if you have any questions.

Does my college student need to quarantine on return to Connecticut?

There is a Travel Advisory in Connecticut stating anyone traveling into the state from states on the Advisory List is required to quarantine for 14 days. As of this week, the Advisory List includes all states except RI, NY, NJ and HI.

However, a negative Covid-19 PCR test will exempt you from the quarantine requirement. The PCR test has to be obtained in the 72 hours before your return to CT or anytime following your return to CT. The CT advisory asks that negative test results be sent to the Commissioner of Public Health via email or fax. Of course, your college student should wait until he or she gets a negative test result to leave quarantine if you obtain the Covid-19 test after returning to CT.

Does my college student need to self-isolate for 14 days when they return?

This is a tough question. Self-isolate means a person sick with a contagious illness is staying away from all other people, whereas quarantine means a person who may have been exposed to a contagious illness stays in their household, but is not completely separated from people who are not sick. The need to self-isolate vs. the need to quarantine depends on your college student’s exposure level and your household’s risk level.  Obtaining a negative COVID test before or after arriving home does not guarantee your college student will not come down with COVID symptoms if they were exposed to COVID just before leaving college to come home.

As part of your assessment, you would want to know how prevalent COVID is on your child’s campus. Check the rates of COVID at your child’s school: many schools maintain a webpage with case counts or check The New York Times tracker on their website.  Some colleges have kept cases very low so your child may be at low risk for bringing it home.

Second, what is your household’s risk level? If your family is all young and healthy then you may be at low risk for serious illness from COVID. However, if you have older relatives in your already in your household or visiting for Thanksgiving, or if anyone has chronic medical conditions, then your risk level may be higher. A high rate of Covid-19 infections at your adolescent’s school along with along with vulnerable household members means self-isolating may be safer.

Keep in mind the risk level of your child’s travel home. Driving home is the lowest risk, but if your child has to fly to get home then the flight is another exposure.

College student bumper stickers - advice for returning home during coronavirusHow can we decrease our risk?

There are certainly ways to mitigate risk if a 14-day self-isolation is impossible for your family. It might be worth having an honest conversation with your college student about his or her risk level before they return. You could ask them to decrease their risk of exposure to COVID: to try to avoid parties, bars, and gatherings and to wear their mask carefully for the week or so prior to their return.

Combining risk mitigation with some period of self-isolation followed by PCR test does not eliminate risk, but will decrease it.  

 

In Office Covid-19 Testing for Symptomatic Patients: Rapid Antigen Test And PCR Test

Rapid Antigen Covid-19 Testing

Covid-19 SARS antigen test box
Willows Pediatrics
has the ability to do rapid COVID-19 testing. This is performed with the rapid lateral flow assay made by Quidel using Sofia 2 test kits. A sample is obtained from the lower part of your child’s nose using a nasal swab. We run the test in our office. Parents receive results within the same day. (If the sample is obtained very late in the day, in those instances we may run your rapid antigen test shortly after the office opens the next morning. Swabs may be kept overnight and run the next morning).


There are a few limitations:

Covid-19 rapid in-office testing available at Willows Pediatrics

  • The rapid Covid-19 test is not recommended for testing asymptomatic individuals`because it may not detect low viral loads. For these individuals, the PCR test is the most accurate.
  • If your child is sick and the rapid Covid-19 test is negative, but symptoms increase or persist, we may recommend that your child also have a PCR test done.
    • Please note: We cannot do a Rapid Test and a PCR Test on the same patient on the same day
  • Rapid testing is now available on Saturdays and Sundays. Please call in the morning on the weekends to have your child seen.

How accurate is the rapid Covid-19 test?

  • In symptomatic individuals, the rapid test detects over 80% of individuals with a Covid-19 infection. Studies have shown rapid antigen Covid-19 tests have a sensitivity ranging from 84.0% – 97.6% compared to PCR testing. However, Covid-19 antigen levels in swabs collected 5-7 days after the onset of symptoms may drop below the limit of detection of the test.
  • In asymptomatic individuals, the rapid test may only detect a third of the positive cases compared to PCR testing

More details on the accuracy of rapid COVID-19 tests is available here.

PCR Covid-19 Testing

Unlike the rapid test, which looks for bits of coronavirus proteins, or antigens, the PCR test is a molecular test that detects genetic material of the coronavirus. PCR tests can detect ultra-low levels of viral RNA, which is why PCR tests are recommended for asymptomatic individuals who may not have enough viral load to be detected by the rapid test. PCR testing can also be done on people with symptoms.

If your child needs a PCR Covid-19 test, a sample is obtained from the lower part of your child’s nose using a nasal swab. This swab is sent to Quest labs, and your child should quarantine until the results come back. The turn-around time for results vary; it typically is 48-72 hours, but may be longer. Since we send the PCR test to Quest labs, we do not have control over when the results are available. (Please note, for individuals who have a Covid-19 PCR test because of an exposure, a negative PCR does NOT mean they can shorten the recommended quarantine period.)

