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Saturday, August 28, 2021

Post #57 All Encompassing COVID Scenario Chart

This updated chart should help families know what to do for almost any COVID scenario.
The Low-Risk vs High-Risk chart is a BLUE FISH concept and it is NOT from the CDC. Because of the abundance of other viruses out there, we have found it far more helpful to use this criteria to help delineate those we consider "presumed" cases. The conservative thing to do is to consider even one Low-Risk symptom COVID until otherwise proven. Of course testing can always help as well.





Friday, August 20, 2021

Post #56 Back-to-School Advice for the COVID-19 Delta Surge

It is with a mix of frustration and hope that I am writing a second back-to-school blog about COVID-19.  At this same time last year, there were so many unknowns about the pandemic and how to handle returning to school. The uncertainty led to fear, which in turn fueled a respect for the virus, which unfortunately is lacking in the current decision-making to ban mask mandates. The irony is we have so much more science and data than we did at this time last year that we could and should be smarter about our policies. Nonetheless, with some children vaccinated, and more to become eligible soon, this next school year should be better than the last.

 

Make no mistake, COVID-19 is alive and kicking and stronger than ever, buttressed by the Delta variant - especially among those who are unvaccinated, which sadly includes all children less than 12 years of age.

 

If the vaccine were already available to all school-age children, it would make our decisions much easier to navigate – especially for those who want to immunize their children and mitigate COVID-19 risk.

 

For those who do not plan to vaccinate their kids, the status quo isn’t any different from a “choice” standpoint, but even these students would benefit from their peers being vaccinated as each shot administered brings the entire student body one step closer to herd immunity. 

 

Unfortunately, we begin this school year with a large portion of our students ineligible for the vaccine, which is why masking is so very important, especially to protect those children with underlying health issues.

 

If the pandemic has done nothing else, it has exposed how differently each family approaches risk. As a pediatrician, we see this everyday in our office, as we navigate choosing car seats, SIDS concerns, medications, tests, and different therapies. Each choice has a tradeoff and every family has their own approach, which is why medicine is truly as much an art as it is a science.

 

Accommodating the varying risk appetites of several hundred families as schools reopen, especially in this polarized political climate, is a herculean task with no easy answer. No matter the policy, there will be naysayers much like the parable of the old man, son, and the donkey. But at the end of the day, decisions have to be made and unlike figuring out who sits on the donkey, science and data can and should help guide our thought process. Importantly, let’s appreciate our teachers, caregivers, and administrators no matter how things play out. 

 

In writing my advice for returning to daycare and school, I have come up with some parameters to assist in decision-making. I recognize there are many caveats to each family’s situation as they come up with the best solution for their own children. One important thing to bear in mind is that our decisions not only affect our children, they affect your neighbor's and friend's children too (and vice versa).

 

Daycare

 

1.    Until the current delta variant surge lessens, when possible I think it is preferable to forego daycare. This may only be for a short time until things improve. I don’t have a clear mathematical answer as to when to return, but a reasonably safe criteria would be when the ICU/hospital capacity is no longer critically full at the children’s hospitals in Houston as it is now. 

2.    For those who are unable to pull their children from daycare, if the facility is following best practices for COVID-19 and the majority of employees are vaccinated and all the adults are masking, I think it is reasonably safe to continue attending daycare. Don’t be afraid to ask the staff about masking policies and overall staff vaccine status – it is important to advocate for your child! Importantly, it would behoove the parents to both get vaccinated as there is a real risk in their infant bringing COVID-19 home to them.

3.    For all children 2 years and older, who don’t have a medical reason not to wear a mask, I would highly encourage mask wearing, even if it is not mandated and others are not complying. Be sure to use a high quality mask.

 

Elementary School/Middle School

 

1.    How safe school is without mandatory masking remains to be seen. Ideally, masks would be mandated other than for those medically unable to wear them. But even without mandatory masking, I think it is reasonable to send children to school, but would highly recommend they wear a high quality mask, regardless of whether other children do or not.

