奥密克戎对儿童有哪些影响，来看看五位儿科医生的解答
随着奥密克戎变异病毒引发的病例持续激增，住院率也在上升，其中也包括儿童。种种问题也一直存在，比如新病毒给孩子造成的风险有多大，父母如何保护脆弱的孩子，以及保护孩子时应用的规则是否有所不同。
《财富》杂志采访了五位儿科医生，讨论了科学、风险，以及如果孩子核酸检测结果呈阳性应如何照顾。
有多少孩子生病了？
这取决于具体地点。新冠疾病专家珍妮佛·莱特医生在纽约大学兰贡医院(New York University Langone Hospital)工作，她表示目前感染流感的儿童比感染新冠的多。
“纽约州有50家可住院治疗的儿科医院，是纽约州不是纽约市，”莱特告诉《财富》杂志。“奥密克戎传染性非常强，目前不管是儿童还是成人，奥密克戎感染率都很高，不过儿童发展为重症的情况很少见。”
加拿大医学会(Canadian Medical Association)主席、加拿大育空地区儿科医生凯瑟琳·斯马特医生说，当地还没发现孩子感染密克戎变异病毒。
然而她指出，加拿大通常比美国落后三到四周，所以预计数字很快就会上升，而且由于奥密克戎传染性极强，意味着会有更多孩子感染。“孩子的情况与所在社区事情一致。”斯马特说。
过去一个半月里，芝加哥柯默儿童医院（Comer Children’s Hospital）的儿科医生奇迪玛·阿科洛努在医院里看到的儿童比整个疫情期间都多。
阿科洛努告诉《财富》杂志：“经常有年纪很小的孩子检测出阳性而且有症状，尤其是青少年，需要呼吸机的几率跟成年人差不多。”
“波士顿儿童的感染率肯定在上升，”马萨诸塞州总医院（Massachusetts General Hospital）青少年和青年医学主任斯科特·哈德兰说。“但值得强调的是，并不是所有的孩子都因为感染新冠病毒入院。孩子因为别的原因去医院时，会自动接受检测。在社区里，还有孩子们住的地方，不可避免有大量新冠病毒。”
孩子们的病有多严重？
哈德兰说，目前还没有正式数据，当前的数据只是传闻。
“人们普遍的关注点是，孩子即便感染也不会像其他年龄段的人一样严重，但仍然可能出现重症，还有可能出现多种并发症，”他说。“即使是轻症，也存在感染新冠后久病不愈以及多系统炎症综合症的风险。”
不过医生们表示，总体来说感染病毒的儿童状态比成年人好。免疫反应有两种形式，一种是人类与生俱来的先天免疫；另一种则是人类接触疾病后获得的适应性免疫。莱特说，孩子们更容易抵抗冠状病毒，因为先天免疫能力比成年人强。
她补充说，新冠病毒对儿童健康的影响与流感相似。事实上，流感对儿童更致命。
“疫情爆发以来，548名儿童死于新冠病毒，与流感严重的年份里死亡率大致相当，”她说。“没人认真讨论这一点，因为把新冠跟流感对标属于禁忌。也确实不该如此对比，因为成年人死亡率并不一样。不过对孩子来说，新冠与流感的影响相似，重症非常罕见，死亡率大约是每100万人出现两例。
“不管具体什么情况，只要是感染新冠病毒，孩子总比成年人情况好一些，成年人比老年人情况好一些，”纽约大学兰贡医学中心哈森菲尔德儿童医院（Hassenfeld Children’s Hospital）儿科传染病科主任亚当·拉特纳告诉《财富》杂志。“单个来看，儿童患重症的可能性远低于成年人。如果大量人口感染，儿童会出现更多重症病例，即使对单个儿童来说比较罕见。
“虽然新冠病毒对成年人的影响肯定比儿童更严重，总体来说并不意味着儿童不会出现重症，”拉特纳说。他还补充说，尽管各年龄段儿童患重症的几率都很低，但未接种疫苗的儿童患重症的几率要高得多。
新生儿受保护吗？
莱特9月在《美国妇产科期刊》（American Journal of Obstetrics & Gynecology）发表的最新研究称，如果孕妇接种了疫苗，进入婴儿体内的脐带血中含有大量抗体。
“接种疫苗和加强针的母亲可在婴儿出生头几个月提供保护，”莱特说。“母乳喂养也能传导抗体，但量级赶不上孕期接种疫苗。”
不过对于奥密克戎变异病毒来说，情况怎样还不清楚，哈德兰表示，“因为我们现在对变异病毒的情况了解太少。”
应该带孩子去看儿科医生还是去急诊室？
和其他疾病一样，父母应该做出最合适的判断。
“一些检测呈阳性的孩子两处都不必去，”拉特纳说。“如果没出现呼吸困难或持续高烧，不一定需要治疗。”不过，当下急诊室都很忙，所以最好是先联系儿科医生。“很多医生都很乐意协助做决定，也能实现分诊。”
斯马特说，新冠病毒是呼吸系统疾病，也就是说父母应该像对待流感、支气管炎等其他呼吸道病毒一样对待新冠病毒阳性的孩子。如果孩子呼吸困难，就该去医院。
“如果孩子看起来喘不过气，或者呼吸急促脸色不好，那就去医院，”她说。其他有必要去医院的症状包括：孩子昏昏欲睡，反应不正常，或者脱水而且不愿喝水。
