Frequent and thorough handwashing remains a top method of protecting against COVID-19 and other viruses, but dry and cracked hands may be an unfortunate side effect in children and adults alike.
“Thorough handwashing is an absolute must during COVID-19, but it can lead to dry skin ,” says Dr. Angela Dangvu, a pediatrician in the CHOC Primary Care Network. “There’s a lot we can do to help, while still ensuring proper handwashing is maintained.”
Here, Dr. Dangvu offers tips to help protect tiny hands against dryness without compromising thorough hand washing that’s so critical during the pandemic.
Choose soap carefully
Start by choosing a moisturizing hand soap, Dr. Dangvu says. Pick soaps that look more like lotions than a typical soap with words like “moisturizing” or “conditioning” on the packaging. Unless your child is already using these and is accustomed to them, try to skip antibacterial or deodorant soaps.
If they are available, use soap and water instead of hand sanitizer, Dr. Dangvu advises. The alcohol content in the hand sanitizer can sting hands that are already dry and cracked. If hand sanitizer is only available, be sure that it has at least 60 percent alcohol to ensure a thorough cleaning.
Timing is important
Parents should remind their children that when they are at home, they ought to be washing their hands at these times:
Before and after cooking or eating
After using the restroom
After cleaning around the house
After touching family pets
Before and after caring for a sick family member
After blowing their nose, coughing or sneezing
After changing a diaper
After being outside — playing, gardening, walking the dog, etc.
Beyond these instances, children do not need to continually wash their hands at home, Dr. Dangvu says.
“Children are such great learners and have been so incredibly adaptable during the pandemic, and many have really taken on to importance of handwashing,” she says. “Too frequent handwashing can worsen dry and cracked hands.”
Creams, not lotions
Applying moisturizer to a child’s hands after hand-washing or bath time can also help prevent dry hands. Select products described as creams rather than as lotions: The former are richer and have more staying power than thinner products like baby lotions, Dr. Dangvu says.
“They tend to stay on and be a better moisture barrier,” she says. “Parents should use them right after children wash their hands. If skin is still a little moist, the cream will trap that moisture. Apply it after bath time too.”
A three-step approach
If a child’s little hands still become dry, Dr. Dangvu recommends a three-step approach:
Start by regularly applying cream to the hands.
If dryness doesn’t improve after a few days, move on to a petroleum-based ointment. Parents can intensify the therapy by applying ointment to hands before bed, and asking children to wear cotton gloves or even socks over their hands to lock in moisture while they sleep.
If the condition doesn’t change after a few more days, parents can try an over-the-counter hydrocortisone cream.
If these steps don’t yield improvement, it’s time to consult the child’s pediatrician to rule out a bacterial infection or other condition, Dr. Dangvu says.
With California teenagers ages 16 years and older eligible to receive the COVID-19 vaccine beginning April 15, parents may have questions about the vaccine and what to expect afterward. Here, Dr. Angela Dangvu, a pediatrician in the CHOC Primary Care Network, answers some common questions about the vaccine and teens.
What vaccine will my teen receive?
At this time, the Pfizer vaccine is the only vaccine authorized for use in people ages 16 years and older to prevent COVID-19. It is administered in two doses three weeks apart, injected into the arm muscle.
The Pfizer vaccine, as well as the Moderna vaccine, which is authorized for people ages 18 years and older, is an mRNA vaccine. When the vaccine is injected, mRNA – a strip of genetic material –enters a body’s cell and prompts the cell to build copies of spike proteins. These spike proteins are the bumps that protrude from the surface of coronavirus particles. The body’s immune system then learns to spot these spike proteins and produces antibodies that block the virus from entering healthy cells in the future.
Studies show that vaccine recipients achieve immunity about two weeks after receiving the vaccine’s second dose. Scientists are still learning about how long that immunity will last.
I have younger children. What is the status of vaccine research in children and adolescents?
To date, Pfizer and Moderna have enrolled children as young as 6 months in clinical trial studies. Janssen and Astra Zeneca also have plans to study their vaccines in younger age groups.
Is the vaccine safe for teens? Are there other risks for teenagers that might not be present for adults?
The Pfizer vaccine is absolutely safe for children ages 16 years and older. In clinical trials, enough teens participated to show that the vaccine is safe for people as young as 16 years. We have no reason to expect that children would tolerate the vaccine less favorably than adults would.