2.    The COVID-19 vaccine should drop down to 5 years of age hopefully by this fall/winter, and when it does I would encourage everyone to get their children protected as soon as possible. Same as daycare, it would behoove the parents to become vaccinated ASAP.

3.    Until the delta variant surge lessens, it may be wise to limit indoor group activities with other children outside of school hours. The more indoor time your child spends with other unvaccinated children, the greater the risk of catching COVID-19, and while the test positivity rate remains high during the surge, aside from school which I deem essential, it is best to reduce exposure otherwise. As things improve, such as the ICU capacity no longer being critically full, it would be reasonable to consider returning back to certain indoor activities. Group outdoor activities (ideally masked) for the most part should be safe, even now.

 

High School

 

1.    The key is to get vaccinated. Every pediatrician I know has vaccinated their teenager(s). Even with the real risk of transient myocarditis (inflammation of the heart), we all recognize the risk/benefit ratio heavily favors immunizing our teenagers. If your teen is vaccinated, I think they can participate in all school activities safely.

2.    Even if your child is vaccinated, I would still encourage them to wear a mask, more for the sake of others, as they themselves will be fine, but they could potentially spread the virus to others who are vulnerable and/or immunocompromised. For those who are unvaccinated, they absolutely should wear a mask.

3.    Despite the delta variant surge, those who are vaccinated should be quite safe, but they can become vectors for spreading the virus. Help them to be aware of this and should they become exposed and/or symptomatic, test for COVID appropriately and should they test positive, have them properly isolate to help mitigate spread of the virus. The better we are all proactive about the pandemic, the sooner things will improve.

 

The bottom line is that school for the most part is reasonably safe for all children, but best practices such as masking and getting vaccinated when eligible are paramount to reducing real risk. Daycare is reasonable, even now, but when possible, waiting out the current surge would be preferable.

 

Risk appetite is different for every family, but keeping our children safe is a common goal that everyone can rally behind.  As much as the pandemic has already stolen from the precious childhoods of our families, it is crucial that we band together as a community to protect this upcoming school year.

 

Saturday, May 8, 2021

Post #55 COVID-19 Vaccine for 12 to 15 Year Old Adolescents

The Pfizer vaccine will soon be offered to 12-15 year olds, raising a mild conundrum for parents.

Should they skip the vaccine, given that most children have fared well when infected with COVID-19 (many already having been infected)? 

 

Or should they immunize their child(ren), even though the vaccine is relatively new and doesn’t have a long track record?


Vaccines have had their missteps, most notably the recalled RotaShield immunization in 1999. However, the recall of RotaShield and the recent temporary pause of the Johnson&Johnson COVID-19 vaccine should instill confidence in the robustness and capability of the Vaccine Adverse Event Reporting System.


255 million doses of the COVID-19 vaccine have been given in the United States to date, with over one-third of the population being fully immunized. 1 out of 3 people you see today will have completed their vaccines, and if the immunizations were causing serious side effects, the data should have captured it by now.


In March, Pfizer reported results from a study with 2,260 children ages 12 to 15. None who received the vaccine contracted COVID-19. There were 18 cases of COVID-19 among children who received the placebo.


The vaccine works in adolescents.


I recently attended to a 15 year old male varsity soccer player with no past medical history, who ended up in the ICU for 10 days due to COVID-19 pneumonia. Thankfully, he survived. The vaccine would have prevented this.


There have been over 275 deaths in children 18 years and younger in the United States thus far from the pandemic. 


And as new variants of COVID-19 infiltrate society, the onus to get protected increases. Even if your child has already been infected with COVID-19, the benefits of broader and longer protection make it worthwhile to receive the vaccine.


As a pediatrician and father of three, it is quite clear that the benefits of the vaccine outweigh the potential unknown risks. 


My 17 year old has received both doses of the Pfizer vaccine, my 15 year old (who contracted a mild case of COVID-19 last summer) will receive it as soon as it is available next week, and my 13 year old received the Moderna vaccine via a clinical trial earlier this year (we are fairly certain based on his reaction to the injections it was not the placebo). 


