COVID-19: How The Health of Children Is at Stake

Children may not be dying in the same number as adults or senior citizens due to COVID-19, but their health is at risk and so are the lives of their parents and grandparents. While children are often more susceptible to certain diseases and environmental toxins, they are also often more responsive to medical treatment and have a better ability to bounce back and heal from health issues.

The latter appears to be the case with COVID-19, but it should not lead to an utter dismissal of their unique health care needs or their special circumstances by politicians.

There is a reason we have experts in the care and treatment of children and the creation of the field of pediatric medicine that includes paediatricians, pediatric nurses, and children’s hospitals. Children have unique health care needs due to the fact that disease, stress and trauma, and health interventions are almost always different for kids than adults. In some ways, it can be far more complicated.

Dr. Kurt Newman, President and CEO of Children’s National, explains:

When you think about a child, they need protection. They’re not fully formed or fully mature. Their organs are not what they’re going to be. But at the same time, that immaturity allows so much bounce back and so much healing and so much ability. So you have to take both those things into mind as you take care of a child.

Kids are hospitalized are lower rates than adults and so the majority of expenses are in adult care and medicine. Attention follows the money, but money also follows the attention.

In his book Healing Children

, Dr. Newman points out:

Adult diseases win more investment; adult doctors are better paid; adult medicine dominates the news cycle. As a society, we prioritize end-of-life and palliative care, while children’s medicine is painfully undervalued and underfunded. In the United States, there are 35 independent children’s hospitals and more than 200 operating as part of a larger integrated health system, but nearly 5,000 hospitals focused primarily on adult care. This in a country with 75 million children under the age of eighteen.

Unfortunately, rather than addressing the unique needs of children, health care systems and policymakers often treat children as an afterthought.

We are seeing that again in the COVID-19 response. Other infectious diseases often more heavily impact children, but for reasons yet to be fully understood, children are less likely to die from this virus. That does not mean they do not have special concerns or needs at this moment in time. Every facet of the lives of children is being disrupted by both COVID-19 and the economic crisis. Children are, as UNICEF points out, the “hidden victims.”

Children Are Not Immune or Invincible

The impact upon children from COVID-19 is immense. It is also variable and complicated. The impact is different based on age, gender, income, disability and health status, geography, and family circumstance.

In comparison to adults, children need different endotracheal tubs, resuscitation bags, laryngoscopes, suction catheters, intravenous catheters, needles, chest tubes, blood pressure cuffs, and medications. Children need more intensive and specialized pediatric nursing care, as children cannot be given instructions for self-care or left unattended in the same way adults are. Hospitals that care for kids must have expertise in child abuse and maltreatment. Children that have certain medical procedures, such as orthopaedic and cardiology, sometimes have to repeat them as they grow and develop.

Unfortunately, in policy discussions, children are often ignored or invisible to policymakers so much of this nuance is ignored. Sometimes policymakers are downright clueless.

It is happening again. On April 8, Florida Gov. Ron DeSantis said he was considering the reopening of public schools in the midst of a statewide stay-at-home directive by claiming:

This particular epidemic is one where, I don’t think nationwide there’s been a single fatality under 25. For whatever reason it just doesn’t seem to threaten, you know, kids.

Gov. DeSantis needs to understand four critical issues related to COVID-19 and child health:

(1) Children and families are getting sick and dying from COVID-19 (recent data from the CDC and South Korea indicates that prior reports from China and Italy significantly understated the impact on children because the data was and still is predominately driven by who is getting tested, which have been older adults);

(2) Like anybody, young people also can carry the virus and infect teachers, coaches, bus drivers, counsellors, teacher aides, janitors, school administrators, etc. and their own parents;

(3) Child health is heavily impacted by family and ensuring the protection of the health of parents and teachers is critical to children; and,

(4) More than 2,152,950 people in the world have tested positive and tens of thousands of others likely have the virus and 142,455 people have already died.

Even though children are not dying at the same rate as senior citizens from coronavirus, it is wrong to assume that children are not being heavily impacted. Elon Musk also made a similar false leap when he tweeted that kids are “essentially immune” from COVID-19. Simply put, they are not.

The fact is that the coronavirus is impacting every aspect of the lives of children, including their health.

Children are neither immune nor invincible. The impact on them is just different. Again, children are not little adults.

According to the Centers for Disease Control and Prevention (CDC), 2,572 of laboratory-confirmed COVID-19 cases in the U.S. between February 12 and April 2 were in children. The median age for children infected in the U.S. for that period was 11 years. Although coronavirus cases in children tend to be less severe than in adults, there are some serious cases and even deaths among children. The CDC is finding that hospitalizations are more frequent for infants than other age groups of children. Data also indicated the underlying medical conditions among children that have been hospitalized are most reported for those with chronic lung disease (including asthma), cardiovascular disease, and immunosuppression.

The CDC concludes:

Whereas most COVID-19 cases in children are not severe, serious COVID-19 illness resulting in hospitalization still occurs in this age group. Social distancing and everyday preventive behaviours remain important for all age groups as patients with less serious illness and those without symptoms likely play an important role in disease transmission.

Children’s Physical and Mental Health Are Linked to Family Well-Being

Policymakers must also recognize the health of children is also greatly influenced by the overall health and well-being of their families. As Dr. Jack Shonkoff at Harvard University’s Center on the Developing Child explains:

The immediate effects and long-term impacts of this rapidly changing situation will not be evenly distributed. The stresses of caregiving (for children as well as for adults at greater risk) are rising for everyone.

Dr. Shonkoff adds:

For the millions of parents who were already struggling with low-wage work, lack of affordable childcare, and meeting their family’s basic needs from paycheck to paycheck, the stresses are increasing exponentially. When unstable housing, food insecurity, social isolation, limited access to medical care, the burdens of racism, and fears related to immigration status are added, the toxic overload of adversities can also lead to increasing rates of substance abuse, family violence, and untreated mental health problems. We cannot lose sight of the massive consequences of these threats to the health and development of our most vulnerable children and their families — now and for years to come