Face coverings during COVID-19: Answers to common questions

Social distancing and proper hand-washing are critical ways to protect yourself and your family from COVID-19. Cloth face coverings are an additional step to slow the spread of COVID-19. Get answers to your frequently asked questions in this Q&A with CHOC Children’s infectious disease experts.

Do I have to wear a face covering in public?

The Centers for Disease Control and Prevention 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.

Is there anyone who should not wear a face covering?

Children under age 2, or anyone who has trouble breathing, is unconscious, incapacitated or unable to remove the mask without assistance should not use a cloth face covering.

What’s the right way to wear a face covering?

Wash your hands before putting on your face covering. It should cover your nose and mouth, be secure under your chin, and fit snugly against the sides of your face. Make sure you can breathe easily while wearing your mask.

Don’t put the covering around your neck or up on your forehead. Avoid touching your face covering. If you do, wash your hands.

Here’s a helpful video from Dr. Katherine Williamson, a CHOC Children’s pediatrician, on how to wear a face covering:

Should I wear a surgical mask?

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

How can I make my own face covering?

The CDC offers tutorials for sewn and non-sewn face coverings.

What’s the best way to remove my face covering?

Untie the stings behind your head or stretch the ear loops. Only hold your face covering by these ties or strings to avoid transferring any germs that may be on your hands onto the portion of the cloth that covers your nose and mouth.

Wash your hands after removing your face mask.

How do I wash my face covering?

Wash your face covering frequently, using one of these methods:

  • In the laundry – It’s OK to include your face covering in your regular laundry. Use your regular laundry detergent and the warmest possible setting for the cloth used in your face covering,
  • By hand – When washing face coverings by hand, the CDC suggests using a bleach solution by mixing 5 tablespoons (or 1/3 cup) of household bleach per gallon of room temperature water OR 4 teaspoons of household bleach per quart of room temperature water. Soak the face covering in the bleach solution for five minutes. Then thoroughly rinse with cool or room temperature water.
    • Always check the label on your bleach before using. Ensure your bleach is intended for disinfection, and that it’s not past its expiration date.
    • Never mix household bleach with ammonia or any other cleanser.

Why should I wear a face covering?

Many people with COVID-19 have no symptoms. Wearing a face covering helps protect others in your community – like those with autoimmune disorders or the elderly – in case you’re infected but don’t have any symptoms.

How can I help my child who is afraid of face masks?

Some children may incorporate mask wearing into their daily lives with ease, while others may find it odd, uncomfortable or even scary. If your child is having trouble wearing a mask, here’s advice from a CHOC pediatric psychologist on how to ease their fears.

Additional resources
The Orange County Health Care Agency has a printable graphic that offers an overview of how to wear and wash your mask available in multiple languages:

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I’m a pediatrician. Here’s what I want you to know about vaccines.

By Dr. Katherine Williamson, a CHOC Children’s pediatrician

dr-katherine-williamson
Dr. Katherine Williamson, a CHOC Children’s pediatrician

Proper vaccination is important for all people, but especially infants and babies. When children follow the recommended immunization schedule outlined by the American Academy of Pediatrics (AAP), they are better protected against potentially life-threatening diseases.

During the COVID-19 pandemic, your CHOC pediatrician’s office is a safe, socially distant environment to keep your child and family safe while still delivering high quality preventive care.

As a pediatrician, I get a lot of questions about baby vaccination and vaccines for children. Here are the most common questions I get about vaccines – and why maintaining your child’s immunization schedule is more important than ever.

Are vaccines safe?

Vaccines are one of the most important things we can do to help protect our children’s health. Vaccines and proper handwashing, more so than all other interventions, have proven to be the most safe and effective ways to prevent disease.

What is the proper vaccine schedule?

The current immunization schedule outlined by the AAP and Centers for Disease Control & Prevention has been researched and proven to be the most effective and safest way for children to be vaccinated against potentially fatal diseases. It’s important to know that no alternative schedule has been shown to be as safe and effective.

Is it better to do multiple vaccines at one time or space them out?

The safest way to keep your child safe from vaccine-preventable diseases is to get all their vaccines on time. There is no advantage to spacing them out, and instead the longer you wait, you increase the risk of them catching one of the preventable diseases before you protect them.

The amount of antigen (protein) in each vaccine is so tiny that your immune system can process multiple vaccines at one time and build an antibody “army” to protect your child for each of those potentially fatal diseases. In fact, the amount of antigen (protein) in each vaccine is 100,000 times less than if your child has a common cold, so there’s no concern about overwhelming their immune system when they get their vaccines.

Can I delay my child’s vaccines during COVID-19?