Risk calculus with a new vaccine is never easy. But parents can take a large amount of comfort in the data we have collected thus far.


Presently, the safety data of 255 million given doses combined with the risk of death and unknown long-term effects from a COVID-19 infection clearly outweigh the unknown specter of side effects from receiving the vaccine (and with each passing day there is more and more data supporting the safety of the vaccines).


I strongly encourage all parents to protect their adolescents as soon as the vaccine is available. The sooner we all become protected, the sooner we can put this pandemic behind us.

Sunday, March 28, 2021

Post #54 Summer Camp Guidance During the COVID-19 Pandemic (2021)

With the widespread deployment of COVID-19 immunizations and the knowledge that children are at far lower risk for serious COVID-19 disease and complications, it may be tempting to sign your children up for summer camp. 

However, please bear in mind that because the COVID-19 vaccine will likely not be available for children (under 16yo) until late 2021/early 2022 and with the spread of new COVID-19 variants, there is still real risk to children from the pandemic.

 

Some questions to ask yourself in choosing whether or not to send your child to summer camp this year:

 

1.    How healthy is your child? Do they have any chronic health conditions that would put them at an increased risk for significant illness from COVID-19, such as (but not limited to) diabetes, asthma, or an immune deficiency?


2.    How important is this camp to your child? If they are ambivalent about going, it may not be worth the increased exposure. If they have been looking forward to it for a long time, a serious family discussion may be warranted.


3.    Can you defer this camp until next year and substitute a safer option this year?


4.    An overnight camp would post the highest risk due to indoor close quarters. Is there a day camp alternative as a safer option this year?


5.    What safety measures is the camp taking against COVID-19? Is there a screening process? What happens if someone get sick at camp? Will they be following CDC guidelines? 


6.  If there remain unvaccinated individuals at home, are they at risk for serious disease if the child brings COVID-19 home from camp?

 

While summer camps create some of the best memories of childhood and friendships that last a lifetime, the pandemic still demands our attention. Although we are almost out of the woods with the COVID-19 pandemic, until children are vaccinated, risks must still be weighed against the benefits of camp. 

 

In the midst of a pandemic, there is no easy one-size-fits-all answer in deciding whether to send your child to camp or not. 


Hopefully, the questions above will provide each family a framework in determining their best plans for the summer.

Sunday, January 3, 2021

Post #53 Parenting by Paul David Tripp: Ownership Parenting vs. Ambassador Parenting

A big picture worldview excerpt from Paul Tripp’s book Parenting really blew my mind this morning. It really helps to put into perspective how we should approach parenting and what our responsibilities truly are and what we can and should turn over to God.

Too many parents saddle themselves with unnecessary and unrealistic burdens about their role in raising their children, which can lead to fractious relationships and sinking self-worth (for both parties).

 

The passage below is in the introduction of Paul Tripp’s book and it was so overwhelmingly insightful, I wanted to share this with everyone who has children, especially if you are struggling. The contrast of ownership parenting vs. ambassador parenting is succinct yet powerful.

 

I believe this information is helpful for all families, but in particular if you are a Christ follower, these parenting principles can help redefine your relationship with your children and allow you to properly understand your identity, work, success, and reputation as a mother or father.

 

Parenting by Paul David Tripp

 

Ownership parenting is motivated and shaped by what parents want for their children and from their children. It is driven by a vision of what we want our children to be and what we want our children to give us in return. It seems right, it feels right, and it does many good things, but it is foundationally misguided and misdirected and will not produce what God intends in the lives that he has entrusted to our care. 

 

There, I’ve said it! Good parenting, which does what God intends it to do, begins with this radical and humbling recognition that our children don’t actually belong to us. Rather, every child in every home, everywhere on the globe, belongs to the One who created him or her. Children are God’s possession (see Ps. 127:3) for his purpose. 

 

That means that his plan for parents is that we would be his agents in the lives of these ones that have been formed into his image and entrusted to our care. The word that the Bible uses for this intermediary position is ambassador. It really is the perfect word for what God has called parents to be and to do. 