“急诊室只会选择一些方式治疗，”阿科洛努说。“如果孩子呼吸非常困难需要用其他肌肉代偿，可能需要插管。我们会给鼻腔插管提供更多氧气，避免呼吸困难。”
呼吸减弱的迹象包括喉部、锁骨附近、腹部或胸腔可见的喘息。孩子如果哭不出眼泪，也可能是脱水的迹象。
“治疗新冠病毒与其他病毒一样，多数病例只是需要在家认真照顾，”阿科洛努说。
可以给孩子吃退烧药吗？
疫情初期，一些医生对感染新冠的儿童服用退热药表示担心。拉特纳说，后来发现担心没什么根据，用布洛芬或泰诺治发烧是可以的。
“对大多数人来说，孩子发烧时，通常吃的布洛芬之类的药，治疗新冠也可以，”他说。
斯马特说，多数感染新冠病毒的症状可以在家服用泰诺或布洛芬，再大量喝水控制。“很多患病毒性疾病的儿童需要安慰护理，而不是急救，”她说。“医院提供输氧和静脉输液之类治疗手段，孩子通常不需要。”
阿科洛努也推荐退烧药；6个月及6个月以上的儿童可以每三小时交替服用泰诺和布洛芬；如果不到6个月，每6小时服用一次泰诺即可。
“孩子生病时，最好让孩子感觉舒服，包括降低体温，”哈德兰说。
学校应该继续开放吗？
《财富》杂志采访的儿科医生们认为：学校应该以必要的方式保持开放。
莱特表示，年纪大一些青少年通常会迅速传播新冠病毒，小一些的孩子传播效率不高。“他们呼出的空气颗粒更少，”她解释道。
拉特纳说，最初病例激增时期关闭学校是正确做法。但他补充说，根据现在对病毒和儿童的了解，保持学校开放对社会、家庭和儿童发展极为重要。
“为了尽可能保持学校开放，有很多事可以做，”他说。“首先确保可以接种疫苗的人，也就是所有5岁及以上的人都接种疫苗。”
“我把孩子送去托儿所，因为我清楚应该采取哪些措施保证安全，”哈德兰说。“有些从一开始就知道的方法现在仍然适用。生病时呆在家里。戴口罩。增加通风。勤洗手。”
阿科洛努对此表示同意。她说：“大多数学校没条件虚拟开放，孩子能吸收的内容差别也很大。解决这一问题，我们需要灵活性、调整和大量的开拓性思考，但必须保持学校开放。”
如果孩子生病了，如何保护其他家庭成员？
成年人传播新冠病毒比儿童快得多。多数感染发生在家中，因此保护儿童的最佳方式是确保每位家庭成员都接种疫苗。“尽管儿童极少出现重症，但我们一例都不想看到。”
如果有孩子新冠阳性，家庭里身体弱的成员，如祖父母或正在治癌症的人应该保持距离。
“很显然父母会在身边照顾孩子，”莱特说。“但根据疾病预防控制中心的说法，孩子在5到10天里不应该接触外部其他人。”
阿科洛努说，对有孩子的家庭来说，正确洗手和勤打扫表面格外重要。因为孩子很容易通过接触的东西吸入病原体。
孩子应该戴口罩吗？
阿科洛努说，能戴口罩的都应该戴口罩。“但是，如果孩子还在蹒跚学步，不管怎么说都会不停摸口罩，而且总会摘掉，那么强迫戴口罩就弊大于利了。”
虽然多数航空公司并不要求5岁以下儿童佩戴口罩，但拉特纳表示，数据表明2岁及以上儿童戴口罩效果相当好。“孩子们因人而异，我们必须根据自己的情况来做决定，但某些情况下戴口罩用处很大。”
哈德兰补充说，如果孩子做不到正确佩戴口罩，可能没法发挥所有益处，但他鼓励家庭成员共同努力正确使用口罩。“孩子可能做不到迅速正确戴面具，好在学得快。”
能约着玩游戏吗？
当然！如果有可能，尽量安排在户外。
“作为家长，我不会因为流感而限制孩子做事情，所以也不会因为新冠疫情限制他们，”莱特说。
阿科洛诺非常鼓励户外活动：“我们不希望解决问题的同时制造新问题。体育活动和社交活动都很关键。”
进入新的一年，斯马特建议尽可能地减少聚会规模。“现在不适合组织50人派对，但如果是两三个都接种过疫苗的家庭，应该是可以的。”
与斯马特的看法相同，哈德兰表示：“如果你的孩子想跟班上另一个孩子一起玩，两个孩子在其他环境里已经交流频繁，在学校外一起玩的风险可能不会显著增加。”
斯马特说，许多父母都希望100%确保孩子永远不会感染新冠病毒。“但不幸的是，传染病就是这样。只能尽可能降低风险，底线是多数孩子健康。”
斯马特将基本的新冠防护比作基础驾驶安全。“尽管清楚导致儿童死亡主要原因是交通事故，我们还是让孩子坐车，”她说。“所以我们用汽车座椅和安全带。买车时买能力范围内最安全的车型；遵守速度限制。新冠病毒也一样。各种层层保护只能让我们尽可能安全，即便永远不会降为零。”
应该给孩子买脉搏血氧计吗？
很多成年人听取建议，随身携带脉搏血氧仪测量血氧饱和度。主要原因是成年人可能容易出现无症状缺氧，即血氧水平骤降，直到为时已晚才能感觉到。但对孩子来说，脉搏血氧计作用没那么大。
“儿童血氧水平不足时会用附属肌肉呼吸，”斯马特解释说。“如果血氧水平下降，孩子会在锁骨上方的颈部，肋骨之间吸气并快速呼吸。不需要为孩子买脉搏血氧计，因为如果出现血氧水平低的症状，很容易发现。”
斯马特有个儿科护理的基本规则，疫情期间同样适用。即认真观察就能判断孩子有没有问题。孩子们身体好的时候状态就会很好，生病时状态就会变差。
