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.
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.
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.
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.
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.