 

The only thing an ambassador does, if he’s interested in keeping his job, is to faithfully represent the message, methods, and character of the leader who has sent him. He is not free to think, speak, or act independently. Everything he does, every decision he makes, and every interaction he has must be shaped by this one question: “What is the will and plan of the one who sent me?” 

 

The ambassador does not represent his own interest, his own perspective, or his own power. He does everything as an ambassador, or he has forgotten who he is and he will not be in his position for long. Parenting is ambassadorial work from beginning to end. It is not to be shaped and directed by personal interest, personal need, or cultural perspectives. 

 

Every parent everywhere is called to recognize that they have been put on earth at a particular time and in a particular location to do one thing in the lives of their children. What is that one thing? It is God’s will. Here’s what this means at street level: parenting is not first about what we want for our children or from our children, but about what God in grace has planned to do through us in our children. 

 

To lose sight of this is to end up with a relationship with our children that at the foundational level is neither Christian nor true parenting because it has become more about our will and our way than about the will and way of our Sovereign Savior King.

 

Owner or Ambassador? 

 

I therefore distinguish between these two models of parenting in four areas that every parent somehow, in some way, deals with: identity, work, success, and reputation. 

 

The way you think about and interact with these four things will expose and define who you think you are as a parent and what you think your job is in raising your children. 

 

1. Identity: Where you look to find your sense of who you are. 

 

Owner: Owner parents tend to look to get their identity, meaning, purpose, and inner sense of well-being from their children. Their children tend to be saddled with the unbearable burden of their parents’ sense of self-worth. 

 

I have to say this: parenting is a miserable place to look for your identity, if for no other reason than the fact that every parent parents sinners. Children come into the world with significant brokenness inside of them that causes them to push against the authority, wisdom, and guidance of their parents. 

 

Parents who are looking to their children for identity tend to take their children’s failures personally, as if they were done against them intentionally, and respond to their children with personal hurt and anger. But the reality is that God simply does not give you children in order for you to feel that your life is worthwhile. 

 

Ambassador: Parents who approach parenting as representatives come to it with a deep sense of identity and are motivated by meaning and purpose. They don’t need to get that from their children because they have gotten it from the One whom they represent: the Lord Jesus Christ. 

 

Because of this they are freed from coming to their children hoping that they will get from them what no child is able to give. They are freed from asking family life to give them life because they have found life and their hearts are at rest. Because of this, they are now freed to forget themselves and parent with the selflessness and sacrifice that ambassadorial parenting requires. 

 

2. Work: What you define as the work you have been called to do. 

 

Owner: Owner parents think that their job is to turn their children into something. They have a vision of what they want their children to be, and they think that their work as parents is to use their authority, time, money, and energy to form their children into what they have conceived that they should be. 

 

I have counseled many children who were breaking under the burden of the constant pressure of parents who had a concrete vision and were determined that these children would be what these parents had decided they would be. 

 

Owner parents tend to think that they have the power and personal resources to mold their children into the children they envision. 

 

Ambassador: Parents who really do understand that they are never anything more than representatives of someone greater, wiser, more powerful, and more gracious than they are know that their daily work is not to turn their children into anything. 

 

They have come to understand that they have no power whatsoever to change their children and that without God’s wisdom they wouldn’t even know what is best for their children. 

 

They know that what they have been called to be are instruments in the hands of One who is gloriously wise and is the giver of the grace that has the power to rescue and transform the children who have been entrusted to their care. They are not motivated by a vision of what they want their children to be, but by the potential of what grace could cause their children to be. 

 

3. Success: What you define success to be. 

 

Owner: These parents tend to be working toward a specific catalog of indicators in the lives of their children that would tell them that they have been successful parents. Things like academic performance, athletic achievement, musical ability, and social likability become the horizontal markers of how well they have done their jobs. 