If teens are less likely to get sick from COVID-19, why do they need a vaccine?
Even though it is rare for children to get seriously ill from COVID-19, children who are 16 years and older have needed hospital care for COVID-19. This is especially true for teenagers with underlying health conditions such as weakened immune systems, obesity or chronic lung conditions. Having the vaccine may also give parents and teens alike peace of mind to return to more typical activities like in-person instruction and participating in sports, which is great for mental health.
Are there any teens who shouldn’t get the vaccine? Should I talk to my pediatrician before scheduling the appointment?
There is no category of teenagers who shouldn’t get the vaccine, unless they have a known allergy to one of the vaccine’s components. Because it isn’t a live vaccine – a vaccine that uses a weakened form of a germ to prompt an immune response – the possibility for reaction is very small. There have been reports allergic reactions to the vaccine, but these occurrences are very rare. Vaccine recipients are monitored for 15 minutes after receiving the injection in case of any allergic reaction. Teens with other types of allergies beyond any vaccine component can feel safe receiving the vaccine.
Teens who recently received other vaccinations should wait two weeks before seeking the COVID-19 vaccine.
Parents are always encouraged to speak with their teen’s pediatrician if they have any questions or concerns.
Will the COVID-19 vaccine affect my child’s fertility?
Definitely not. Because it is an mRNA vaccine (see explanation above), the vaccine does not get incorporated into or change the DNA of the body’s cells in any way. There is no reason to worry that the vaccine will affect fertility or future offspring.
The COVID-19 vaccine was developed quickly. Should I be concerned about that?
No. The vaccine was developed quickly because scientists received additional money and resources to support from the government. This allowed scientists to follow all the typical processes but overlap some steps, which sped up the process. Also, it was easy to find volunteers to participate in clinical trials because many were excited by the possibility of receiving the vaccine. None of these factors compromised the quality of the trials, and the same processes for safety and effectiveness was followed.
I’ve read about COVID-19 variants. Will the vaccine protect my teen against them?
We are still learning about how effective the vaccine is against variants. While there may be some decrease in immune response, the vaccine is still largely protective. An important step in fighting variants is to ensure as many people as possible get the vaccine. The more people who get sick – even mildly – with COVID-19, the more opportunity is presented for the virus to continue to mutate.
My teenager already had COVID-19. Should they have the vaccine?
Yes. We don’t know how long the immunity lasts from natural illness, and the vaccine is made to create a longer lasting immune response.
What if my teenager has COVID-19 now?
Your child should wait until they are feeling better and no longer need to isolate based on guidelines from the Centers for Disease Control.
What if my child has received convalescent plasma treatments?
Your child should wait 90 days to get the vaccine after receiving convalescent plasma or monoclonal antibody treatments. Your child’s pediatrician can help you determine when it’s appropriate to get the vaccine.
Can my child take their normal medications before the COVID-19 vaccine?
Your child should continue to take their normal medications as prescribed.
Can my child take acetaminophen, ibuprofen or an antihistamine before the COVID-19 vaccine to offset any potential side effects?
No. It is best to avoid preventatively administering these medications – either before the vaccination or right afterward if no side effects are present – because there is a chance they can decrease the immune response.
Do I need to accompany my child to the vaccination?
Yes. Anyone under 18 must have a parent or legal guardian present to receive the vaccine.
What should we bring to my teen’s COVID-19 vaccination appointment?
Bring a photo ID and a document verifying your teen’s date of birth. See more details from the Orange County Health Care Agency about what documentation is required for minors. There’s no need to bring your child’s vaccine records, as they will receive a card specific to the COVID-19 vaccine. It would be helpful if the teen wears a short-sleeved shirt, as the injection is administered into the arm.
What should my child expect at the COVID-19 vaccination appointment?
After checking in and taking care of paper work, the teen will be asked some questions about their health. The shot will be administered into the arm. After receiving the shot, the teen will be monitored for 15 minutes to ensure no adverse reactions. The teen will also receive a card indicating when they received the vaccine and information about the vaccine.
What should I do with their vaccination card?
Take a picture of it just in case anything happens to it and store in a safe place. There is no need to laminate it.
Do we really need to come back for a second COVID-19 vaccine?