How accurate is the PCR Covid-19 test?

PCR tests have a sensitivity and specificity greater than 95%. This means the chances of a false negative or a false positive are less than 5%.

Insurance

We submit the cost of the Rapid Covid-19 test to your insurance. When the PCR test is done, Quest Labs submits the bill for the test to your insurance. Please note, Husky Health does not cover the rapid Covid-19 test. Children or adolescents covered by Husky Health needing Covid-19 testing must have the PCR test done.

Family First: Developing And Encouraging Healthy Eating Habits During The Pandemic

As we head into the fall season, many parents are asking what they can do to keep their children as healthy as possible. With families needing to adjust work and school schedules, many familiar routines have changed, including meal time. Healthy nutrition has always been vital to the well being of children and adolescents, and even more so as families are spending more time at home, often in front of screens, and for many, managing a reduction in activities outside the home.

Abby Greenspun, RD, our nutritionist, was recently interviewed by Fox61 and offered her suggestions on how to encourage healthy eating habits during this time.

Some of the tips Abby offers include:

Brightly colored foods are often more appealing – “eating the rainbow” in particular bright colored fruits and vegetables. These foods are rich in minerals, vitamins, and fiber.

Fresh foods are preferred over processed, packaged foods.

Whole wheat pasta has all three layers of the wheat kernel: the bran, the germ, and the endosperm, which gives it an edge over white pasta when it comes to fiber and micronutrients.

Overall, Abby recommends keeping your family food options simple, colorful, and fresh. To hear Abby’s interview, please click here.

Sleep: Getting Back On Track For School

As we head into the school year, especially during this uncertain time, we thought it was a good time to talk about sleep.

Sleep is critical for many reasons. We are sure you have heard how important it is for growth and development and for encoding new memories. We also know not getting enough sleep can contribute to inattention, trouble focusing, and mood changes.

Right now, kids and adults are dealing with a lot of uncertainty. It can be extremely helpful for children and teens to have a consistent routine.

How much sleep do children need?

Of course, every child is different! But here are some general guidelines from the American Academy of Pediatrics.

Recommended sleep chart - Willows Pediatrics

Bedtime at our house has moved later and later, how do we move it back?

It is common for bedtimes to shift over the summer when it is lighter later and we don’t have to get up early for school. This is especially true this year since summer was preceded by several months of remote school. We recommend gradually shifting your child’s sleep schedule earlier.

Here are some strategies:

  • Starting a few weeks before school, wake your child up a little earlier each morning (try 15 minutes) and get ready for bed a little earlier each night
  • Get morning sunlight, this helps reset our biological clock
  • Try to get some active time each day
  • Put away screens 1 hour before bedtime
  • Limit snacks and sweets a few hours before bedtime
  • Establish a consistent routine that you can repeat each night so your child knows what to expect
  • Have a family discussion about the sleep plan so that your child will understand the new routine.

Why are screens bad for sleep?

Electronic devices such as tablets and phones emit an artificial blue light, which tricks the body into thinking it is daytime. Blue light suppresses your body’s natural release of melatonin. Melatonin induces sleep as part of your circadian rhythm, your body’s internal clock. Using screens later at night disrupts your body’s natural sleep drive.

We encourage parents to establish a bedtime routine that does not include screens. Instead encourage other quiet activities such as reading a print book or journaling.

Do you have any specific advice for teens?

Sleep is especially important but also difficult for teens. The biological clock in teenagers is shifted later, meaning they often have trouble initiating sleep as early as would like.  Here are some tips especially for them:

  • Have a conversation with your teen about sleep and getting back on track for school. Try to get their buy in, help them understand why you are doing this.
  • Lots of teens are sleeping in late this summer; start getting them up earlier to help them adjust to an earlier bedtime.

Advice for teens (continued)

  • Set an electronics curfew and store phones outside of the bedroom overnight. This is a great habit for teens to establish. We are all addicted to our phones but we want to protect our teens from this as much as possible.
  • Use an alarm clock that is not their phone! A traditional alarm clock is a worthwhile investment. They even make mobile ones, for hard to wake teens (check out Clocky).
  • Make your teen’s bed only for sleep. The brain will associate the bed with being awake if your teen spends the day lounging or doing remote school there. If possible, try to have your teen do their schoolwork in a different location.

What if I have other questions or these tips are not working?

We are here to help! These tips are just a starting point. We are happy to discuss your individual child and family. Please give your physician or PA a call!

COVID 19 Testing: Antibody and Viral tests

There are two kinds of tests for COVID-19: a viral test and an antibody test.