 

Now these things are not unimportant, but they simply are unable to measure successful parenting. Good parents don’t always produce good kids, and parents should constantly be asking themselves where they get the set of values that tell them whether they have “good” kids or not. I am afraid that many good parents live with long-term feelings of failure because their children have not turned out the way they hoped. 

 

Ambassador: These parents have faced the scary truth that they have no power at all to produce anything in their children. Because of this they haven’t attached their definition of successful parenting to a catalog of horizontal outcomes. 

 

Successful parenting is not first about what you’ve produced; rather, it’s first about what you have done. Let me say it this way: successful parenting is not about achieving goals (that you have no power to produce) but about being a usable and faithful tool in the hands of the One who alone is able to produce good things in your children. 

 

4. Reputation: What tells people who you are and what you’re about. 

 

Owner: Owner parents unwittingly turn their children into their trophies. They tend to want to be able to parade their children in public to the applause of the people around them. This is why so many parents struggle with the crazy, zany phases that their children go through as they are growing up. 

 

They’re not so much concerned about what that craziness says about their children, but what it say about them. Children in these homes feel both the burden of carrying their parents’ reputation and the sting of their disappointment and embarrassment. 

 

Owner parents tend to be angry and disappointed with their children, not first because they’ve broken God’s law, but because whatever they have done has brought hassle and embarrassment to them. 

 

Ambassador: These parents have come to understand that parenting sinners will expose them to public misunderstanding and embarrassment somehow, someway. They have come to accept the humbling messiness of the job God has called them to do. And they understand that if their children grow and mature in life and godliness, they become not so much their trophies, but trophies of the Savior that they have sought to serve. 

 

For them, it’s God who does the work and God who gets the glory; they are just gratified that they were able to be the tools that God used. 

 

If you found this information as powerful as I did, I encourage you to read the rest of the book. Paul Tripp is one of my favorite Christian authors and his insight into parenting is both biblical and practical.

Wednesday, September 23, 2020

Post #52 Overkill: When Modern Medicine Goes Too Far by Paul Offit M.D.

Overkill: When Modern Medicine Goes Too Far by Paul Offit M.D.

I am admittedly a huge fanboy of Paul Offit, an infectious disease guru at Children's Hospital of Philadelphia, one of the preeminent pediatric hospitals in the world. 


His latest book Overall: When Modern Medicine Goes Too Far, is a collection of medical facts that are already known to the well-read individual, but fly in the face of wrongly-held, out-dated, commonly-believed medical concepts. 


The majority of the incorrect information was previously considered the standard of care, but newer and better science and studies have clearly demonstrated updated - often conflicting - medical truths.


I have summarized some of the more salient facts here as a quick read for the over-worked and under-rested parent, so that they can take better care of their precious little ones without having to read the whole book (although I highly recommend it). 



Chapter 1: Treating Fever Can Prolong or Worsen Illness


Fever-reducing medicines are found to prolong and worsen infections in experimental animals and people. Societies that use fever-reducing meds suffer a 5% increase in flu cases and deaths. Researchers have estimated that avoiding fever-reducers during a flu season would save about 700 lives in the USA and about 40,000 lives worldwide every year.


In my pediatric practice I only recommend fever-reducers for two reasons:


  1. If a fever is affecting a child’s activity level to the point they refuse to drink, fever-reducers may help perk a child up to encourage fluid intake to stay hydrated
  2. As a litmus test. The activity level of a child is a great way to assess how serious an infection truly is. If a child’s activity level is down, a fever-reducer can help perk them up (even if for just 30 minutes), which should reassure a parent that their fever source is very likely non-serious. If a child's activity level continues to be depressed despite taking a fever-reducer, it is a good idea to touch base with your pediatrician.


Chapter 2: Finishing the Antibiotic Course is Often Unnecessary


The thinking used to be that antibiotic courses needed to be fully completed per doctor’s order to prevent antibiotic resistance from occurring. Many health organization including the World Health Organization in 2016 used to ingrain this idea into doctor's and patient's heads alike. 


