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Coronavirus: What parents should know

We know how frightening it may be for parents to hear news reports about the 2019 novel Coronavirus (COVID-19). Get answers to your frequently asked questions – and some peace of mind – in this Q & A with CHOC Children’s infectious disease experts.

What is COVID-19?
COVID-19 is a disease caused by a novel strain of coronavirus. Coronaviruses are a large family of viruses and commonly infect people around the world with mild upper respiratory infections. Sometimes coronaviruses that infect animals can evolve and become a new human coronavirus strain. These can cause more severe illness. The current outbreak began in Wuhan, Hubei Province, China and has spread to other countries, including the U.S.

Who is at risk for COVID-19 infection?
Mostly people older than 60 and those with pre-existing health conditions are at greater risk. Additionally, people who have had contact with people confirmed to have COVID-19. Based on available evidence, healthy children do not appear to be at higher risk for COVID-19 related complications compared to adults, according to the CDC.

How do you get COVID-19?
We are still learning exactly how COVID-19 spreads. What we do know though that the virus is spread mainly from person-to-person contact. This can happen when people within 6 feet of each other inhale respiratory droplets produced when someone speaks, coughs or sneezes.

COVID-19 is thought to be spread primarily through inhaling droplets produced when someone coughs or sneezes or by transmission between people in close contact.Can someone spread the virus without being sick?
The CDC reports that recent studies show a significant portion of individuals with COVID-19 lack symptoms. Even the people who eventually develop symptoms can pass the virus to others before showing symptoms. This means that the virus can spread between people interacting in close proximity — for example, speaking, coughing or sneezing — even if those people are not exhibiting symptoms.

Can I get COVID-19 from touching an object?
This is not thought to be the main way the virus spreads. However, it is possible that someone who touches their nose, mouth or eyes after touching a surface with the virus on it could possibly get the virus.

What are the symptoms of COVID-19 infection?
Symptoms can include fever, cough and shortness of breath. The CDC has identified muscles aches and loss or taste or smell as additional possible symptoms. For an updated list of possible symptoms as reported by the CDC, click here.

Symptoms typically appear two to 14 days after exposure.

According to the CDC, the symptoms of COVID-19 are similar in children and adults. However, children with confirmed COVID-19 have generally presented with mild symptoms. Reported symptoms in children include cold-like symptoms, such as fever, runny nose and cough. Vomiting and diarrhea have also been reported.

How can I protect my family from COVID-19?
With no vaccine currently available, the best way to prevent illness is to avoid being exposed. It’s also important to take preventative steps:

  • The CDC recommends the use of cloth face coverings in public for those over age 2
  • Avoid close contact with people who are sick.
  • Avoid touching your eyes, nose and mouth.
  • Stay home when you are sick.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
  • Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.
  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing or sneezing. Get more information on hand-washing— and here’s a fun graphic.
  • The CDC recommends laundering items including washable plush toys as appropriate following the manufacturer’s instructions. When possible, use the warmest appropriate water setting for the items and let them dry completely. Laundry from an ill person can be washed with other people’s items.
  • Check out this list of how to prepare your household for a potential COVID-19 outbreak.

Should my children and I wear masks?
The CDC recommends cloth face coverings in public settings in places like grocery stores and pharmacies where physical distancing measures can be difficult to maintain. These face coverings can slow the spread of COVID-19 and help people who may have the virus and do not know it from transmitting it to others. It is not necessary for children under the age of 2 to wear cloth face coverings.

The governor of California has mandated that face coverings be worn by the general public when outside the home. This applies to high-risk situations such as entering public spaces; obtaining medical attention; riding public transit; certain work settings; and while outdoors in public spaces when maintaining a physical distance of 6 feet from persons who are not members of your household is not feasible. Exemptions include children age 2 and younger; persons with a medical condition, mental health condition or disability that prevents them from wearing a face covering; the hearing impaired or those communicating with them; persons seated at restaurants while eating or drinking, provided they maintain physical distancing; and those engaged in outdoor work or recreation alone or with household members while maintaining physical distancing from others. Read the full order here.

Here’s guidance from the CDC on how to properly wear a cloth face covering, as well as tutorials on how to make your own mask.

N-95 or surgical masks are not recommended for public use, as supplies are needed by healthcare workers and first responders.

Practicing proper cough and sneeze etiquette can help prevent the spread of illness.My family has upcoming travel plans. Should we cancel?
We recommend following the CDC’s guidance for travel, and for using public transportation.

Should we stay away from gatherings like church, sporting events or amusement parks? What about smaller gatherings?
Fluctuating numbers of COVID-19 cases have led to changes in what businesses and organizations may operate. See updated guidelines here.

