All posts by CHOC Children's

Breastfeeding during COVID-19

We understand how stressful it can be to navigate life as a new parent. With the added anxiety brought on by COVID-19, we want to share trusted information to breastfeeding mothers who are COVID-19 positive or suspected positive, on whether their milk is still safe and beneficial for their baby.

COVID-19 is a new disease and researchers are still studying how the disease spreads. However, breast milk remains the best source of nutrition for most infants.

Current guidance from the Centers for Disease Control 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. These steps include:

  • Washing hands with soap and water for 20 seconds before touching the infant.
  • Wear a face mask when breastfeeding if possible.
  • If using a breast pump, washing hands before touching the pump and following CDC recommendations for cleaning the pump after each use.
  • If bottle feeding pumped breast milk, have someone who is well feed the baby, if possible.

“Although there’s limited research available on whether COVID-19 is transmitted via breastmilk, studies on similar viruses did not find the virus in the milk,” said Dr. Reshmi Basu, a CHOC Children’s pediatrician. “A mother’s milk does contain specially made antibodies, produced by the mother’s body to protect her and her child from various viruses. These antibodies are transferred in breastmilk.”

If you have specific questions about breastfeeding and your baby, contact your pediatrician.

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How parents can deal with COVID-19 stress

With schools and many businesses closed amid the COVID-19 pandemic, parents have been tasked with more than ever and many are dealing with COVID-19 stress. Their homes are now distance learning facilities, daycares, activity centers, remote offices and more.

The American Academy of Pediatrics (AAP) urges parents during this uncertain and difficult time to practice self-care, ask others for help, and use healthy discipline techniques when necessary.

How parents can practice self-care

“It’s more important than ever for parents to take care of themselves first,” says Dr. Katherine Williamson, a CHOC Children’s pediatrician and president of the Orange County chapter of AAP. “Unless parents are themselves well nourished, well-rested and maintaining healthy relationships, they won’t be able to provide the care or environment their kids need right now.”

There are several ways for parents to practice self-care while juggling their added responsibilities:

  • Eat a balanced diet
  • Exercise
  • Get enough sleep
  • Maintain social connections with friends and family via phone or video chat. These relationships are an important source of support during trying times.

Healthy discipline techniques

Children have also had their lives disrupted by COVID-19. Schools are closed, and they can’t have play dates with friends. When children are bored or frustrated, they are more likely to act out.

“When children misbehave, effective discipline teaches them to regulate their emotions and helps them gain a better understanding of rules and expectations,” Williamson says.

The AAP recommends the following techniques when children feel stressed:

  • Engage kids in constructive activities. Here’s a roundup of activities for kids during COVID-19.
  • Help kids sort through their fears. Kids old enough to understand the news may be scared someone they love will die. Acknowledge their fear and share all the things your family is doing to stay safe, like washing your hands and staying home. Here’s a pediatric psychologist’s advice on helping kids cope with COVID-19 anxiety.
  • Call a time-out. Warn children they will get a time-out if their current behavior continues. Remind them what they did wrong in as few words with as little emotion as possible. Remove them from the environment for a pre-set amount of time. One minute per year of age is a good guide.
  • Know when not to respond. If your child isn’t doing something dangerous and gets plenty of attention for good behavior, an effective way to stop bad behavior can be just ignoring it.
  • Catch them being good. Point out good behavior, and praise children for their good tries and success. This is especially important in the disruption of children’s normal routines and friends.
  • Give them your attention. The most powerful tool for effective discipline is attention—to reinforce good behaviors and discourage others. Remember, all children want their parent’s attention. When parents are trying to work at home, this can be particularly challenging. Clear communication and setting expectations can help, particularly with older children.

“Corporal punishment – like spanking or hitting – can harm children and hinder brain development long-term. It is also not effective in teaching kids self-control,” Williamson says.

The AAP also cautions caregivers never to shake or throw a child. Tips for calming a fussy baby:

  • Check to see if your baby’s diaper needs changing.
  • Swaddle your baby in a large, thin blanket. Your child’s pediatrician can show you how to do it correctly to help her feel secure.
  • Feed your baby slowly, stopping to burp often.
  • Offer your baby a pacifier.
  • Hold your baby against bare skin, like on your chest, or cheek-to-cheek.
  • Rock your baby using slow, rhythmic movements.
  • Sing to your baby or play soft, soothing music.
  • Take your baby for a walk in a stroller.
  • Go for a ride with your baby in the car (remember to always use a car seat).

Most babies get tired after crying for a long period of time and then fall asleep. If your child continues to cry, call your pediatrician to discuss your concerns and stress. There may be an underlying medical reason for your child’s tears.

