Parenting Advice

Should Kids Return to School in the Fall?

July 11, 2020

It is a question I am being asked regularly these days, by family, friends, and the parents of my patients…Should our kids be going back to school in the Fall? It is safe? As a Pediatrician and a mama of two, these are questions I have thought about and researched extensively over the past few weeks. 

The American Academy of Pediatrics has recently published a statement of guidance on this very issue: 

“The AAP strongly advocates that all policy considerations for the coming school year should start with a goal of having students physically present in school. These coordinated interventions intend ‘to mitigate, not eliminate, risk’ of SARS-CoV-2.”

“Mitigate, not eliminate.” This is an important distinction. It is not possible to eliminate the risk of this virus at this point (of note – SARS-CoV-2 is the name of the virus, while COVID-19 is the name of the illness it causes). It is too infectious. The goal from the beginning has been to slow the spread so the impact is less severe at one time and does not become overwhelming. This included the closing down of schools in March for much of the country, and the transition to online learning for our children. Was this necessary? I believe so. Is it necessary to continue this for the upcoming Fall semester? I do not believe so – and the purpose of today’s post is to help explain why. 

Will opening schools make the pandemic worse?

Keep in mind that daycares have been open throughout the pandemic – essential workers have been taking their babies and toddlers in to daycare while they continue to work. Temperature checks are done upon arrival to the buildings, all adult caretakers are wearing masks, surfaces are being sanitized even more than usual. There has not been a huge influx of COVID-19 cases in these children or in their daycare workers. 

While it is true that children are huge vectors, or transmitters, of diseases such as influenza, strep, and stomach viruses, this does not seem to be the case with COVID-19. Obviously, there is limited evidence on transmission of the virus through children – it just has not been around long enough to be studied extensively. But the research we do have suggests they are not the major causes of transmission – adults are. 

Children, thankfully, are far less affected by infection with the virus as well – in a review of cases in multiple countries, including  China, South Korea, Italy, the United States, Switzerland, and the United Kingdom, children only accounted for 1-5% of all cases. A very small minority of infected children require hospitalization. There has been a lot of media coverage of Multisystem Inflammatory Syndrome in Children, or MIS-C, but in truth this is a rare complication of COVID-19 infection in children (please see the following link for more information on MIS-C: https://www.cdc.gov/mis-c/). 

What are the risks of NOT opening schools?

School is not just for book learning. For the students that attend every day, it is so much more. It is a source of academic instruction, yes, but it is many more things as well:

  • A source of social and emotional skills development. Learning to interact with peers and adults other than parents is a crucial skill in development. Learning to identify facial expressions, body language, and how to interpret the actions of others emotionally are skills that require face-to-face interactions. 
  • A place of safety. For working parents, school provides a safe environment for children during the day, with close supervision by responsible adults. The alternative is supervision by older siblings or staying home alone, both of which carry risks to safety.
  • A source of nutritious meals. For some children, the meals they receive at school are vital parts of their overall nutrition, due to inadequate food sources and resources at home. Many school systems have continued to offer free lunches during quarantine but this requires students’ families to physically pick up these meals at the school, which can be difficult. The continued loss of these meals has the potential to be devastating to the nutritional health of children in need. 
  • A source of physical activity. For many children, the only physical activity they participate in is at recess, through Physical Education classes, or through school-sponsored sports. Without these measures, these children turn to electronics and indoor activities that do not promote good physical health. 
  • A place of therapy for developmental delays and mental health. Therapy and specialized learning plans for children with speech delays, physical disabilities, and learning difficulties is available to the students who need them, but this is just not feasible through online learning. In addition, many children utilize the school counselors for help with anxiety, depression, stress, loneliness, and other mental health issues. The absence of access to these counselors has had a detrimental effect on the mental health of these children. 

The impact of restriction of each of these factors on our children has been great, because they cannot be replaced by online learning modules or distance education programs. 

Children and adolescents are not immune to the stressors that have been magnified over the pandemic and their quarantine from schools. They are at a higher risk of exposure to physical and sexual abuse, substance use, and mental health issues including anxiety, depression, and suicidal thoughts.  Orthopedic injuries and fractures occurring at home have increased in children during this time. 

Children are very social beings. They thrive on social interactions with their peers and adults. The pandemic and quarantine have sharply reduced these social interactions and this has been shown to have a significantly negative effect. 

How can we make the schools safer?

The best ways to prevent spread of the virus in any setting are physical distancing, face coverings, and hand hygiene. The AAP suggests that if face coverings are worn, a distance of 3ft rather than 6ft is adequate for children. Parents should start teaching children to wear face masks now, so it will not be as difficult for them to wear them when school starts. Disinfecting surfaces and sanitizing classrooms and common areas will be important as well.  It is likely not feasible to take the temperature of every student who arrives at school. However, any child or teacher with fever should be instructed to stay home or should be sent home immediately if it develops during school hours.

Children and adolescents should continue to have well-child checkups done per their regular schedule to ensure health of all students and make sure vaccinations are up to date. Additionally, it is recommended they receive the influenza vaccine in the Fall when it is available. 

Obviously, in-school safety measures will look very different in preschool and Kinder than in high school. So what are the recommendations based on age?

Preschool:  let’s be honest. It will be impossible to keep children at this age apart from each other, let alone maintain a 6ft distance. Cohorting them together – keeping groups of children together and making sure they do not change classrooms and/or teachers regularly – can cut down on the number of social interactions they experience. Going outside as much as possible will also help. It will vital to teach them the importance of hand washing. Students may need to eat lunch at desks in the classroom. Teachers and other adults should wear face masks. 

Elementary School:  Consider cohorting students into groups that do not change. Face masks may be helpful but children will have to keep them on and avoid touching their faces, which is likely to be challenging. If possible to space desks apart, classrooms should do so. Students may need to eat lunch at desks in the classroom or outside when possible. Students, teachers and other adults should wear face masks. 

Middle and High School:  Again, keeping students together and having teachers move instead of students may be helpful in cutting down the number of points of contact with different individuals. Keep distance between individuals when possible. One-way hallways may help. Students may need to eat lunch at desks in the classroom or outside when possible. Students, teachers and other adults should wear face masks.

Are there special considerations?

Even with safety plans in place as schools reopen, there are students with high-risk medical conditions themselves or in their immediate family members that may need to continue online learning programs from home. According to the CDC, these high-risk individuals include those of any age with the following:

  • Chronic kidney disease
  • Immunocompromised from organ transplant
  • Obesity
  • Congenital heart disease
  • Sickle cell disease
  • Type 2 diabetes mellitus
  • Children with medically complex neurologic, genetic, or metabolic conditions

Students in these situations should work with their doctors and school administration for assistance in keeping them as safe as possible. 

It will also likely be necessary to take into consideration the number of cases in the community. Temporary closures of schools due to high rates of disease in the community may be needed.

Final thoughts

Watching the children in my life – both my own and those I care for in clinic- go through the stress of this pandemic has been heart-wrenching. I worry for their physical health, of course, but overall health is not limited to the effects of COVID-19 infection. It is the health of their bodies, the health of their minds, the health of their emotions, the health of the food they consume…it is the affects of all of this on their growth and development that we must take into consideration. It is with all of this in mind that I agree with and promote the AAP’s recommendation to reopen schools for in-person education in the Fall in whatever capacity is possible. It is my hope that with the information presented here, parents can rest a little easier as well. 

Resources for this article:

If you enjoyed this post, please sign up below to subscribe for blog emails. You will receive notification when new posts are available.

If you do not receive a welcome email upon registering, please check your spam folder.

Leave a Reply