When visiting entities that are open, people are encouraged to be mindful that physical distancing and wearing face coverings reduce the likelihood of transmission of COVID-19.

In addition to practicing proper handwashing, people should watch for symptoms and avoid going out if they feel ill. When outside the home, people should physically distance from others whenever possible and wear a face covering.

How can my family stay safe when venturing out?

If you have COVID-19 symptoms or have been exposed to someone with COVID-19, stay home and away from other people. If you choose to leave home, be mindful that the more closely you interact with others and the longer the interaction, the higher the risk of COVID-19 spread.

Before leaving home, the CDC recommends people think about:

  • How many people will you interact with?
    • Being in a group with who people who are not practicing physical distancing or wearing face coverings increases your risk, as does engaging with people who don’t live with you.
  • Can you keep 6 feet of space between yourself and others? Will you be outdoors or indoors?
    • The closer you are to other people who may be infected, increases your risk of getting sick.
    • Indoor spaces are more risky than outdoor spaces where it might be harder to keep people apart and there’s less ventilation.
  • What’s the length of time you will be interacting with people?
    • The more time you spend with others, the higher your risk of becoming infected, as well as their risk of being infected if there’s any chance you have COVID-19.

Before leaving home, consider the following questions to help determine your level of risk:

  • Is COVID-19 spreading in my community? The CDC’s latest COVID-19 information and map of states with reported COVID-19 infections can help you determine your risk.
  • What are the local orders in my community? Check updates from the OC Health Care Agency.
  • Will my activity put me in close contact with others? Practice physical distancing from anyone who doesn’t live in your home by staying 6 feet apart whenever possible. The CDC recommends wearing cloth face coverings in public. Choose outdoor activities and places where it’s easy to physically distance, like parks.
  • Am I, or is someone in my home, at risk for severe illness? If so, take extra precautions. Older adults and anyone with underlying health conditions can be at increased risk for severe illness from COVID-19.
  • Do I practice everyday preventive actions? Continue to monitor for symptoms, staying home if you’re sick, practice proper handwashing and physical distancing, and wear a face covering in public.
  • Will I have to share items or equipment with others? Choose places where there is limited sharing of items and where any shared items are cleaned and disinfected between use.

See the CDC’s full guidance of venturing out safely.

My kids are worried about COVID-19. What can I do?
Check out these tips from a CHOC psychologist about reducing children’s anxiety about COVID-19. This comic book was developed to help kids understand COVID-19 and lessen their fears. The Orange County Health Care Agency has developed some kid-friendly infographics to help children understand what they can do to help stay well: English | Spanish

What should I do if I think my child has COVID-19?
Call your healthcare professional if your child has a fever, in addition to a cough or breathing difficulty, and has had close contact with a person known to have COVID-19, or you live in or have recently traveled to an area with an ongoing spread of the virus.

Do not go to the doctor’s office without calling first. Your provider will work with the local healthcare agency to determine whether testing is necessary.

Speak to a CHOC nurse 24/7 to answer your questions about COVID-19 and your child by calling 1-844-GET-CHOC (1-844-438-2462).

Parents who suspect their child may have COVID-19 should call their healthcare provider before going to the doctor’s office.

Can my child be tested for COVID-19?
If your child has a cough and fever, particularly with underlying health issues, call your doctor to discuss if testing is needed.

How is COVID-19 treated?
There is no specific antiviral treatment recommended for COVID-19. People with COVID-19 should receive supportive care to help relieve symptoms. For severe cases, treatment should include care to support vital organ functions.

What is the link between COVID-19 and MIS-C?
Multisystem inflammatory syndrome in children (MIS-C) is a condition where different body parts become inflamed, and many children with MIS-C have previously been diagnosed with or exposed to COVID-19. Scientists are still studying the correlation, but this Q&A with a CHOC pediatric infectious disease specialist answers parents’ most common MIS-C questions.

Can I transmit COVID-19 to my baby through breastmilk?
Current guidance from the CDC states that a mother who has been confirmed or suspected to have COVID-19 should take all precautions to avoid spreading the virus to her infant. Learn more here.

Can I transmit COVID-19 to my pets?
Until experts learn more about how this virus affects animals, treat pets as you would other human family members to protect them from a possible infection. The CDC offers the following guidance:

  • Do not let pets interact with people or other animals outside the household.
  • Keep cats indoors when possible to prevent them from interacting with other animals or people.
  • Walk dogs on a leash, maintaining at least 6 feet from other people and animals.
  • Avoid dog parks or public places where a large number of people and dogs gather.