However, multiple studies for many different types of infections in both adults and children have shown that finishing the antibiotic course is unnecessary


Pediatric Urinary Tract Infections


In 2002, Australian investigators reviewed the results of ten studies of 650 children, and they found that for a bladder infection there was no difference between 2 to 4 or 7 to 14 days of antibiotics when measured by the elimination of bacteria from the urine and for resolution of clinical symptoms.


Other Pediatric Infections


Studies now show that for adults and as well for children old enough to describe their symptoms, the best advice for diseases such as bladder infections, kidney infections, pneumonia, sinus infections, skin infections, appendicitis, and ear infections is to stop the course of antibiotics when symptoms begin to improve. 


When the immune system, working synergistically with the antibiotics, has defeated the bacteria, the signs and symptoms of inflammation, such as fever and accompanying symptoms will abate and at this point the bacteria are no longer actively reproducing.



Chapter 3: Antibiotic Drops Don’t Treat Pinkeye


About 70% of people who develop conjunctivitis (pinkeye) will visit their doctor. Most will receive an antibiotic that costs the healthcare system between $377 and $857 million each year!


The most common cause of conjunctivitis is allergies - every year up to 40% of Americans suffer from allergic pinkeye. The second most common cause is viruses - about 80% of infectious pinkeyes are caused by viruses. The least common cause of pinkeye is bacterial.


A simple rule for differentiating the 3: allergic is itchy, viral is accompanied by other cold symptoms, and bacterial causes thick, purulent discharge. Unfortunately there is a lot of overlap. But even so, the studies show that antibiotics don’t treat bacterial conjunctivitis.


In 2012, researchers from the University of Edinburgh reviewed all of the existing studies on conjunctivitis and they found two high-quality studies, one of which was performed in children.


In July 2005, researchers from Oxfordshire in the U.K. divided 320 children into 2 groups. One group was given antibiotic drops every 2 hours for the first day and then 4 times a day until the infection resolved. The other group was given a placebo eye drop. Seven days later, 86% in the antibiotic group and 83% in the placebo group were cured - an insignificant difference.


The adult study from Switzerland and the Netherlands found the same result.


As a consequence of these studies, the American Academy of Ophthalmology now recommends watchful waiting for those suffering from acute pinkeye, whether it’s caused by bacteria or not.


Complications of using antibiotic eye drops include irritation, emergence of antibiotic resistant strains, and expense of the medication. In general, patients are probably better off using cheaper over-the-counter lubricating eye drops or cold compresses for comfort.


Unfortunately (and incorrectly), many work places and schools will not allow return until drops have been utilized for 24 hours.



Chapter 8: Embrace Allergenic Foods for Infants


In 2000, medical advisory boards in the United States put out recommendations to avoid peanut-containing foods early in life.  By 2008, overwhelming evidence proved that this recommendation was useless and not decreasing the incidence of peanut allergies.


In 2015, researchers from the U.K. published a groundbreaking study called the LEAP trial, for  “Learning Early About Peanut Allergies.”


Between 2006 to 2009, 640 infants between 4 and 11 months old who had eczema or egg allergies or both were divided into 2 groups. One group consumed 6 grams of peanut protein per week until age 5; the other group was instructed to completely avoid all peanut-containing foods. 


At the end of the study there was an 86% reduced risk of developing peanut allergies in the group that was fed peanuts early on. In other words, eating peanuts early in life decreased the risk of peanut allergies later in life.   



Chapter 10: Avoid Reflux Medicines for Fussy Babies


All babies cry and all babies spit up, but very few require treatment for gastroesophageal reflux disease (GERD). If they are gaining weight appropriately, there is low cause for concern.


Evidence clearly shows that reflux medicines do not work to treat fussy babies. In fact reflux medicines are known to cause several concerning side effects:


  1. Decreased stomach acid which increases the risk of bacterial infections such as pneumonia and necrotizing enterocolitis. Acid kills bacteria, so reducing it increases the risk of infection.
  2. Reflux medicines change the healthy bacteria living in our intestines (the microbiota)  which can have downstream effects on obesity, allergies, diabetes, and other medical problems.
  3. More recently, a study of 850,000 babies found that those who received reflux meds were at higher risk of bone fractures.


