Establishing structure and routine for kids during COVID-19

By Dr. Cindy S. Kim, pediatric psychologist at CHOC

During a time of crisis when so many things are unknown, creating a routine helps children in several ways. Creating a routine for kids during COVID-19 can provide structure and predictability during times of uncertainty. Structure also promotes reassurance and a sense of safety. Routines can also promote positive physical and mental health.

Children inherently turn to structure and routine for reassurance during times of uncertainty. Structure and routine help to maintain balance and normalcy. The more a child can anticipate what’s up ahead, the better they are prepared to face daily challenges and expectations.

Here are some suggestions in establishing a routine for kids during COVID-19:

  • Don’t get carried away and over-commit to an extensive schedule. Start small and slowly build into is as you see it working for your child.
  • Set aside some time to review the schedule and expectations with your child. This will ensure that they understand what is expected of them as well as when they can have free or play time.
  • For younger children, consider using a visual schedule format. This could be in the form of a chart, a clock with activities placed on it, or any other format your child can understand.
  • Start with a good wake up and bedtime routine. The goal is to stay as close to their daily school schedule as possible to allow for a smooth transition. This allows their physiological system to maintain a healthy balance between activity and rest periods. This is essential for regulating key hormones linked to our mood, hunger, and sleep to name a few.
  • Encourage your child to change out of pajamas and participate in regular grooming and hygiene activities such as brushing their teeth, washing their face, taking showers, etc.
  • Schedule time for meals and snacks, the way they would normally have them during a typical school day.
  • Set aside a quiet workspace for your child to complete schoolwork. Most schools are in the process or have already transitioned to distance learning. Get into the habit of having your child complete their daily school assignments each day.
  • Schedule harder tasks, such as classwork, to be completed earlier in the day when your child is more refreshed and rested. Save easier tasks for later in the day.
  • Allow for natural breaks or recess throughout the day. This time can be spent relaxing, listening to music, reading for fun, engaging in a hobby or exercising. During this time, be attentive to your child’s mood. When they are overly stressed or anxious, you might schedule in additional fun breaks.
  • Allow opportunities for your child to help around the house and do simple chores. This can be as simple as setting the table, folding laundry, or walking the family dog. Giving a child a simple task or job to do can help build up their sense of empowerment.
  • Encourage hobbies and other creative outlets. Your once busy child now has the gift of time to engage in creative outlets such as drawing, painting, cooking, designing, writing a short story or play, or building a fort. Hobbies are a great way to foster creativity and imagination all while giving a child something to do to break up their day.
  • Set aside time for outdoor activities, following social distancing guidelines. This is a great opportunity to go for a short family hike, bike ride or walk around the neighborhood. The goal is to remain active and physical while upholding good social distancing practices.
  • Engage in mindfulness and stress-relieving activities. Many meditation and mindfulness apps are offering free downloads or reduced subscription dues for many effective mediation, guided imagery, and stress reduction exercises or activities your child can do. CHOC offers online guided imagery.
  • Allow screen time as needed. It’s inevitable that your child will want to connect with friends online or spend some time in front of a screen. Screen time is a great way to reward your child for completing their tasks such as chores and schoolwork. As always, monitor and ensure safety measures are in place to allow for safe screen time.
  • Schedule time to connect with friends via technology. This can include video conferencing, text or social media. Social connections are important for children to continue to achieve their developmental goals. You can use video chats, for example, to have a virtual play date while children do the same activity such as creating the same craft together.

What to expect at CHOC outpatient offices during COVID-19

As CHOC and other healthcare facilities adapt to the fluid environment created by the COVID-19 pandemic, and national, state and local recommendations and guidelines changing frequently, you may notice some changes the next time you visit the doctor’s office. We appreciate your patience and understanding as we adjust our practices to ensure a safe environment for our patients, families, staff and community.

You are going to be asked more questions

Your history of potential COVID-19 exposure, travel history and recent symptoms are clues to your family’s risk. We are screening on the phone and prior to entry into our clinical areas.

We will ask you to limit the number of people with your child

For the safety of our patients, families, physicians and staff, we are limiting the number of people who can accompany a patient. Please check choc.org/visiting for the latest visitor guidelines by location.

Our phone lines are busy

We anticipate our phone lines being busier than normal. Thank you, in advance, for your patience with our staff, who remain dedicated to providing the best customer service. If you have questions about your child’s health and COVID-19, call our 24/7 nurse line at 1-844-GET-CHOC.

You may be asked to see your doctor virtually

Many appointments can be done through telehealth, which means you can interact with a provider from the comfort and safety of your home. Depending on your child’s health needs, you may be asked to see your doctor using a computer or mobile device. When you schedule a telehealth appointment, you will receive a link by email or text message, which will connect with a CHOC provider at your appointment time.

Appointment times might change

Your appointment may be moved to a different location, date or time. Appointments that can be safely delayed may be rescheduled  to accommodate surging demand. We will continue to do our best to accommodate our patients and appreciate your patience and flexibility.

You may see a different provider

We will relocate some providers to different locations to ensure adequate staffing and to protect providers who may be at risk. If your child’s provider is not available, you will be given the option of seeing a different provider or rescheduling for a future date if possible. We thank you for being flexible with our providers.

No one will come to work sick

This has always been our policy, but we will be extra cautious in the current climate. Please be aware that there may be occasions when we will need to make last-minute cancellations or location/provider changes due to staffing issues.

Our cleaning procedures are rigorous

We will continue to thoroughly sanitize our offices to the most rigorous standards. Clinical areas will be cleaned multiple times per day, in addition to the medical grade sanitization we have always provided.

This is a rapidly evolving situation and our efforts to provide you with the safest and most effective care will not stop. Please stay tuned to choc.org/visiting for the latest information about visiting our locations.