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Siete maneras para ayudar a los niños sobrellevar la ansiedad debido al coronavirus (COVID-19)

Si la propagación continua del coronavirus (COVID-19) le causa a los adultos ansiedad, estrés e incertidumbre, considere lo difícil que debe ser para los niños.

Dependiendo de la edad y su exposición a los medios de comunicación, los niños pueden saber más de lo que los adultos piensan. Aún si no saben, los niños pueden sentir la tensión y la ansiedad de los adultos a su alrededor.

A continuación, la sicóloga pediátrica de CHOC Children’s Dra. Sabrina Stutz ofrece 7 recomendaciones que los padres pueden usar para reducir la ansiedad de sus niños acerca del COVID-19.

Responda a las preocupaciones de los niños con compasión y validación

  • Escuche con atención sus preocupaciones y averigüe de donde escucharon la información. Validar sus temores al decir lo siguiente “Puede ser miedoso cuando se presenta una enfermedad que no conocemos completamente”.
  • Corrija cualquier concepto erróneo que hayan escuchado y anímelos a continuar hacer preguntas.
  • Mantener una rutina les ofrece a los niños sensación de seguridad. Continuar con un horario usual que incluye escuela, actividades y tareas protegerá la salud mental y física.

Mantenga los hechos apropiados de acuerdo con su desarrollo

  • ​Evite tener conversaciones adultas sobre COVID-19 alrededor de los niños. Al igual, vigile cuidadosamente la exposición de sus niños a los medios de comunicación sobre el COVID-19.
  • Conteste preguntas con explicaciones breves apropiadas para su desarrollo. Por ejemplo:  puede decirle a un niño pequeño, “coronavirus es un tipo nuevo de gripe y resfriado que para estar sanos es muy importante que nos lavemos más seguido las manos y estornudemos en el codo.”
  • Recuérdeles a los niños que los doctores y otros expertos alrededor del mundo están trabajando fuertemente para parar el virus. Esto puede ayudar a que los niños entiendan que personas inteligentes y capacitadas están tomando acción.

Tranquilice a los niños otorgándoles poder

  • Decirles a los niños la manera como pueden ayudar convierte la ansiedad en una meta que se puede lograr.
  • Asegúreles a los niños que se pueden proteger a sí mismos y a otros practicando la manera apropiada de lavarse las manos, de toser y tomar otros pasos sanos.
  • Los niños también pueden incluirse en otras preparaciones familiares. Por ejemplo, si usted se está preparando para la posibilidad de tener que permanecer en casa por un tiempo, pregúntele al niño lo que desea para comer o que actividades le gustaría durante ese tiempo.

 Busque métodos para niños

  • Haga que sea divertido el aprender a lavarse las manos y tomar otras medidas preventivas. Ayude a que los niños aprendan sobre los gérmenes dándoles una loción y luego rociar “diamantina” en sus manos. Dígale que la diamantina es como los gérmenes y luego pídale al niño que trate de quitárselos con una toalla de papel o con tan solo agua. ¡No lo lograran!  Luego puede explicarle como el jabón y el agua tibia puede lavar mejor la diamantina y los gérmenes.
  • Enséñeles a los niños por cuanto tiempo se lavan las manos cantando juntos una canción de 20 a 30 segundos. Canciones de “Feliz cumpleaños” o el “ABC” son clásicas.  Usted puede ser creativo y estimar los 20 a 30 segundos de una canción que le guste a su niño.

Enfatice la bondad

  • Como siempre, ayude a enseñarle a los niños continuar siendo bondadosos con todas las personas independientemente del país de origen o su apariencia. Aunque ellos sientan temor, siempre es posible la bondad.
  • Para ayudar a que los niños realísticamente consideren el riesgo, enséñeles que la mayoría de las personas que visitan a un médico o que usan una mascarilla probablemente no tienen el virus.
  • Es importante acordarles a los niños que todos estamos haciendo lo mejor para estar sanos y que nadie es culpable si se llegan a enfermar.

Recuerde demostrar un comportamiento positivo

  • Los padres que demuestran buenas habilidades de afrontamiento pueden ayudar a darle la tranquilidad a los niños de sentirse seguros. De todas maneras, los niños aprenden de sus padres cómo reaccionar en situaciones nuevas.
  • Recuerde que los niños cometen errores. Si su niño accidentalmente no se lava las manos o no estornuda en su codo, recuérdeselo cariñosamente. No ayuda asustar a los niños por los errores con consecuencias potenciales.
  • Los adultos deben demostrar comportamientos para cuidarse a sí mismos: Mantener los horarios de las actividades y del sueño. Comer de manera sana y practicar etiqueta para lavarse las manos y toser.
  • También ayuda que los adultos limiten su atención a los medios de comunicación sobre el coronavirus (COVID-19) y más bien sigan a los recursos de confianza tales como el Centro para control de enfermedades para prevenir tanta información y la ansiedad.