Getting vaccinated on time is important because even though we have the threat of COVID-19 to contend with, all the diseases that we can prevent easily with vaccines are still a threat. These diseases — such as whooping cough and measles — are ready to emerge at any time that we don’t have the majority of our kids vaccinated.

When global travel begins to pick back up again, the risk for the emergence of vaccine-preventable diseases is going to be very high if we don’t keep our kids protected against these fatal diseases. While we are waiting for a COVID19 vaccine to stop the pandemic, it is up to us to keep our kids safe and prevent any future epidemics by using the tools we already have to prevent disease.

Do I really need a flu shot every year?

Yes. Now more than ever, it is important that everyone 6 months of age and older receive an influenza vaccine this fall. As many experts are expecting an increase of COVID-19 cases in the fall, an important step to protect our families is to make sure they are vaccinated for influenza in addition to their routine vaccines. While the influenza vaccine does not protect against COVID-19, it may help children if they are exposed to the new virus and may be at higher risk of developing pneumonia or other complications if their bodies are also fighting influenza.

Influenza causes a higher number of death and illness over any other disease annually in the U.S., and your best chance of preventing influenza is the flu vaccine. Symptoms of influenza include high fevers, chills, muscle aches, and respiratory symptoms that can lead to pneumonia and respiratory failure. Children under 2 years and adults over 60 years of age are at the highest risk of becoming seriously ill if they are exposed to influenza.

The CDC recommends an annual influenza vaccine for everyone 6 months of age and older. You should be vaccinated as soon as the influenza vaccine becomes available. Although flu season peaks between December and February, it can start as early as October and last through May.

What can I do to make my child more comfortable while receiving a vaccination?

Studies have shown that preparing your child for vaccinations should ideally include three components: explaining what will happen, how it will feel, and strategies for coping with any related stress or discomfort. Here’s more tips on how to make shots less stressful.

This article was updated on May 18, 2020.

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Is it OK to skip your child’s checkup if they’re healthy?

The first few years of your child’s life are a major factor in their lifelong growth and development, which is why we recommend all well checkups for your child even if they’re healthy. During the COVID-19 pandemic, your CHOC pediatrician’s office is a safe, socially distant environment to keep your child and family safe while still delivering high quality preventive care.

These checkups, also known as well child checks, are an opportunity to track your child’s development, make sure they’re getting the care they need to stay healthy, and for parents to get answers to any parenting questions.

Under the current stay at home orders, it may be tempting to skip something called a “well child check” if your child is feeling healthy. Here are six reasons why it’s not OK to skip your child’s checkup, even if they’re feeling healthy.

dr-katherine-williamson
Dr. Katherine Williamson, a CHOC Children’s pediatrician

#1 Developmental screening

At every well checkup your pediatrician will be making sure that your child is meeting her or his developmental milestones, whether they are 4 months, 4 years, or 14 years old. For babies and toddlers, these milestones come rapidly as children’s brains are learning many new skills every day, from crawling to walking, and from first words to conversations. It is important to make sure your child is acquiring these necessary skills for brain development every step of the way. For older kids and teens, these milestones become less apparent, but are just as important, and are often reflected in a child’s ability to handle academics, relationship, and emotions. Your pediatrician is here to help at every stage of your child’s development.

#2 Relationship building

It’s important for your child to develop a rapport with their pediatrician. We are positive role models for young kids and help lessen their fear of going to the doctor. When your child is a teenager, parents are often asked to leave the exam room so the pediatrician can speak to the teen in private. Your child will feel more comfortable asking personal questions about their body and puberty later in life if their pediatrician has been a constant figure and steady resource since childhood.

#3 Mental health check up

Well checks also serve as a mental and behavioral health check-in. Your pediatrician can help evaluate your child’s mental health and wellbeing over time.

During well child checks amid the pandemic, mental health has been a bigger part of conversations during appointments than ever before. This is a chance for pediatricians to check on how the whole family is coping with stress related to COVID-19. They can share advice for how to talk to kids about COVID-19 and help them cope with COVID-19 anxiety as well as how to teach teens the importance of stay at home orders.

You can also talk to your pediatrician about how your child is coping with social distancing, or a lack of playdates and time with friends. They can offer advice on how to make this a positive time for your family.

#4 Enforcing healthy habits

Well child checks are a great opportunity to reinforce healthy habits. Often, kids will listen to their pediatrician more than their parents. We can remind children about the importance of eating healthy, doing their homework, brushing their teeth, wearing helmets—and listening to their parents!

Do you ever struggle with the question, “How much screen time is too much?” or find yourself battling your children over screen time limits? Your pediatrician can be a resource for you in helping reinforce screen time limits with your child. We can help explain to your children why their bodies need less screen time and more play, and how too much screen time affects their body and brain.