  • A viral test (nasal or oral swab) tells you if you have a current infection
  • An antibody test (blood test) tells you if had a previous infection

Viral Tests: Testing for current infection

To learn if you have a current infection, viral tests are used. A viral test is collected by a nasal or oral swab at a testing center in our area.

Who should be tested?

  • The decision to get tested depends on several different factors including how sick the patient is, what medical problems the patient has and who resides in the patient’s household (e.g. an immunosuppressed family member, a parent who is a health care worker)
  • At this time, we still encourage testing only if you have symptoms suggesting a COVID-19 infection.
  • If you have symptoms suggesting COVID-19 and want to get tested, please call our office.
  • If you have gotten tested and are awaiting the results, please isolate/quarantine to avoid possibly spreading the infection to others.

Interpreting the results

  • If you test NEGATIVE for COVID-19 by a viral test while you have symptoms, then you likely do NOT have COVID-19. Though we know that there are some false negatives, meaning people who actually DO have COVID but get a negative test result, a false negative result is unlikely.
  • If you test POSITIVE for COVID-19 by a viral test then you have an active infection. Please quarantine in your home and isolate as much as possible from others in your home. If you test positive, we can discuss with you how to minimize spread within your home and when you can safely leave isolation.

Antibody Tests: Testing for past infection

Antibody tests are blood tests that check if your body has antibodies from a previous infection with the virus. Antibodies are proteins our immune system makes when we are exposed to a virus and continue to circulate in our blood after we have recovered from the infection. COVID-19 antibody tests cannot be used to see if you have a current infection, as sometimes the antibodies cannot be detected for weeks after the initial infection.

We use antibody testing for many other diseases to tell us if a patient has had an infection or has immunity to a disease. For diseases that have been studied over time we know what level of antibody is effective and we know whether that antibody can give you temporary or permanent immunity. However, since COVID-19 is a new disease we don’t have all the facts yet.

Cautions regarding antibody tests:

  • We do not know at this time if antibodies provide immunity against getting re-infected
  • We do not know how specific the antibody tests are for detecting antibodies to SARS-CoV-2 versus closely related coronaviruses such as the common cold.
  • There are many tests available right now but few of them have been FDA approved, meaning we do not know how accurate these tests are. In other words, if the test says you have antibodies, or don’t have antibodies, how likely is that to be true?

Given all of these cautions, we are not currently recommending antibody testing for most people. The only scenario in which we DO recommend testing is if you have had a positive COVID-19 viral test and are interested in plasma donation.

Why we don’t think you should get an antibody test now:

  • We are concerned that you may get a “positive” result when you don’t actually have antibodies to COVID. This could happen because these tests are still very new, they were released to the market before the FDA validated them and you may have very similar antibodies from a very similar virus you’ve had in the past. If you got a positive result you may interpret that to mean you are immune, when in fact you are not. This could be dangerous as you may not be as rigorous about wearing a mask or social distancing and accidentally expose yourself or others.
  • We don’t know yet what having antibodies to COVID-19 means. We don’t know if those antibodies confer immunity and, if so, how long that immunity lasts.
  • Antibody tests are usually expensive. Since many of the tests on the market are not FDA approved they may not be covered by insurance.
  • Antibody tests require a blood draw in a doctor’s office or hospital. We usually do everything we can to minimize blood draws in kids to avoid discomfort.

Looking forward:

The scientific community is working furiously to learn more about COVID-19 each and every day. We are hopeful that soon we will know more about COVID-19 antibodies and immunity. We are also hopeful that the FDA will review the tests on the market and guide us to which tests are the most accurate. We will continue to follow this issue closely to give you the best guidance and we will update you when our recommendations change.

For now, please continue to social distance, stay home if you or anyone you’ve been in contact with is sick, and wear a mask when social distancing is not possible.

Sources and Suggested Reading

https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/testing.html

https://www.scientificamerican.com/article/what-covid-19-antibody-tests-can-and-cannot-tell-us/

https://www.idsociety.org/news–publications-new/articles/2020/emphasizing-need-for-more-information-idsa-releases-antibody-testing-primer2/

Pediatric Multisystem Inflammatory Syndrome: What Parents Should Know

You may have seen recent news reports about a syndrome affecting kids during the COVID-19 pandemic called Pediatric Multisystem Inflammatory Syndrome. This new syndrome has only been recently detected and is still being investigated. We know some of these reports can be scary so we would like to try to separate fact from fiction and give you clear information.

The first reports about this syndrome came out of the United Kingdom at the end of April. Last week, the first U.S. cases were reported in New York City. Today, cases have been reported in Connecticut. While this new syndrome is serious, the good news is that the number of children affected so far is very small compared to the staggering number of people affected by COVID-19.

What is Pediatric Multisystem Inflammatory Syndrome?