Observe cambios en el comportamiento

  • Cambios en el sueño del niño, el apetito, su interés en querer estar con amigos o de salir de la casa, o maneras de buscar seguridad, al igual que lavarse en exceso las manos pueden ser señales que es necesario más ayuda.
  • Si no ayudan las técnicas básicas para la reducción del estrés tales como respiración honda, distracción o imaginería guiada, comuníquese con su médico primario para apoyo adicional.
Get more information on Coronavirus (COVID-19)

Related posts:

  • Breastfeeding during COVID-19
    We understand how stressful it can be to navigate life as a new parent. With the added anxiety brought on by COVID-19, we want to share trusted information to breastfeeding ...
  • How parents can deal with COVID-19 stress
    With schools and many businesses closed amid the COVID-19 pandemic, parents have been tasked with more than ever and many are dealing with COVID-19 stress. Their homes are now distance ...
  • 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 ...

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.

At this time, there are not many cases in children. Children who did have the virus tend to have mild symptoms.

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 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?
People are thought to be most contagious when they are showing symptoms. Some spread, however, might be possible before people show 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. Symptoms typically appear two to 14 days after exposure.

According to the Centers for Disease Control, 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:

  • 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.
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.

Should we stay away from gatherings like church, sporting events or amusement parks? What about smaller gatherings?
On March 19,  the governor of California ordered all state residents to stay home — except  for essential needs, such as if your work supports the continuity of critical infrastructure sectors, or if you need to access essential services like food, pharmacies, banks or laundromats. The order is in place until further notice. Read more here. This order establishes consistency across the state in order to slow the spread of COVID-19.

As of March 17, the Orange County health officer had prohibited public and private gatherings of any number of people, occurring outside a single household, except for those deemed essential activities. That order is in effect until March 31, 2020 but may be extended. Read the health officer’s full order here.

Although current CDC guidelines includes avoiding social gatherings of more than 10 people, they also encourage the public to follow the directions of state and local authorities.

Here’s a roundup of activity ideas to keep kids entertained, educated and busy during school closures.

During this time, help your child stay active. Encourage them to play outdoors, which is good for their physical and mental health. Take a walk or a bike ride. Indoors, try stretch breaks and dance breaks.

Should my children and I wear masks?
Although the California Department of Public Health does not require people to wear face coverings when leaving their homes for essential activities, the agency has said wearing a cloth face covering could reinforce social distancing and reduce the spread of infectious particles. Read the CDPH guidance on face coverings issued April 1 here.

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

Experts say the best defense against COVID-19 is staying at home and physical distancing; washing hands frequently; avoiding touching eyes, nose and mouth with unwashed hands; avoiding being around sick people; and staying home if you’re sick.

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.

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

Can I transmit COVID-19 to my baby through breastmilk?
No information is available yet on the transmission of the virus that causes COVID-19. However, no evidence of the virus has been found in breast milk of women with COVID-19.

Who can I call for more information about COVID-19?
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.

Or, 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).

This article was last updated on April 2, 2020.

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Teaching family values during a time of crisis

By Dr. Nicole Vincent, pediatric psychologist at CHOC Children’s

During this unique and emotional time, many parents are juggling health concerns for our families and communities, employment and financial fears, and navigating additional roles we’ve been thrust into — teacher, sports coach and activities coordinator, to name a few. This is no easy task.

Despite the struggles many of us are collectively coping with, there can be an opportunity within this global crisis. We may be having more family time and living at different pace due to stay at home orders. As some of life’s typical obligations, activities and distractions are stripped away, we have the opportunity to find more clarity on our fundamental values and what is truly important to us and to our families. In doing so, we can help our children understand and act on these values as well. We can even show children and teens how to identify and develop some of their own independent values.

Why is this important? Clarity in values can be a guiding light during both calm and stormy times; and it can enhance the meaningfulness and wisdom we gain through life experiences.

So how do children learn values? Not just through academic discussion. Learning about values takes time, and is most effective when modeled by parents, discussion of real-life examples, and through children’s own experiential learning.

Here are other tips for parents on teaching values to their children during a crisis:

  • Be generous in showing love and affection to your children. This provides a foundation for them in developing compassion, as well as for their understanding of all other values.
  • Take notice of what you are modeling through your own actions, as this will speak louder than your words.
  • Apologize when you make mistakes.
  • Talk about your values and why they are important to you. Discuss the role of your own values as you make everyday choices.
  • When you see your child showing a value you prioritize, label it and applaud your child’s actions.
  • Discuss examples of values and choices from the news or from your own day.
  • Help your child identify important values from their own life experience and challenging situations they face. Encourage your child to reflect on and talk about how they made a difficult decision, weighing different factors. Help them identify the values that guided their decision.
  • Use movies, books and television shows as a springboard for discussion of the characters’ values and choices. Common Sense Media provides a helpful guide to children’s/teen’s TV shows and movies, organized by the various values, strengths and character traits that they promote.
  • Involve your children in helping others.
  • Have each family member pick one or two values that are especially important to them. Take turns talking about why they are important to that family member. Consider developing a family mission statement that incorporates the values identified by everyone. Refer back to this mission statement to help navigate challenging moments. You can even develop a family mascot that represents these values and serves as a fun and tangible reminder.