Yes. Clinical trials that led to the Pfizer vaccine’s licensing incorporated two doses. So, the determined efficacy is based on two doses and we don’t yet know how effective one dose alone is. The Johnson & Johnson/Janssen vaccination is administered in one dose, but at this time it is only approved for people ages 18 and older.
What are the side effects of the COVID-19 vaccine? Are there any different side effects for kids?
The most common side effects are fever and feeling achy or tired. Any side effects should be relatively short-lived and ease within 24 hours. Because teens have more robust immune systems, it’s possible that they may feel these side effects more strongly than adults would. This is a sign that their immune system is mounting a response against the virus.
If side effects do appear after the COVID-19 vaccination, what can I use to treat them?
It is fine to treat side effects once they surface with over-the-counter pain medicine. Either ibuprofen or acetaminophen is fine, so long as the child hasn’t had previous reactions to these medications.
Should my child stay home from school after the COVID-19 vaccine?
If they have a fever, the teen should stay home. Beyond that, so long as they are feeling well, there is no need to limit activities.
What if my child is exposed to COVID-19 after they’ve been vaccinated?
Once two weeks have passed since their second dose, they have reached full immunity and there is no need to self-isolate after exposure to someone with COVID-19. Monitor them closely, however, to ensure they aren’t developing symptoms. If COVID-19 symptoms surface, begin self-isolation and contact your pediatrician.
After receiving both COVID-19 vaccine doses, can my child stop wearing a mask?
No. It’s important that they continue to take precautions against COVID-19. Though they are highly effective, the vaccine is not 100 percent effective, and while among a group of people, it’s impossible to know who is and who isn’t vaccinated.
How will the COVID-19 vaccine change socializing for my child?
Teens and families alike can definitely have more peace of mind about the safety of resuming more typical activities, which will be wonderful for mental health. In group activities, teens should still continue to wear masks. In one-on-one activities where a teen and their friend are both fully vaccinated, they can feel comfortable removing their masks so long as no one in either household is high-risk and unvaccinated.
Should I be concerned about having my older vaccinated teen around their younger siblings who are not vaccinated?
No. These children were already interacting with each other in the same household before one received the vaccine. The entire family can take comfort in knowing that one more person in household who has been vaccinated offers more protection for the whole family.
Does having COVID-19 affect my child’s ability to play sports safely?
If your child had symptoms of or tested positive for COVID-19 at any point, it is important that they see their provider before returning to sports.
Research shows that sometimes after a COVID-19 infection, a patient has a small risk of developing myocarditis (inflammation of the heart) or multisystem inflammatory syndrome in children, also known as MIS-C, an inflammation of multiple areas of the body.
Even if your child had a sports physical recently, it is important that children have another physical exam after a COVID-19 infection before returning to sports.
In some cases, providers may recommend additional tests for your child’s heart or that they see a cardiologist, or heart doctor, for further evaluation. This is to ensure that children are safe to return to sports.
What is a sports physical and why are they important?
A sports physical helps determine whether it’s safe for a child to participate in a sports or athletics. They can also help uncover and treat health problems that might interfere with participation. The provider may also offer tips to help with training and injury prevention.
What should I expect at a sports physical?
A sports physical is divided into two halves: the medical history and the physical exam.
During the medical history portion, the provider will ask key questions about serious illnesses among family members; current or previous medical conditions, such as asthma, epilepsy or diabetes; past injuries; and more.
During the second half of the visit the provider will perform a physical exam. The physical exam will measure the athlete’s vital signs; check the athlete’s heart and lungs; evaluate strength and flexibility; vision; and more.
The provider will also ask questions about the athlete’s mental health, use of drugs, alcohol or dietary supplements, including steroids or other so-called “performance enhancers” and weight-loss supplements.
What happens after the physical?
When the exam is over, the provider will complete and sign a form indicating fitness to participate in the sport, if all is well. In some cases though, the provider may recommend a follow-up exam, additional tests, or specific treatment for medical problems.
Young athletes shouldn’t worry that additional follow-up care means being benched. A sports physical’s ultimate goal is to ensure athletes are safe while playing sports – not to stop them from playing.
Additional follow-up could be as simple as rechecking blood pressure in a few weeks. A referral to a specialist could ultimately help athletic performance, such as in the case of slight knee pain during running that an orthopedic or sports medicine specialist can demystify and treat.