“如果孩子的血氧含量只有80%，就不会到处玩、表现得正常，”她说。“同样也不会有孩子看起来不舒服但实际上身体很好。如果孩子躺在床上不愿意玩，拒绝喝水，对周围环境没反应，都是危险的迹象。”
哈德兰也鼓励家长放弃脉搏血氧仪：“多数情况下脉搏血氧仪没必要，只会让家长多担心一件事。”
为了孩子安全，最应该做什么？
每位儿科医生都认同：接种疫苗。
哈德兰说，现在16岁及以上的青少年可以打加强针，这很关键，因为防护奥密克戎病毒方面加强针看起来作用巨大。家里所有符合条件的人都要接种疫苗，因为正如莱特所指出的，多数感染都发生在家里。
斯马特说，接种疫苗和加强针，限制与未接种疫苗的人接触，在公共场合佩戴高质量且合适的口罩是当务之急。
“作为父母，这些都是能控制的事，”她说。“最重要的是防护的层级。只确保一层肯定不能高枕无忧，要确保所有防护都实现，做出明智的选择。
“我们知道预防病毒方面疫苗并不完美，但在预防重症和住院方面效果很好。了解这一点非常重要。”斯马特说。“可以避免糟糕的结果，这点非常重要。”（财富中文网）
译者：梁宇
审校：夏林
随着奥密克戎变异病毒引发的病例持续激增，住院率也在上升，其中也包括儿童。种种问题也一直存在，比如新病毒给孩子造成的风险有多大，父母如何保护脆弱的孩子，以及保护孩子时应用的规则是否有所不同。
《财富》杂志采访了五位儿科医生，讨论了科学、风险，以及如果孩子核酸检测结果呈阳性应如何照顾。
有多少孩子生病了？
这取决于具体地点。新冠疾病专家珍妮佛·莱特医生在纽约大学兰贡医院(New York University Langone Hospital)工作，她表示目前感染流感的儿童比感染新冠的多。
“纽约州有50家可住院治疗的儿科医院，是纽约州不是纽约市，”莱特告诉《财富》杂志。“奥密克戎传染性非常强，目前不管是儿童还是成人，奥密克戎感染率都很高，不过儿童发展为重症的情况很少见。”
加拿大医学会(Canadian Medical Association)主席、加拿大育空地区儿科医生凯瑟琳·斯马特医生说，当地还没发现孩子感染密克戎变异病毒。
然而她指出，加拿大通常比美国落后三到四周，所以预计数字很快就会上升，而且由于奥密克戎传染性极强，意味着会有更多孩子感染。“孩子的情况与所在社区事情一致。”斯马特说。
过去一个半月里，芝加哥柯默儿童医院（Comer Children’s Hospital）的儿科医生奇迪玛·阿科洛努在医院里看到的儿童比整个疫情期间都多。
阿科洛努告诉《财富》杂志：“经常有年纪很小的孩子检测出阳性而且有症状，尤其是青少年，需要呼吸机的几率跟成年人差不多。”
“波士顿儿童的感染率肯定在上升，”马萨诸塞州总医院（Massachusetts General Hospital）青少年和青年医学主任斯科特·哈德兰说。“但值得强调的是，并不是所有的孩子都因为感染新冠病毒入院。孩子因为别的原因去医院时，会自动接受检测。在社区里，还有孩子们住的地方，不可避免有大量新冠病毒。”
孩子们的病有多严重？
哈德兰说，目前还没有正式数据，当前的数据只是传闻。
“人们普遍的关注点是，孩子即便感染也不会像其他年龄段的人一样严重，但仍然可能出现重症，还有可能出现多种并发症，”他说。“即使是轻症，也存在感染新冠后久病不愈以及多系统炎症综合症的风险。”
不过医生们表示，总体来说感染病毒的儿童状态比成年人好。免疫反应有两种形式，一种是人类与生俱来的先天免疫；另一种则是人类接触疾病后获得的适应性免疫。莱特说，孩子们更容易抵抗冠状病毒，因为先天免疫能力比成年人强。
她补充说，新冠病毒对儿童健康的影响与流感相似。事实上，流感对儿童更致命。
“疫情爆发以来，548名儿童死于新冠病毒，与流感严重的年份里死亡率大致相当，”她说。“没人认真讨论这一点，因为把新冠跟流感对标属于禁忌。也确实不该如此对比，因为成年人死亡率并不一样。不过对孩子来说，新冠与流感的影响相似，重症非常罕见，死亡率大约是每100万人出现两例。
“不管具体什么情况，只要是感染新冠病毒，孩子总比成年人情况好一些，成年人比老年人情况好一些，”纽约大学兰贡医学中心哈森菲尔德儿童医院（Hassenfeld Children’s Hospital）儿科传染病科主任亚当·拉特纳告诉《财富》杂志。“单个来看，儿童患重症的可能性远低于成年人。如果大量人口感染，儿童会出现更多重症病例，即使对单个儿童来说比较罕见。
“虽然新冠病毒对成年人的影响肯定比儿童更严重，总体来说并不意味着儿童不会出现重症，”拉特纳说。他还补充说，尽管各年龄段儿童患重症的几率都很低，但未接种疫苗的儿童患重症的几率要高得多。
新生儿受保护吗？
莱特9月在《美国妇产科期刊》（American Journal of Obstetrics & Gynecology）发表的最新研究称，如果孕妇接种了疫苗，进入婴儿体内的脐带血中含有大量抗体。