20-second songs to sing while you wash your hands

How long do you have to wash your hands? At least 20 seconds each time. This equates to the time it takes to sing “Happy birthday” twice. But if you’re looking for a refresh on your hand-washing set let,  Kevin Budd, a CHOC music therapist, has compiled this list of 20-second snippets of your favorite songs, to sing while you wash your hands. (And you can get more hand-washing tips from a CHOC pediatrician here.)

Just the Way You Are – Bruno Mars

When I see your face
There’s not a thing that I would change
’cause you’re amazing
Just the way you are
And when you smile
The whole world stops and stares for a while
‘Cause you’re amazing
Just the way you are

Mr. Brightside – The Killers

Jealousy, turning saints into the sea
Swimming through sick lullabies
Choking on your alibis
But it’s just the price I pay
Destiny is calling me
Open up my eager eyes
‘Cause I’m Mr. Brightside

Love on Top – Beyoncé

Baby it’s you
You’re the one I love
You’re the one I need
You’re the only one I see
Come on baby it’s you
You’re the one that gives your all
You’re the one I can always call
When I need to make everything stop
Finally you put my love on top

Stressed Out – Twenty One Pilots

Wish we could turn back time,
to the good old days
When our momma sang us to sleep
but now we’re stressed out
Wish we could turn back time,
to the good old days
When our momma sang us to sleep
but now we’re stressed out

Can’t Hold Us – Macklemore

Can we go back? This is the moment
Tonight is the night; we’ll fight till it’s over
So we put our hands up
Like the ceiling can’t hold us
Like the ceiling can’t hold us X2

Some Nights – fun.

Some nights, I stay up cashing in my bad luck
Some nights, I call it a draw
Some nights, I wish that my lips could build a castle
Some nights, I wish they’d just fall off
But I still wake up, I still see your ghost
Oh Lord, I’m still not sure, what I stand for oh
What do I stand for? What do I stand for?
Most nights, I don’t know anymore

Truth Hurts – Lizzo

Why men great ‘til they gotta be great
Don’t text me; tell it straight to my face
Best friend sat me down in the salon chair
Shampoo press, get you out of my hair
Fresh photos with the bomb lighting
New man on the Minnesota Vikings
Truth hurts, needed something more exciting
Bom bom bi dom bi dum bum bay

Whatever it Takes – Imagine Dragons

Whatever it takes
‘Cause I love the adrenaline in my veins
I do whatever it takes
‘Cause I love how it feels when I break the chains
Whatever it takes
You take me to the top I’m ready for
Whatever it takes
‘Cause I love the adrenaline in my veins
I do what it takes

CHOC Foundation events postponed

We understand there are rising concerns about coronavirus (COVID-19). We want to assure you that CHOC is taking precautions to protect the health and well-being of the community. One precautionary measure we have decided to take is to postpone all Foundation events and activities through April 30, 2020.

Below is a list of events that have been postponed or cancelled.

Postponed
March 16, 2020 – Jack & Jill Tee it Up for CHOC

Canceled
March 28, 2020 – Lamp Lighter & Squires – Cheers CHOC

Postponed
March 27-28, 2020 – CHOC Follies

Postponed
April 30, 2020 – Unidos Por CHOC

This was a difficult decision, but we believe it’s in the best interest of our family of supporters and the community at large. We will miss engaging with you, our wonderful partners, and sincerely appreciate your understanding. We will reschedule our beloved events when the time is right, and we will be thrilled to see all of you then.

CHOC leadership, including our internationally recognized infectious disease team, will continue to work with health and governmental agencies to ensure we continue to deliver high-quality care to the children and families who depend on us to be there for them.

The safety of our staff and community is our utmost priority. Thank you for your understanding and your continued support of our passionate defense of childhood.

View all Foundation events here.

For all inquiries related to these events, please contact communityengagement@choc.org.

This article was last updated on March 16, 2020.

8 ways to protect children with diabetes from COVID-19

We know how frightening the spread of the 2019 novel Coronavirus (COVID-19) may be for parents – especially parents of children with diabetes.

The good news is that for children with diabetes, there is no evidence this virus will be any different than most other viral respiratory illnesses. As always, an illness will require increased glucose monitoring, possible ketone testing, and increased attention to insulin and carbohydrate intake.

If any person with diabetes gets sick — from any cause— CHOC endocrinology department recommends the following:

  1. If you are using a glucose meter, check your glucose more often, every two to three hours at minimum.
  2. If you are using a continuous glucose monitoring, or CGM, device such as DexCom or Libre, review the data from your continuous glucose every one to three hours to monitor for trends and adjust your insulin/food intake.
  3. If you are on injections, always take your long-acting insulin (such as Lantus, Levemir, Tresiba or Basaglar), even if you are eating less. If you are experiencing overnight lows, you can decrease your dose by 10%. For example, if you use 20 units nightly, then decrease down to 18 units, but if you need to decrease further for continued low blood glucose values, please contact your provider.
  4. If you are using an insulin pump, continue to wear the pump for basal insulin.
  5. Continue to stay hydrated by drinking lots of fluids.
  6. Check for ketones if glucose readings are higher than 300 for more than three hours.
  7. If you have moderate or large ketones, especially if you are vomiting, contact your provider.
  8. Ensure you have your diabetes supplies, and that you are not close to running out.

For type 1 diabetes–specific topics related to COVID-19, please visit JDRF.org/coronavirus.

CHOC’s endocrinology department continues to offer on-site office visits, but if you or your child is sick, please stay home and notify us that you will not be attending the visit. Our team will work with your family on alternative arrangements if you cannot make it to your scheduled visit.

CHOC endocrinology can be reached during daytime hours at 714-509-8634. During evenings and weekends, call 714-765-7679.