If my child has a sports physical, do they still need a regular physical or well check?
It’s critical that patients of all ages undergo a regular physical every year, whether or not they also have a sports physical. Depending on when your child had their last physical, it can be done at the same visit as the sports physical.
While sports physicals focus on well-being as it relates to athletics, regular physicals are more comprehensive, addressing broader physical and mental health concerns, and helping to ensure patients are up-to-date on vaccinations.
Where can my child get a sports physical?
Families usually have many options for receiving sports physicals. Your child’s physician or a sports medicine physician can provide a sports physical exam.
Remember, your pediatrician knows your child’s medical history thoroughly, can make referrals if needed, and will play a critical role in any ongoing care plans – not to mention, is one of their biggest fans.
When 20-year-old Matthew came down with a mild case of COVID-19 before the holidays, he thought it had run its course. He didn’t expect to end up with MIS-C and in the hospital – much less, the one where his mom had worked for 15 years.
Matthew’s mom, Tiffani, was a clinical dietitian at CHOC at Mission Hospital for most of that tenure before recently transitioning into a program manager role with The Sharon Disney Lund Medical Intelligence and Innovation Institute (MI3). Having spent many years working at patients’ bedside across many units at CHOC at Mission, Tiffani was already very familiar with CHOC’s practices, physicians and the environment of care, but when her son became critically ill, her role was solely that of a mom.
“When you are the parent of a sick child — whether he is 2 years old or 20 years old — you realize how truly dependent you are on the care team and must trust them to provide the solutions you can’t,” she says.
Positive for COVID-19
In December, Matthew tested positive for COVID-19. He had mild symptoms and quarantined for two weeks, spending Christmas apart from his family. Matthew got a negative COVID test in early January, and later tested positive for antibodies. He thought his illness was behind him and was making plans to donate convalescent plasma to help others fighting COVID.
The day after his antibody test, Matthew came down with a high fever. When that was followed by the quick onset and rapid progression of nausea and gastrointestinal symptoms, he headed for a local urgent care, which resulted in negative rapid flu and COVID tests.
A few days later he felt worse, so Tiffani took him to a local emergency department where he received fluids and a work-up. He was discharged, but Tiffani’s intuition and clinical background made her suspicious something else was going on. Dr. Antonio Arrieta, CHOC’s medical director of infectious disease, and Dr. Jacqueline Winkelmann, a pediatric hospitalist, were consulted.
“From the minute we arrived in the emergency department at CHOC, things were completely different. I was allowed to stay with Matthew. The limited visitor policy in effect due to COVID still allows for one parent to be at the child’s bedside in most cases,” Tiffani says. “At the previous emergency department we visited, which was an adult facility, I had to drop him off at the curb and hope for the best, and that he would be able to advocate for himself despite feeling so sick.”
By this point, it had been nearly a month since Matthew’s original COVID diagnosis. Once at CHOC, Matthew was admitted and quickly diagnosed with MIS-C.
“The original emergency department we went to didn’t suspect MIS-C at all because of Matthew’s age,” Tiffani says. “He is 20, and typically MIS-C affects younger kids, but CHOC was on high alert because of the increasing cases in the community. They saw beyond the typical case presentation and evaluated his labs and clinical status and found the rare case immediately. I am so grateful we were able to receive Matthew’s care at CHOC.”
Finding answers and a treatment plan at CHOC
MIS-C can affect young adults up to age 21. It causes inflammation in blood vessels throughout the body due to a storm of reactions by the immune system. MIS-C is a relatively new syndrome that generally appears in people who have recovered from COVID-19.
A care team comprised of more than a dozen doctors from seven specialties, plus dozens of nurses, cared for Matthew in what would end up being a weeklong stay at CHOC. Those specialties included infectious disease, rheumatology, hematology, intensivists, hospitalists and cardiology. His pediatrician, Dr. Eric Ball, part of CHOC’s Primary Care Network, was updated and consulted as well.
Pharmacists at CHOC ensured that Matthew received the IVIG that he needed. High dose IVIG, or intravenous immunoglobulin, helps the body modulate inflammation . Matthew also received anticoagulants to reduce the risk of blood clot formation.