“接种疫苗和加强针的母亲可在婴儿出生头几个月提供保护，”莱特说。“母乳喂养也能传导抗体，但量级赶不上孕期接种疫苗。”
不过对于奥密克戎变异病毒来说，情况怎样还不清楚，哈德兰表示，“因为我们现在对变异病毒的情况了解太少。”
应该带孩子去看儿科医生还是去急诊室？
和其他疾病一样，父母应该做出最合适的判断。
“一些检测呈阳性的孩子两处都不必去，”拉特纳说。“如果没出现呼吸困难或持续高烧，不一定需要治疗。”不过，当下急诊室都很忙，所以最好是先联系儿科医生。“很多医生都很乐意协助做决定，也能实现分诊。”
斯马特说，新冠病毒是呼吸系统疾病，也就是说父母应该像对待流感、支气管炎等其他呼吸道病毒一样对待新冠病毒阳性的孩子。如果孩子呼吸困难，就该去医院。
“如果孩子看起来喘不过气，或者呼吸急促脸色不好，那就去医院，”她说。其他有必要去医院的症状包括：孩子昏昏欲睡，反应不正常，或者脱水而且不愿喝水。
“急诊室只会选择一些方式治疗，”阿科洛努说。“如果孩子呼吸非常困难需要用其他肌肉代偿，可能需要插管。我们会给鼻腔插管提供更多氧气，避免呼吸困难。”
呼吸减弱的迹象包括喉部、锁骨附近、腹部或胸腔可见的喘息。孩子如果哭不出眼泪，也可能是脱水的迹象。
“治疗新冠病毒与其他病毒一样，多数病例只是需要在家认真照顾，”阿科洛努说。
可以给孩子吃退烧药吗？
疫情初期，一些医生对感染新冠的儿童服用退热药表示担心。拉特纳说，后来发现担心没什么根据，用布洛芬或泰诺治发烧是可以的。
“对大多数人来说，孩子发烧时，通常吃的布洛芬之类的药，治疗新冠也可以，”他说。
斯马特说，多数感染新冠病毒的症状可以在家服用泰诺或布洛芬，再大量喝水控制。“很多患病毒性疾病的儿童需要安慰护理，而不是急救，”她说。“医院提供输氧和静脉输液之类治疗手段，孩子通常不需要。”
阿科洛努也推荐退烧药；6个月及6个月以上的儿童可以每三小时交替服用泰诺和布洛芬；如果不到6个月，每6小时服用一次泰诺即可。
“孩子生病时，最好让孩子感觉舒服，包括降低体温，”哈德兰说。
学校应该继续开放吗？
《财富》杂志采访的儿科医生们认为：学校应该以必要的方式保持开放。
莱特表示，年纪大一些青少年通常会迅速传播新冠病毒，小一些的孩子传播效率不高。“他们呼出的空气颗粒更少，”她解释道。
拉特纳说，最初病例激增时期关闭学校是正确做法。但他补充说，根据现在对病毒和儿童的了解，保持学校开放对社会、家庭和儿童发展极为重要。
“为了尽可能保持学校开放，有很多事可以做，”他说。“首先确保可以接种疫苗的人，也就是所有5岁及以上的人都接种疫苗。”
“我把孩子送去托儿所，因为我清楚应该采取哪些措施保证安全，”哈德兰说。“有些从一开始就知道的方法现在仍然适用。生病时呆在家里。戴口罩。增加通风。勤洗手。”
阿科洛努对此表示同意。她说：“大多数学校没条件虚拟开放，孩子能吸收的内容差别也很大。解决这一问题，我们需要灵活性、调整和大量的开拓性思考，但必须保持学校开放。”
如果孩子生病了，如何保护其他家庭成员？
成年人传播新冠病毒比儿童快得多。多数感染发生在家中，因此保护儿童的最佳方式是确保每位家庭成员都接种疫苗。“尽管儿童极少出现重症，但我们一例都不想看到。”
如果有孩子新冠阳性，家庭里身体弱的成员，如祖父母或正在治癌症的人应该保持距离。
“很显然父母会在身边照顾孩子，”莱特说。“但根据疾病预防控制中心的说法，孩子在5到10天里不应该接触外部其他人。”
阿科洛努说，对有孩子的家庭来说，正确洗手和勤打扫表面格外重要。因为孩子很容易通过接触的东西吸入病原体。
孩子应该戴口罩吗？
阿科洛努说，能戴口罩的都应该戴口罩。“但是，如果孩子还在蹒跚学步，不管怎么说都会不停摸口罩，而且总会摘掉，那么强迫戴口罩就弊大于利了。”
虽然多数航空公司并不要求5岁以下儿童佩戴口罩，但拉特纳表示，数据表明2岁及以上儿童戴口罩效果相当好。“孩子们因人而异，我们必须根据自己的情况来做决定，但某些情况下戴口罩用处很大。”
哈德兰补充说，如果孩子做不到正确佩戴口罩，可能没法发挥所有益处，但他鼓励家庭成员共同努力正确使用口罩。“孩子可能做不到迅速正确戴面具，好在学得快。”
能约着玩游戏吗？
当然！如果有可能，尽量安排在户外。
“作为家长，我不会因为流感而限制孩子做事情，所以也不会因为新冠疫情限制他们，”莱特说。
阿科洛诺非常鼓励户外活动：“我们不希望解决问题的同时制造新问题。体育活动和社交活动都很关键。”
进入新的一年，斯马特建议尽可能地减少聚会规模。“现在不适合组织50人派对，但如果是两三个都接种过疫苗的家庭，应该是可以的。”
与斯马特的看法相同，哈德兰表示：“如果你的孩子想跟班上另一个孩子一起玩，两个孩子在其他环境里已经交流频繁，在学校外一起玩的风险可能不会显著增加。”