There is a small number of animals around the world reported to be infected with the virus that causes COVID-19, mostly after having contact with a person with COVID-19. Talk to your veterinarian if your pet gets sick or if you have any concerns about your pet’s health.

If you have a confirmed or suspected case of COVID-19, limit contact with your pets, just like you would with people. If you must care for your pet or be around animals while you are sick, wear a cloth face covering and wash your hands before and after you interact with them.

Call your veterinarian with questions or concerns on your pet’s health before bringing them to the veterinary clinic.

Who can I call for more information about COVID-19?
Speak to a CHOC nurse 24/7 to answer your questions about COVID-19 and your child by calling 1-844-GET-CHOC (1-844-438-2463).

Also, the Orange County Health Care Agency is taking calls from the public about COVID-19. Call 800-564-8448 Monday through Friday from 8 a.m. to 5 p.m.

This article was last updated on July 14, 2020.

Get more information on Coronavirus (COVID-19)

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Tips for making the most of your first mental health telehealth appointment

By Dr. Sabrina Stutz, pediatric psychologist at CHOC Children’s

Mental health services don’t always need to be carried out in person. Services can be delivered via a smartphone, tablet or computer. You and your child can engage in mental health services for telehealth from any private location with internet access.

If you are new to mental health telehealth services, here’s a guide for how you can prepare for your visit virtual appointment and what to expect, plus benefits of telehealth for mental health and answers to some commonly asked questions.

What happens before my first visit?

  • CHOC’s psychology team will email you a secure link for your virtual appointment. It is recommended that you practice signing onto the teleconference link prior to your visit.
  • We will also email a link to consent to mental health evaluation and treatment, for you to review and sign prior to your appointment.
  • We recommend that you find a place with stable internet service and good lighting in which you and/or your child can speak openly and freely with privacy.
  • Please ensure that a parent or adult caregiver will be physically present in the same location as the child at all times during telehealth mental health visits in case of emergency.

Who needs to be at the first telehealth mental health session?

Both a legal guardian and the child should be present at the beginning of the first session to go through the consenting process. It is recommended that the primary caregiver and the child be in the same physical location for the first appointment.

What will we talk about?

Your clinician will introduce themselves and confirm that a legal caregiver and child are present. They will review and confirm your contact information in the event of technology disruption or an emergency. Then, your clinician will review the consent process and answer any questions about using the teleconferencing software.

After the family consents to services, the clinician may wish to speak to the parent(s) and child separately. Your provider will review your concerns and your child’s history, and will offer feedback and recommendations/resources at the end of your visit. They will also answer any questions or concerns you may have about your child’s symptoms.

Is telehealth therapy as effective as in-person therapy?

Yes! Telehealth-delivered therapy techniques have been studied for over a decade. Many evidence-based therapies have research to prove that they are just as, if not more effective when delivered via telehealth. Cognitive behavior therapy (CBT), trauma-focused interventions, and parent-coaching models all have research to support their effectiveness when delivered online by a trained, licensed provider. Some minor adaptations can be made to ensure appropriate delivery of most evidence-based outpatient therapeutic interventions online.

What are the benefits of receiving mental health therapy via telehealth?

Telehealththerapy is a great way to access mental health services from the safety, comfort and convenience of your own home. Here are some of the other benefits of telehealth delivered therapy that families and clinicians have shared:

  • Families find it easier to attend sessions.
  • Families have flexibility in their schedule when cutting out commute time.
  • There are reduced childcare costs for untreated siblings.
  • Families save time, especially during high-traffic appointment times or when living far away.
  • Therapy is still accessible when on vacation within the state of California.
  • Children who might be nervous to do therapy feel more at ease using telehealth for a first session. Then, they are more likely to follow-up with telehealth mental health sessions afterwards.
  • Family members in separate locations can both attend a therapy session without having to be in the same location.
  • Parents at work can call in on their breaks to participate in family sessions.
  • Children and families are better able to remember and use coping skills when they have learned and practiced them in their own home environment.
  • Clinicians can see and live-coach families through difficult home-based situations like picky eating at mealtimes, setting behavioral limits such as a time out, or supporting a child in accepting a medical intervention such as  injections, pill-swallowing or nebulizers.
  • Clinicians have a richer and more nuanced understanding of families when they can see them in their home environment.
  • Clinicians can make more personalized and immediate recommendations. For example, “That looks like a great spot to put a reminder to check your blood sugar! Let’s create a reminder together and put it up during our session today.”

My child has trouble keeping their attention on the screen. What can you do for them?