“We felt very calm and secure about the plan. Every specialty that was consulted was an active participant in Matthew’s plan of care,” Tiffani recalls. “The first night was really hard for us because Matthew’s blood pressure wasn’t stable, but we knew the care team was in close contact with the pediatric intensive care unit and would transfer Matthew there if he needed a higher level of care.”
Since MIS-C can cause inflammation in the heart and with his very low blood pressures, Matthew was ultimately transferred to CHOC’s cardiovascular intensive care unit. He began receiving high-dose IV steroids and monoclonal antibodies under the care of Dr. Andrew Shulman, a CHOC rheumatologist, in order to further reduce inflammation.
Part of the care team
The early days of Matthew’s stay at CHOC are a blur to him, but he does remember doctors involving him in his care plan when he felt well enough for those conversations.
“I remember Dr. Arrieta telling me about the medicine and treatment I would receive. He said they have other tools in their toolbox, but he hoped they didn’t have to use them,” Matthew says. “I’m older than some of their typical patients, and I appreciated that they respected me as an adult. All my doctors had a great bedside manner. Every single doctor made sure I knew what was going on, and that was important to me.”
Despite her history as a longtime CHOC employee, Tiffani knew the high level of care her son received wasn’t simply because she was part of the CHOC family.
“Everyone at CHOC receives this level of care. We didn’t get special treatment because I work here,” Tiffani says. “In clinical settings we cannot always guarantee results, but the team strives to get the best outcome, using their collective skills, and everyone goes above and beyond.”
Tiffani did feel, however, that she had a big team rooting for her and Matthew behind the scenes.
“My colleagues from 15 years at CHOC checked in on us all the time, both virtually and physically on the unit,” Tiffani recalls. “Their support meant the world to me.”
Turning a corner
Matthew started to turn the corner almost as quickly as he got sick.
“It was miraculous,” Tiffani recalls.
Once Matthew started to feel better and more lucid, one of the first things he told his mom was how much he appreciated that everyone at CHOC cared so much about him getting better.
“Even though he had been so sick, he remembered that the person who cleaned his room knew his name, and the food service worker delivering his meals said she hoped he enjoyed his food and that it would make him stronger,” Tiffani recalls.
Matthew started connecting with his clinicians as well. As an electrical engineering student, Matthew was interested in the inner workings of the electrical circuits in his EKG – or electrocardiogram, which records the electrical signals from the heart to check for various heart conditions. The technician who performed Matthew’s EKGs would explain everything she was doing and how the machine worked. They also discussed how to improve the technology and what future devices might look like.
Although Matthew is still committed to becoming an electrical engineer someday, he took a special interest in healthcare after his experience as a patient. Even though he doesn’t want to become a clinician, he does see how he can contribute to advancing pediatric medicine with his coding and engineering skills. He has applied for CHOC’s MI3 Summer Internship Program, and hopes to work with Dr. Anthony Chang, CHOC’s chief intelligence and innovation officer, on data science and innovation projects.
A special gift from his care team
As Matthew continued to get better, and closer to going home from the hospital, his care team wanted to send him home with something to remember his journey and be a symbol of their continued support.
It’s a tradition for heart patients at CHOC to receive a red heart-shaped CHOC Heart Institute pillow, signed by all their caregivers, when they finally go home.
“This gift is not only endearing to the patient, but symbolic to the parent,” Tiffani says, “These caregivers are tattooed on our hearts for their heroic efforts to save our kids.”
While Matthew’s care team closely monitored his status and lab reports as indicators of when he would be able to go home, his mom was noticing signs he was feeling better, too.
“I was encouraged when I saw the whites of his eyes again, as they had been pink before when he was really sick,” Tiffani says. “And when I took a photo of him and could see his cheekbones that was significant because it meant the medicine was removing the puffiness and inflammation from his body.”
A journey for both patient and Mom
While this health journey was Matthew’s, it affected his mom as well.
“As a CHOC employee, I’ve long admired the talented doctors, nurses and other clinicians for the excellent care they provide. I am humbled to call them my colleagues,” Tiffani says. “As a parent, I am so thankful we have such a wonderful children’s hospital to care for kids in our community – whether they be 20 days, 20 months or in our case, 20 years old.”
A week after Matthew was admitted to the hospital, he was well enough to go home. Since MIS-C is a new condition, little is known about its potential long-term effects. Matthew will remain in the care of CHOC cardiology, infectious disease and rheumatology, plus undergo regular lab work to monitor his health.