斯马特说，许多父母都希望100%确保孩子永远不会感染新冠病毒。“但不幸的是，传染病就是这样。只能尽可能降低风险，底线是多数孩子健康。”
斯马特将基本的新冠防护比作基础驾驶安全。“尽管清楚导致儿童死亡主要原因是交通事故，我们还是让孩子坐车，”她说。“所以我们用汽车座椅和安全带。买车时买能力范围内最安全的车型；遵守速度限制。新冠病毒也一样。各种层层保护只能让我们尽可能安全，即便永远不会降为零。”
应该给孩子买脉搏血氧计吗？
很多成年人听取建议，随身携带脉搏血氧仪测量血氧饱和度。主要原因是成年人可能容易出现无症状缺氧，即血氧水平骤降，直到为时已晚才能感觉到。但对孩子来说，脉搏血氧计作用没那么大。
“儿童血氧水平不足时会用附属肌肉呼吸，”斯马特解释说。“如果血氧水平下降，孩子会在锁骨上方的颈部，肋骨之间吸气并快速呼吸。不需要为孩子买脉搏血氧计，因为如果出现血氧水平低的症状，很容易发现。”
斯马特有个儿科护理的基本规则，疫情期间同样适用。即认真观察就能判断孩子有没有问题。孩子们身体好的时候状态就会很好，生病时状态就会变差。
“如果孩子的血氧含量只有80%，就不会到处玩、表现得正常，”她说。“同样也不会有孩子看起来不舒服但实际上身体很好。如果孩子躺在床上不愿意玩，拒绝喝水，对周围环境没反应，都是危险的迹象。”
哈德兰也鼓励家长放弃脉搏血氧仪：“多数情况下脉搏血氧仪没必要，只会让家长多担心一件事。”
为了孩子安全，最应该做什么？
每位儿科医生都认同：接种疫苗。
哈德兰说，现在16岁及以上的青少年可以打加强针，这很关键，因为防护奥密克戎病毒方面加强针看起来作用巨大。家里所有符合条件的人都要接种疫苗，因为正如莱特所指出的，多数感染都发生在家里。
斯马特说，接种疫苗和加强针，限制与未接种疫苗的人接触，在公共场合佩戴高质量且合适的口罩是当务之急。
“作为父母，这些都是能控制的事，”她说。“最重要的是防护的层级。只确保一层肯定不能高枕无忧，要确保所有防护都实现，做出明智的选择。
“我们知道预防病毒方面疫苗并不完美，但在预防重症和住院方面效果很好。了解这一点非常重要。”斯马特说。“可以避免糟糕的结果，这点非常重要。”（财富中文网）
译者：梁宇
审校：夏林
As the Omicron variant continues surging, hospitalization rates are ticking up, including among children. But questions remain about how much of a risk the new virus poses to kids, how parents can protect vulnerable young ones, and whether the rules are different this time around.
Fortune spoke with five pediatricians about the science, the risks, and how to care for your child should his or her test come back positive.
How many kids are getting sick?
It depends where you are. Dr. Jennifer Lighter, a pediatric infectious disease specialist at New York University Langone Hospital in New York City, said she’s currently treating more children with the flu than with COVID-19.
“There are 50 pediatric hospitalizations in New York State—not New York City, state,” Lighter told Fortune. “Because it’s so contagious, Omicron cases are sky-high right now, in both children and adults, but children progressing to severe disease is rare.”
Dr. Katharine Smart, president of the Canadian Medical Association and a pediatrician in the remote Yukon territory of Canada, said she has yet to see a single kid sick with the Omicron variant.