With children spending more time at home than ever, your pediatrician can be a resource on activity ideas for kids during COVID-19.

#5 Getting answers to questions you didn’t know you had

During many appointments in my office, my conversation with parents takes a turn from why they originally came in to see me. They might have an appointment to get a rash checked out, but then I’ll notice a mole on the child I hadn’t seen before, and they’ll realize they too were wondering about that, but just forgot to ask.

Pediatricians are resources for parents just as much as we are caretakers of your children. We’re here to help you get answers to your questions on acne, headaches, academic concerns and anything in between.

#6 A fresh perspective on parenting

Pediatricians specialize in taking care of infants, children and teens – but they can be there for you as a parent, as well.

Right now, parents have been asked to take on more than ever – working from home, overseeing their child’s distance learning curriculum, keeping kids entertained and engaged around-the clock, and more – and they are understandably overwhelmed.

Having a fresh set of eyes on a family’s situation may help troubleshoot what they are trying to figure out. Many of my patients’ parents are struggling with a seemingly never-ending to-do list. Their child’s pediatrician is someone they trust and respect, and I validate that they are doing their best.

Parents should congratulate and forgive themselves. At the end of the day they may be hard on themselves and wish they had done more, and that feeling compounds by the end of the week or month. What parents are juggling right now is Herculean. I applaud each and every one of you.

This article was updated on May 18, 2020.

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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. Discussion forums and online communities of other parents can be especially helpful.
  • Use your helpers. If you have a new baby at home, older siblings can help in developmentally appropriate ways.
  • Speak with your healthcare provider about your mental health. Many doctors and mental health providers are offering telehealth visits.

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.

This article was last updated on April 14, 2020.

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Teen advisers offer tips on avoiding peer pressure to vape

The dramatic rise in vaping among teens is alarming to pediatricians and parents alike. It’s common for teens’ first exposure to vaping to come as an effect of peer pressure, says Dr. Katherine Williamson, a CHOC Children’s pediatrician.

“The rate at which vaping has increased over the last several years see is really scary for me to see as a pediatrician,” Williamson says.

CHOC Children’s teen advisers, a group of teens active in their community, committed to academic success, and who support CHOC’s mission, offer their advice for teens struggling to deal with peer pressure to vape.

  • It’s just not worth it – “My freshman year of high school, I was offered the opportunity vape more than 10 times. In these situations, it’s your choice how to respond. Vaping is simply not worth it. Do not be guilted or tempted by those around you.” – Andei, age 16
  • Consider the long-term consequences – “You may not feel it at first, but as you vape, your lungs are being damaged. You could end up in the hospital as a result of vaping. Turn down the offer to vape and walk away from the situation.” – Sam, age 12
  • Offer a valid excuse – “My parents always told me that to get out of a peer pressure situation, I could tell a white lie and blame it on them. I could say something like, “My parents are super strict and will drug test me, so I can’t. Or, I remove myself from situations by saying I have to get to volleyball practice or have another commitment.” – Noah, age 17
  • Complications of addiction – “Teens endure tremendous social pressure, which makes it easier for teens to fall victim to vaping. Avoiding peer pressure to vape might not be an easy task, but it’s far easier than having to withdraw from addiction.” – Christian, age 17
  • Health consequences —
    • “Always think about the serious health consequences of vaping. It’s very addictive, causes breathing difficulties and increases your risk of cancer or even death.” – Lauren, age 15
    • “Although it is marketed as a safer alternative to cigarettes, they contain addictive chemicals. It’s a newer trend, and some teens may not be as educated on the dangers of vaping.” – Layla, age 14
    • “Vaping can change your life in an unhealthy way. Not only can you damage your lungs, but it can impact your life in others way, too. You could be punished by your school and parents, as well.” — Carina, age 15
    • “Although the side effects may
  • Re-evaluate your friend group – “Walk away from the situation and stop hanging out with friends who are pressuring you. That means they don’t care about you. Find new friends who do.” –Trevor, age 15
  • Social/school consequences – “Schools take vaping seriously. They can take away your ability to participate in activities, sports or dances.” – Jorian, age 15

Harmful effects of vaping

As more teens develop an addiction to vaping nicotine or CBD oil, Williamson has treated more and more teens with lung problems, agitation and anxiety.

Vaping hasn’t been around long enough for us to know its long-term effects on the body. But health experts are reporting serious lung damage in people who vape, including some deaths.

E-cigarettes also:

  • Irritate the lungs
  • May cause serious lung damage and even death
  • Can lead to smoking cigarettes and other forms of tobacco use

Some people use e-cigarettes to vape marijuana, THC oil and other dangerous chemicals. Besides irritating the lungs, these drugs also affect how someone thinks, acts and feels.

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