The mental health community has created inventive and engaging ways to keep a child engaged over telehealth! Your clinician will talk with you and observe your child to assess their capacities for sustained attention, and can adapt interventions to fit their needs. For some children, we may ask parents to print out or set up certain activities before the therapy session to help facilitate. Other engagement strategies include share-screen therapeutic drawing and games such as Pictionary or Heads Up, gratitude scavenger hunts, “show and tell” topics, and parent-assisted relaxation exercises. If a child is unable to interact over telehealth, parent training models in which the therapist helps coach the parent to interact therapeutically with their child, are available.

How can I ensure my privacy?

 CHOC clinicians hold your confidentiality and privacy rights during telehealth sessions as seriously as they do when you come to the office. During a mental health telehealth appointment, your clinician will be in a private space where no one can see or hear them, and will be using secure, encrypted video conferencing software. We recommend that you access any mental health telehalthe services through your own password protected device on a password protected internet network to maximize your privacy. You may also wish to use headphones in order to have a more private conversation when sharing a home with others. For some very sensitive conversations, some families have chosen to step out to their cars or another more private location.

I have to work, but my child is home with another adult. Can we do a mental health visit via telehealth?

 For the first session, it is best if a legal guardian and their child can be together in the same location. Please contact your clinician for questions about special circumstances. For follow-up sessions, it will be up to you and your clinician to determine whether it is appropriate for the parent to call in from work while the child is at home with another trusted adult caregiver. Please talk to your clinician in advance of any adjustments that might need to be made for the supervision of your child during scheduled therapy sessions.

What if my child has very serious mental health symptoms?

If your clinician feels that your child’s mental health symptoms are too severe to manage over telehealth, they will review their recommendations and alternative options with you.

If you are concerned your child may be having a mental health emergency, do not wait for a telehealth mental health appointment. Instead, contact one of the crisis lines below, go to your nearest emergency department, or call 911.

  • National Suicide Prevention Lifeline: 1-800-273-8255
  • Crisis Text Line: Text HOME to 741-741
  • Orange County Crisis Assessment Team: 866-830-6011

If it becomes clear to a mental health clinician during the course of a telehealth session that your child is having a mental health emergency, the clinician will advise you to go to the nearest emergency room or call 911.

Learn more about mental health services at CHOC

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Tips for parenting a child who is depressed

We understand that in these very difficult times, children and teens can struggle with feelings of depression.

If you are a parent who is concerned about your child or one of their friends, here are tips for starting the conversation. This guide on common sayings to avoid, and what to say instead, can help as well.

Below are parenting tips for a child or teen who is depressed, from the mental health experts at CHOC Children’s:

  • Show your love. Children need love, empathy and respect. Let them know you care and that this is important. Just be present, sit with them and reassure them that you understand how they feel.
  • Make a date. Schedule time to spend with your child, even if they won’t talk during this time. Schedule pleasant activities, preferably out of the house and active such as walking or going to the park. Before and after the COVID-19 pandemic, these dates might look like going to a movie or getting ice cream. Your child may not want to engage in activities. Encourage them to do it anyway.
  • Stick to a routine. Schedules and routines create a sense of structure and security. Make things seem normal – even though they may not be. Learn more about creating structure and routine for kids during COVID-19.
  • Focus on the positives. Track your ratio of negative to positive comments to your child. Your goal should be one negative to five positives.
  • Stay calm. Kids who are depressed are very sensitive. Small things set them off, so communicate calmness through your voice and body language.
  • Develop a positive environment and atmosphere to help your child relax. Make a list of fun things to do and follow through with them.
  • Take care of yourself. Find a support group, exercise, or ask another adult in the home to stay with the kids so you can relax. You have to take care of yourself before you can take care of your child. Learn more about how parents can deal with stress during COVID-19.
  • Find treatment for your child. Your child may benefit from some treatment to help them feel Options include therapy/counseling and medications. Speak with your doctor to determine what will work best for your family.
  • Get help. If your child expresses thoughts about wanting to kill themselves or is saying scary things, call 911 or bring your child to your local emergency department.

Helpful books for parents of children who are depressed:

  • “Depressed Child: A Parent’s Guide for Rescuing Kids” by Douglas A. Riley
  • “Help me, I’m sad: Recognizing, Treating and Preventing Childhood Depression and Adolescent Depression” by David G. Fassler and Lynne S Dumas
  • “Lonely, Sad and Angry: How to Help Your Unhappy Child” by Barbara D. Ingersoll
  • “Raising Depression-Free Children: A Parent’s Guide to Prevention and Early Intervention” by Kathleen Panula Hockey
  • “The Childhood Depression Sourcebook” by Jeffrey A. Miller

If you or your child are thinking about suicide or hurting yourself, please use one of these resources:

If you or your child is in immediate crisis and/or danger, you can call the Orange County Behavioral Health Crisis Assessment Team (CAT) at 1-866-830-6011. They will come to where the child is to do a safety evaluation. You can also call 911 or proceed to the nearest emergency department.