She noted, however, that Canada typically trails three to four weeks behind the U.S., so she expects numbers to rise soon, and because of the sheer contagiousness of Omicron, that means more kids will catch it. “What happens with kids corresponds with what’s happening in their community,” Smart said.
But at Comer Children’s Hospital in Chicago, pediatrician Dr. Chidimma Acholonu has seen more children in the hospital in the past month and a half than throughout the entire pandemic.
“Younger kids are testing positive and having symptoms,” Acholonu told Fortune. “Teenagers in particular are on par with adults in terms of needing respiratory support.”
“We’re definitely seeing a rise in pediatric infections in Boston,” Dr. Scott Hadland, chief of adolescent and young adult medicine at Massachusetts General Hospital, said. “But it’s worth highlighting that not all kids are admitted because they have COVID; when they come in for something else, they’re automatically given a test. There’s an enormous amount of COVID out in the community, and, inevitably, in the places kids live.”
How sick are kids getting?
We don’t have formal data yet, Hadland said, and current figures are anecdotal.
“There’s been a lot of attention paid to the idea that kids don’t get as sick as other age groups, but they can still get very sick and have enormous complications,” he said. “They’re at risk of long COVID and multisystem inflammatory syndrome, even with mild cases.”
But on the whole, children who are infected fare better than adults, doctors say. Immune response comes in two forms: innate immunity, which humans are born with; and adaptive immunity, which humans acquire after disease exposure. Kids are better able to combat the coronavirus because their innate immunity is stronger than that of adults, Lighter said.
The health impact of coronavirus in children is similar to that of the flu, she added; in fact, the flu is more fatal in that age group.