It is much safer to burp frequently, position upright after feeds, thicken feeds, and if breastfeeding avoid milk, eggs, coffee, and spicy foods - all of these things can be discussed in more detail with your pediatrician.



Chapter 18: Don’t Ice Sprains


The acronym RICE (rest, ice, compression, elevation) was originally developed by a Baylor College of Medicine doctor named Gabe Mirkin. Because of the easy-to-remember acronym, it was widely used as the standard of care for sprains. However, clear evidence since has demonstrably refuted the RICE method, leading to Dr. Mirkin himself no longer recommending to follow his original advice.


Multiple well-done studies from New Zealand, Ireland, Amsterdam, and Taiwan have shown that icing sprains delays healing.


The key to healing is inflammation, which recruits helpful immune cells to the damaged area by increasing blood flow. Increased blood flow also promotes the manufacturing of collagen, which is necessary to create new, healthy ligaments and muscles.


Therefore, anything reducing blood flow, such as rest, ice, compression, and elevation, actually stymies the healing process. Of course all or these things lessens the initial pain, so people are still tempted to employ these techniques. However, for faster healing, you are better off using warm compresses, stretching, and movement to promote blood flow to the injured area.



The remaining chapters are not quite as relevant to pediatrics (or the truth is better known - such as the teething chapter) but they are equally compelling. I have listed them below as the chapter titles themselves express the salient information which can be expounded upon by reading the actual book. The book itself is a quick read and well catalogued with studies that drive each point home. It is time well spent and the dividends will lead to better health for the whole family.


Modern medicine continues to progress at an exponential rate, but as Paul Offit clearly demonstrates, sometimes it is important to take a breath and make certain that in proactively treating things we are not causing more harm than good.



Chapter 4: Vitamin D Supplements Aren't a Cure-all


Chapter 5: Supplemental Antioxidants Increase the Risk of Cancer and Heart Disease


Chapter 6: Testosterone for "Low T" is Dangerous and Unnecessary


Chapter 7: Baby Aspirin Doesn't Prevent First Strokes or First Heart Attacks


Chapter 9: The False Security of Sunblock


Chapter 11: Prostate Screening Programs Do More Harm Than Good


Chapter 12: Thyroid Cancer Screening Programs Do More Harm Than Good


Chapter 13: Breast Cancer Screening Programs Aren't Exactly as Advertised


Chapter 14: Heart Stents Don't Prolong Lives


Chapter 15: Surgery For Knee Arthritis is Unnecessary


Chapter 16: Don't Remove Mercury Dental Fillings


Chapter 17: Vitamin C Doesn't Treat or Prevent Colds


Chapter 19: Teething Doesn't Cause Fever

Saturday, August 1, 2020

Post #51 Our Family’s School Decision Making Process

My boys do not want to wear pants.


A small factor, but part of the reason they campaigned for remote learning. My daughter, who generally prefers clothing, remained on the fence.


The remote vs. in-person learning decision has so many different factors it is very difficult as a pediatrician to give families a single clear answer.


As new data emerges, it further confounds a family’s decision that seemed crystal clear just 2 internet articles ago.


Several people have asked point blank, “What are you doing for your own kids?”

If I have left your text unanswered or have not replied to your email or Facebook comment, I apologize! A binary, “remote” or “in-person” response seemed too hasty and irresponsible.


While every family will have their own personal best answer, I hope sharing how my wife and I arrived at our decision will benefit the process for other parents.


To start off, some demographics are in order:


Our children are 12, 14, and 16 years of age – boy (7th grade), boy (9th grade), girl (11th grade) respectively. I am a pediatrician and my wife is a former elementary school teacher and now stay-at-home mom.


We are zoned to Cy-Fair Independent School District and the schools our children attend are Title 1 schools, with an eclectic mix of socio-economic backgrounds.