This syndrome is a new health condition in which children who have had the coronavirus and recovered from it develop an excessive immune response that causes significant inflammation to their organs. Children with this syndrome have prolonged fever (greater than 5 days), their blood work shows inflammation, and they present with certain clinical findings such as:

  • abdominal pain
  • eye redness
  • enlarged lymph nodes or glands on one side of the neck
  • skin rash
  • red, cracked lips or a red “strawberry” tongue
  • swollen hands or feet

IMPORTANT: Children with this syndrome will look very ill. They will not bounce back from their fever with Tylenol or ibuprofen. They will have persistent symptoms over several days. This is NOT something you can easily miss.

What should I do if I think my child has this new syndrome?

If you are concerned that your child meets these criteria, but she only has mild symptoms, please call our office. If your child is very ill and it is an emergency, as always, please call 911.

If my child was sick before (either with a positive COVID test or not) should I get my child checked?

At this time, if your child has recovered from a prior illness and is doing well, there is no recommendation to do so. If your child becomes ill and has a high fever for several days in a row please call our office so we can evaluate him or her.

What is Kawasaki Disease and is it related?

Kawasaki Disease is a rare inflammatory disease that only occurs in children. It is still unclear how or if Kawasaki Disease and COVID-19 are related but they have similar symptoms and presentations.

Kawasaki Disease existed long before COVID-19, and we are not sure what causes the immune systems in these children to go into overdrive. In Kawasaki’s Disease, children present with a prolonged fever, some clinical symptoms (rash, strawberry tongue, swollen lymph nodes, swelling of hands and feet) and signs of inflammation throughout the body eventually including swelling of the blood vessels of the heart. Typically, there are about 3,000 cases per year in the United States. This is an easily treatable condition and typically children do not have long-term complications.

Is there treatment for Pediatric Multisystem Inflammatory Syndrome?

Doctors are working hard to determine the best treatment. If we suspect your child has this syndrome, we would likely direct you to a hospital or emergency room for evaluation. Patients with Kawasaki Disease or Pediatric Multisystem Inflammatory Syndrome need monitoring and specialist evaluation. Treatments for Kawasaki Disease are being tried for patients with this new syndrome. These treatments include supplemental doses of immunoglobulin (intravenous immunoglobulin, IVIG) and steroids. Rarely, children have gotten very sick and needed to be in an intensive care unit for fluids, medications for blood pressure, and assistance with breathing. While this new disease is serious, remember that children with this syndrome will look very ill and that this is NOT something you can easily miss.

Save the Children: Story Time

Save with Stories - HashtagWe know that families are enduring unprecedented times.  With families spending more time self-isolating at home, we wanted to share with you a wonderful opportunity to bring story telling into your home.  Save the Children in Fairfield is on the front lines of helping millions of kids during these times of social distancing.  That’s why Save the Children and No Kid Hungry have partnered to offer stories on Instagram and Facebook to provide fun and education to kids and parents stuck at home during the coronavirus outbreak.

The #SavewithStories campaign was started by Jennifer Garner and Amy Adams.  They currently have over 100 celebrities reading some of their favorite children’s books.  Kids love listening to them!  No donation is required.  It’s a great way to keep your kids entertained, or listen to their favorite stories together.

See Dr. Allison read “The Hungry Caterpillar” on the Save with Stories Instagram account.
Join us, along with @savethechildren and @nokidhungry, to #SAVEWITHSTORIES.

Dr. Allison - Willows Pediatrics, Save With Stories

To access more information about Save with Stories, please click the link below. Save the Children also is providing tools and tips you can trust for parents, caregivers, teachers and all those who care about children in crisis. The Save the Children Coronavirus Resource Center offers parents tips on how to talk to their kids about Coronavirus, activities and how to cope with extended school closures.

Save the Children and No Kid Hungry Logo

Links:
Save With Stories
Coronavirus Resource Center

 

Coronavirus: News and resources for families

We understand that families are concerned about coronavirus (COVID-19). All of us at Willows Pediatrics are carefully monitoring the situation on a daily basis. We are here to answer your questions, and let you know how we can help you and your family stay safe at the same time we address the more routine questions and concerns about your child’s health. The CDC website is a reliable source of information for news and updates on COVID-19: cdc.gov/coronavirus. Below are steps you can take to protect yourself, your family, and our community. While most families are already aware of them, they are still key:  Read More

Eastern Equine Encephalitis – Q & A

Mosquito bites and eastern equine encephalitis

Many families are aware that the Connecticut State Department of Health recently reported a mosquito infected with the virus causing Eastern Equine Encephalitis (EEE) has been detected in Fairfield County. While infections due to this virus are rare in people, two cases of EEE, one fatal, have also recently been reported in Connecticut shoreline towns. As many families are spending a great deal of time outside during the early fall, with possible exposure to mosquitoes, we would like to provide answers to questions about keeping your infants, children, and adolescents safe during this year’s EEE season. Read More