“Since the pandemic started, 548 children have died of COVID-19; that’s about the same as [die of flu in] a typical flu year,” she said. “No one really talks about that, because it’s taboo to equate COVID-19 to the flu. And you shouldn’t, because in adults, it’s not the same. But with kids, the health impact is similar; severe disease is rare, and the fatality rate is about two per 1 million.”
“In almost every case, you’d rather be a kid than an adult with COVID, and rather an adult than an elderly person,” Dr. Adam Ratner, director of the pediatric infectious diseases division at Hassenfeld Children’s Hospital at NYU Langone, told Fortune. “On a person-to person basis, kids are much less likely to have severe disease than adults. But when a huge chunk of the population is infected, you’ll see more severe disease in kids, even if it’s a rare outcome for any individual kid.
“While COVID certainly hits adults harder than children, in the aggregate, that doesn’t mean you don’t end up with very sick children,” Ratner said, adding that while the odds of severe disease for kids of all ages is low, it’s much higher for unvaccinated kids.
Are newborns protected?
Lighter’s recent study, published in September by the American Journal of Obstetrics & Gynecology, showed that among pregnant women who received the vaccine, the cord blood that went to their baby was rich in antibodies.
“Vaccinated and boosted moms will provide their babies protection for the first few months of life,” Lighter said. “Breastfeeding can also transmit antibodies, but not at the level of pregnancy vaccination.”
But for Omicron specifically, it’s impossible to know, Hadland said, “just because we know so little about the variant at this point.”
Should I take my kid to their pediatrician or to the ER?
As with any other ailment, parents should use their best judgment.
“Some kids who test positive don’t have to go either place,” Ratner said. “If they’re not having trouble breathing or don’t have a persistent high fever, they don’t necessarily need medical attention.” ERs are still concerningly busy, though, so a great way of making the call would be contacting a pediatrician first: “Most are happy to help make the decision and triage concerns.”
COVID is a respiratory illness, Smart said, which means parents should watch their COVID-positive kids the way they’d watch them with any other respiratory virus, such as the flu or bronchitis. If a child has trouble breathing, it’s time to go to the hospital.
“If a kid looks like they’re huffing and puffing, or they’re feeling short of breath and turning off-color, go to the hospital,” she said. Other main reasons for a hospital visit: if a child is really lethargic, not responding normally, or is dehydrated and unable to keep liquids down.
“In the ER, we’re only going to do so many things,” Acholonu said. “When a kid’s breathing becomes so labored that they compensate with other muscles and tire out, they may need to be intubated. We try to avoid that by giving them extra oxygen sooner through a nasal cannula.”
Signs of reduced breathing include panting visible in the throat or near the collarbone, or in the abdomen or rib cage. Kids may also show signs of dehydration when they cry but aren’t producing tears.
“Managing COVID is the same as managing other viruses—most of it is just TLC at home,” Acholonu said.
Can I give my kid a fever reducer?
At the beginning of the pandemic, some doctors expressed concerns about administering fever-reducing medicines to kids with COVID. Those concerns proved unfounded, Ratner said, and treating fevers with Motrin or Tylenol is fine.
“Whatever you would normally do for a kid with a fever—and for most people, that means something like ibuprofen—that’s fine to do with COVID,” he said.
Most COVID symptoms can be managed at home, Smart said, by administering Tylenol or Advil and providing ample clear fluids. “Most of the care children with a viral illness need is comfort care, not emergency care,” she said. “Hospitals are for medical treatments, like oxygen and IV fluids, which kids don’t usually need.”
Acholonu recommends fever reducers, too; children 6 months and older can alternate between Tylenol and Motrin every three hours; under 6 months, stick with Tylenol every six hours.
“It’s best to help your kids feel comfortable when they’re ill, and that includes reducing their fever,” Hadland said.
Should schools stay open?
The pediatricians Fortune spoke with agree: Yes, schools should stay open, by any means necessary.
Often, Lighter said, older adolescents can spread COVID-19 quite quickly, while younger kids aren’t as efficient. “They’re just breathing out so many fewer air particles,” she explained.
Closing schools during the initial surges was the right thing to do, Ratner said. But with all we know now about the virus and kids’ role, he added, keeping schools open is vital for society, for families, and for kids’ development.
“There are multiple things you can do to try to keep schools open as best you can,” he said. “The primary thing is anyone who’s eligible for vaccination, that’s everyone aged five and up, must get vaccinated.”
“I’m sending my kids to day care, because I know there are ways we can do this safely,” Hadland said. “There’s a lot we’ve known from the very beginning that still applies now. Stay home when you’re sick. Wear masks. Increase ventilation. Wash your hands.”
Acholonu agrees. “Most schools just aren’t equipped to operate virtually, and there’s a huge discrepancy in what kids are able to retain,” she said. “It’ll require flexibility, adjustments, and a lot of thinking outside the box, but we’ve got to keep them open.”