Children’s Health


The first and most important factor in making our decision was the health of our children. As of the writing of this blog, the overall risk to healthy children from COVID-19 is very small.


The CDC keeps a provisional death count by age, and as of August 1, 2020, there have been a total of 42 deaths in children younger that 15 years for the entire country. To put things in perspective there have been 185 deaths due to influenza in children younger than 18 for the 2019-20 season. Overall, children have fared extremely well with the pandemic in terms of deaths and medical complications.


If I were only factoring in the health risk to our children, I would feel safe sending them to school, given a few caveats that I will get to later in this blog.


Family’s Health


Our home is solely occupied by our nuclear family (no grandparents) and everyone is in relatively good health with no underlying health conditions.


If we had people over 60 living at home (the older the more concerning) or if someone at home had a serious underlying medical problem, I would be much more concerned about in-person learning.


The newest data from Chicago shows that, contrary to earlier studies, young children do get infected and do have high levels of virus.


Further, in a study from a Georgia sleep-away camp of all ages, of 344 campers and staff for whom tests were available, 260 tested positive after just a few days at camp.


The vast majority of kids may not get seriously ill, but it appears they can bring it home, and as such, an important part of the decision making process has to include the risk to family members.


Community Spread


The initial data from Europe, Asia, and Australia was quite comforting in terms of community spread risk from reopening schools. It is important to note that local COVID-19 caseload numbers were low and under control in the countries that reopened schools.


The recent data from Israel, South Korea, Georgia, and Chicago has rained on the parade.

Epidemiologists all agree that schools will contribute to spread in some fashion, but to what extent is still up for debate. The pendulum appears to be swinging towards children being as infectious as adults.


Ultimately, regardless of children’s infectiousness, the more important factor affecting community spread will be a school’s ability to follow certain protocols: masking, social distancing, and sanitizing. If these measures are rigorously followed, community spread should be minimal.


Additionally, it will be prudent to pay attention to local COVID-19 statistics. If caseloads are rising and hospital are overwhelmed, school closures may be necessitated.


Another important factor in community spread will be the population density at each school. As more families opt out of in-person learning, it will commensurately improve the risk for those who do attend, including the risk to our educators, many of whom will not have a choice but to be physically present.


For those who have the ability to do so, I encourage you to strongly consider remote learning to lessen the risk for those who cannot.


Educational Value


A child’s aptitude for learning remotely has to be a major factor. For some children, the value of in-person school is enormous.


Can they learn independently?


Can they focus for extended periods of time?


Will the lack of peer stimulation hamper their education?


Continuity


Attending in-person school may get interrupted from time-to-time should quarantine and isolation protocols be triggered by someone in the classroom testing positive for COVID-19.


This may force remote learning for periods of time, disrupting the continuity and flow of school.


For those kids who do not do well with change, remote learning may be the better option.


Family Decision


These were some of the variables that my wife and I contemplated as we arrived at our decision. We let our children voice their opinions as well, which we factored in.


So what did we decide?


I thought my wife said it perfectly, so with her permission, I have copied her words from her recent Facebook post.


“We are going online for the first grading period for the following reasons:


· Online instruction will be live and interactive (as opposed to the video lessons we did last spring).


· My kids are able to focus fairly well with the online learning.


· They actually are not going insane with the lack of peer interaction (they see some friends occasionally, with safety measures in place). I know this is a big deal for a lot of kids, and I totally get it.


· Our school community is around 70% low income. A lot of those families would benefit from in-person instruction, so we will be 3 less kids on campus to try to help with the numbers.


· If school has to shut down, we won’t have to transition from in-person to online instruction (I still can’t wrap my head around what this will look like).


· Masking for long periods of time is hard. So is wearing pants.


So this is our decision. We will do this for the first grading period and see how it goes. Stuff is constantly changing, so it’s hard to plan ahead this far in advance. We still have a lot of questions about how things will work, but we just have to wait and see.”


As my wife mentioned, this is a decision in flux that may change as new data or family issues emerge.


But at least for the first six weeks, my boys will be pants-less.