If you or your child is struggling, you can access these resources 24 hours a day:

  • California Youth Crisis Hotline 1-800-843-5200
  • Suicide Prevention Center 1-800-784-2433
  • Suicide Prevention Lifeline 1-800-273-8255 (TALK)
  • Crisis Text Line 741741
Learn more about mental health services at CHOC

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  • Depression coping tips for kids and teens
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Depression: Say this, not that

Talking to someone with depression can seem like you are walking on eggshells. Although you may have the best of intentions, the words you use may not express exactly what you mean. Here are some common statements to avoid and some tips on what to say instead. You can also learn how to start a conversation around mental health.

Say this: “Whenever you feel like talking about what’s going on, I am here to listen.”

Not that: “What do you have to be depressed about?”

Clinical depression is a serious medical condition; it is not a choice.

Say this: “No one is rushing you to feel better; take as long as you need.”

Not that: “Hurry up and get over it!”

A person with depression can’t just get over it. They have to learn the skills to effectively manage their depression.

Say this: “You are not alone in struggling with depression.”

Not that: “There’s someone worse off than you!”

When you compare other problems with depression, you run the risk of minimizing the person’s struggle with depression.

Say this: “I can help you get whatever help you may need.”

Not that: “Stay away from therapy and drugs.”

Many people are scared to ask for help because of the stigma of mental illness. They may come from a culture that shames them for talking about personal problems with a stranger.  The use of medications can also feel scary to them because of stories of addiction and dangerous side effects.

Say this: “I may not know exactly how you feel, but I know it must be hard.”

Not that: “It can’t be that bad.”

Depression is a complex condition.

Learn more about mental health services at CHOC

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Depression coping tips for kids and teens

We understand that in these very difficult times, children and teens can struggle with feelings of depression.

If you are a parent who is concerned about your child or one of their friends, here are tips for starting the conversation and tips for parenting a child who is depressed.

If you are a teen struggling with depression, here are tips for coping.:

Try not to bottle up your feelings

Seek out a trusted friend or adult, such as your parent, to talk to about your feelings and what is on your mind.

Understand that there is a name for what you are going through, and that you are not alone

At least half of your classmates will experience symptoms of depression at some point in their lives. There are other people who have felt the same way you do.

Keep up with friends and activities

Even if you do not want to do things, you should still try to do them. Push yourself to try to do fun things, even if you have to go through the motions. During the COVID-19 pandemic, some of the activities you used to enjoy may not be safe in their typical form. Talk to your parent or guardian about activities you can have fun doing while still being safe.

Do something that makes you feel proud.

Do your homework, finish a chore (such as cleaning your room), and notice what a good job you did. Feel proud of your hard work.

Talk about your sadness

Sometimes when people feel sad, the things they think about are sad, too. If your best friend told you they were feeling really sad or had a problem, what would you say to them?

Talk about scary thoughts and feelings

Sometimes when kids feel upset, they think a lot about death or dying. If you notice yourself having scary thoughts such as, “I want to die,” tell a trusted adult, such as your parent or guardian.

Focus on getting enough sleep

We are more likely to get upset or feel down if we don’t get enough rest. Try to make the hour before you go to bed peaceful and relaxing. Try to stay away from your phone and the TV, since the light tricks your brain into thinking it is daytime.

If you are thinking about suicide or hurting yourself, please use one of these resources:

If you are in immediate crisis and/or danger, you can call the Orange County Behavioral Health Crisis Assessment Team (CAT) at 1-866-830-6011. They will come to where you are to do a safety evaluation. You can also call 911 or proceed to the nearest emergency department.

If you or your child is struggling, you can access these resources 24 hours a day:

  • California Youth Crisis Hotline 1-800-843-5200
  • Suicide Prevention Center 1-800-784-2433
  • Suicide Prevention Lifeline 1-800-273-8255 (TALK)
  • Crisis Text Line 741741
Learn more about mental health services at CHOC

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  • Tips for parenting a child who is depressed
    We understand that in these very difficult times, children and teens can struggle with feelings of depression. If you are a parent who is concerned about your child or one of ...
  • Depression: Say this, not that
    Talking to someone with depression can seem like you are walking on eggshells. Although you may have the best of intentions, the words you use may not express exactly what ...
  • 8 ways for teens, kids to cope with depression
    Even if it’s not uncommon for teens and kids to feel sad sometimes, those moments can still feel overwhelming. The good news is there is a lot you can do ...