Matthew also decided to join a research study led by Dr. Arrieta, which is looking at MISC-C and its long-term effects.
“I kind of look at it as I just overcame this new disease and joining the research study isn’t a lot of trouble for me. So, if I can help the doctors help other people, then of course I’ll do it,” Matthew says.
These days, Matthew is feeling a lot better. He is improving every day and working to get his strength back but is avoiding exercise at the advice of his cardiologists.
Tiffani is back at work, with a renewed sense of appreciation for CHOC.
“I love working at CHOC, but because it is a clinical setting, I don’t get to take my kids to work with me and show them what I do,” she says. “I have often told them about how special the team is. They have seen me go back to work late at night to help a family or answer a doctor’s call on the weekend. So, when Matthew got sick, I needed my work family to show up for me, and they did. Now the whole family understands why those of us that work at CHOC, do what we do —because every family deserves this type of care. We didn’t receive special care because I work at CHOC, we received special care because of CHOC.”
It’s a busy Friday morning on CHOC’s Orange campus, and a steady stream of staff, young patients and their parents make their way to a COVID-19 screening station.
After answering questions about COVID-19 symptoms and possible exposures and have body temperatures 100.4 degrees or lower, patients and their guardians who clear screening are asked to place a small round sticker on their upper body before they head to their appointments.
The stickers are a different color every day, and they tell others that their wearers have no COVID-19 symptoms or exposure. This screening process is one of a host of processes and procedures in place to ensure CHOC’s facilities are safe for patients, families, staff and physicians.
These other safety measures include daily health screenings for staff; masking and increased personal protective equipment when necessary; physical distancing practices; enhanced cleaning practices; and COVID-19 vaccination for staff and providers.
Health screenings are conducted by members of the CHOC team, and during slower stretches of their shifts, many of the screeners have taken to adding kid-friendly doodles to the small circular stickers worn by patients and families.
And while far from professional renderings and just a small gesture, the drawings cheer up young patients who sometimes might feel scared about visiting the doctor.
“I really love the dinosaur sticker!” one girl declared before heading to her appointment.
Madison McCracken, an EMT and emergency department tech, has been a CHOC screener for two months.
“We are defenders of childhood,” Madison says. “While going to the doctors might be scary, drawing on little dots is one way we can defend childhood and have fun.”
Winnie Le, a clinical nurse and supervisor of the screening program, oversees the 50 to 75 screeners who sign up for shifts in six-week schedules and are stationed at a handful of locations throughout the Orange hospital campus.
“I’m glad to see that screeners are getting creative with their skills,” Winnie says.
Chloe Parise has been serving as a screener for nearly six months.
“Drawing on the stickers is important to me because even drawing something as simple as a smiley face can brighten someone’s day,” she says. “I didn’t realize how much of an impact it was making until some coworkers were telling me how excited the kids were about the stickers.
“It may not seem like it at first, but a drawing on a sticker can help focus on the positive side of things, and parents can forget the stressful reason their child is at the doctor’s for just a second and smile at the pizza doodle that someone made.”
When Chloe first started drawing on stickers, she noticed patients chose a sticker with a doodle over a blank one every time.
“So, I started drawing smiley faces, muffins and tacos because those were things I loved to draw on my homework when I was in high school,” she says.
“The next week, they wanted me to do it again, and people were commenting on how much they loved them. A security guard at CHOC gifted me some colored pens he wasn’t using not long after that, and I’ve been doing my best to draw on every sticker I can ever since.”
Chloe’s screening co-worker was Davina Lance, a health information nurse who has been at CHOC for 31 years.
Davina says she loves working as a screener because she doesn’t see patients much during her regular duties, which mostly involve her performing triage over the phone.
“I used to get a little fix seeing the kids in the hospital hallways, but COVID has changed all of that,” Davina says. “So, I love being a screener.”
Davina bought a set of colored gel pens and keeps her designs simple.
“Believe me, I’m no artist,” she says with a laugh. “But when I’m going through the screening questions with a parent, the child is looking at which sticker he or she wants to choose. It happens every time.”
Davina draws doodles appropriate to the season or day. She went to town during the holiday season, and on the first day of March 2021, she drew bunny faces because spring and Easter are around the corner.
“It was also windy today,” Davina says. “So I drew kites.”