There are numerous values to consider when identifying those most important to you and your family. Some ideas include: fairness, empathy, responsibility, honesty, loyalty, leadership, playfulness, kindness, faith, caution, achievement, forgiveness, justice, humor, self-control, dependability, patience, respect, courage and more.

Below are additional examples of several values that may be of particular benefit to highlight as we all do our part as families and as a community to overcome the current health crises our country and the world is facing.

 1. Kindness and helping others

There are many ways to demonstrate these values during the current COVID-19 pandemic, and to recognize these behaviors in others. Lend a helping hand, offer to grocery shop for an elderly or medically vulnerable neighbor, and do your part to support social distancing. Children can help with chores and help a younger sibling with homework. Your family may be able to donate money or supplies to others in need.

2. Health and self-care

Both physical and emotional health and well-being are more important now than ever. Prioritize a healthy routine for all family members — parents included! Ensure plenty of sleep; time for exercise; time for leisure activities such as art projects, music and reading; time for social connection; and time for work and learning.

3. Peaceful conflict resolution

Social distancing has resulted in a lot more family time in many homes. This can be wonderful at times and can try our patience at other times. This is an opportunity  to model and help children practice staying calm and keeping a clear head in the face of disagreements and frustration. Work on effective communication strategies. Take a deep breath, engage in perspective taking, hear the situation from another viewpoint and consider others’ perspectives, and work on finding a compromise together.

4. Creativity

Point out the ways in which all family members are using creative problem-solving to adjust to our new lifestyles. For children, this means adapting to online school, finding new ways to stay connected to friends that don’t require in person contact, creating space for multiple family members to work from home, and managing on smaller family budgets.

5. Curiosity and learning

Find interesting new books to read online and take advantage of the many online learning and enrichment programs available. Many of these resources are free during the COVID-19 pandemic. Here’s a list of educational and fun resources that are free during this time. Support your child in identifying an area of interest and encourage them to research it over the next few weeks. You can help them in finding videos, books and articles that give more information about this this topic. Or, help them research and learn a new skill like sewing, cooking, .art, science or music, for example. They can even give a presentation to the family about their new area of knowledge.

6. Perseverance and resilience

Focus on the things we can control in a time a great uncertainty. Emphasize how getting through a difficult time can build strength, wisdom and the resilience to manage other challenges that life may bring. Learn more about teaching your child resilience during COVID-19.

 7. Teamwork

This may be a time when you are able to help your children learn new responsibilities around the home to help the family. Praise them for helping parents cook meals, cleaning up or helping a younger sibling.

8. Gratitude and appreciation

Model and teach these values to your children in challenging moments. Help them return focus on the positives. Remind them of the joy and satisfaction that can be found in the small moments— like playing with siblings, creating a new art project, learning a new skill, cuddling with a favorite pet, enjoying a cozy spot in their home, reading a great book and the presence of loved ones. Express appreciation for all the essential workers who are helping keep our communities running, despite the ways in which this may increase their own risk of becoming ill.

 9. Flexibility

Many of us have had to shift gears and change short- and longer-term plans abruptly amid the COVID-19 pandemic and resulting social distancing guidelines. Our children and teens are also facing major changes to the plans they had laid out for the coming months. High school students are facing the prospect of missing prom, graduation ceremonies and other important rituals and rites of passage. Younger children are missing sports events, school classes, birthday parties, playdates, family gatherings, academic competitions, and many other events both large and small. In the face of these disappointments, help your child acknowledge their losses and praise their ability to embrace new ways to learn, connect with friends and family, and celebrate important milestones. This flexibility will be a tremendous strength when facing future disappointments when life doesn’t follow our best laid plans. Learn more about how to talk to kids about disappointment during COVID-19.

 10. Mindfulness

Work toward staying centered during stressful and uncertain times. Help your children take time to appreciate small moments. Show support for the difficult emotions our current health crises and lifestyle changes bring, and help children understand that a full life is a mix of ups and downs. Teach them that these difficult times can add to the fabric of our existence and the meaning we find in life, contributing to our wisdom and compassion for others.

11. Love and compassion

Model compassion for others and oneself. When making mistakes, accept, apologize and move forward. Be forgiving to ourselves as parents – doing what we can each day, accepting our imperfections and recognizing the good intentions in our efforts.

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