If my kid is sick, how can I protect other members of my family?
Adults transmit COVID-19 more efficiently than kids do, Lighter said. Most transmissions occur in the home, so the best way to protect children is to ensure every member of the family is fully vaccinated. “Even though severe disease is rare in children, we don’t want any.”
If a child is COVID-positive, any vulnerable member of the household, such as a grandparent or individual undergoing cancer treatment, should keep his or her distance.
“The parent will obviously take care of and be around that child,” Lighter said. “But then that child, according to the CDC, shouldn’t be around other people outside the house for five to 10 days.”
Especially important in households with kids is proper handwashing and wiped down surfaces, Acholonu said; kids are prone to ingesting pathogens through what they touch.
Should my toddler wear a mask?
Anyone who can wear a mask should do so, Acholonu said. “But if you have a toddler who’s just going to keep touching it and taking it off anyway, you’re doing more harm than good.”
While most airlines don’t mandate masks for children under 5, Ratner says data suggests kids age 2 and older do fairly well with mask wearing. “There’s kid-to-kid variability, and you have to choose your battles, but there are places where it can be very valuable.”
If a child isn’t able to wear a mask appropriately, it probably won’t offer the full benefit, Hadland added, but he encourages families to work together on proper mask usage. “Kids may not immediately do well with masks, but they learn.”
Can we have playdates?
Sure! But, if possible, bring them outdoors.
“As a parent, I don’t restrict my kids from doing things because of the flu, so I don’t do it because of COVID-19,” Lighter said.
Acholonu strongly encourages outdoor play: “We don’t want to make new problems while trying to solve other ones. Physical activity and socializing are key.”
Going into the new year, Smart recommends keeping your playdate bubble as small as possible. “Maybe now isn’t the time for a 50-person party. Maybe limit it to two or three other families, also fully vaccinated.”
Hadland says the same: “If your child wants to have a playdate with another kid from their class, your child and that child have already been mixing in another setting and probably doesn’t substantially increase the risk to hang out with them outside of school.”
Many parents look for 100% guarantees of never getting COVID, Smart said. “But, unfortunately, that’s now how infectious diseases work. It’s about risk mitigation, and the bottom line is, most kids do fine.”
Smart likens basic COVID protections to basic driving safety. “Our kids ride in cars even though we know the leading cause of death in kids is motor collisions,” she said. “So we use car seats and seat belts. We buy the best safest vehicle we can afford; we obey the speed limit. COVID’s like that; these layers of protection make us as safe as possible, even though it’ll never be zero.”
Should I buy a pulse oximeter for my kid?
Many adults have been advised to keep a pulse oximeter on hand as a tool for measuring oxygen saturation in the blood. This is because adults can be prone to silent hypoxia, which is when blood oxygen levels plummet with no discernible feeling—until it’s too late. But a pulse oximeter isn’t nearly as useful for kids.
“Kids with low oxygen use accessory muscles to breathe,” Smart explained. “If their oxygen levels are dropping, they suck in at the neck above the clavicle, between the ribs, and breathe quickly. You don’t need to buy a pulse ox for a kid; if they have low blood oxygen, you’ll notice.”
Smart has a basic rule about pediatric care which remains true even during COVID: You can tell when something’s wrong with a kid by looking at them. Kids look fine when they’re fine, and don’t look fine when they’re not.
“You won’t have a kid playing around, acting normally, if their blood oxygen is at 80%,” she said. “Likewise, you won’t have a kid who looks really unwell but is okay. If they’re lying in bed, and you can’t get them to play, and they’re refusing fluids and not responding to their environment, those are danger signs.”
Hadland also encourages parents to forgo the pulse oximeter: “It’s not needed in most cases, and just puts them in the position of worrying about yet another thing.”
What is the best thing I can do to keep my kid safe?
Every pediatrician agrees: Get vaccinated.
Boosters are now available for teens age 16 and older, Hadland said, which is key, as boosters appear to make a huge difference in Omicron protection. Everyone in the household who’s eligible needs to get vaccinated, because, as Lighter points out, most transmissions happen at home.
Getting fully vaccinated and boosted, limiting contact with unvaccinated people, and wearing high-quality, well-fitting masks in public are top priorities, Smart said.
“As a parent, those are the things you can control,” she said. “What’s most important are the layers of protection. One thing isn’t a magic bullet; it’s about doing all these things together, and making smart choices.
“We know the vaccines aren’t perfect in prevention, but they work very well in preventing severe disease and hospitalization; that’s so important to understand,” Smart said. “Bad outcomes can be avoided, and that’s what matters.”
