A pediatrician’s tips for promoting a safe return to sports during COVID-19

With some kids and teens returning to team sports after an extended break amid the COVID-19 pandemic, parents and pediatricians alike have safety top of mind.

Taking care of your physical and mental well-being will lead to more achievement and fun on the field, says Dr. Matthew Kornswiet, a sports medicine pediatrician in CHOC Children’s Primary Care Network.

How can you keep your kids safe on the field after so much time off?

Coaches and parents should continue to follow safe return to sports guidelines from the Centers for Disease Control & Prevention and locally, the California Interscholastic Federation.

Remembering the acronym SPORTS can also help support a safe and healthy return to play and participation in athletic activities during the COVID-19 pandemic.

With support from Dr. Chris Koutures, a CHOC pediatrician and sports medicine specialist, Dr. Kornswiet offers these tips for parents, guardians and coaches:

  • Start slowly. It’s been a while since your child has played sports, so do not expect them to start where they left off. It may take several weeks to get back into shape. Start with a review of basic skills and techniques and build up to more advanced skills. Plan shorter workouts to give them time to build up endurance. And limit repetitive movements such as throwing, swinging and jumping.
  • Pay attention to your body. Quickly returning to athletic activities after time off increases the risk of overuse injuries. Follow your instincts – if you are hesitant to return to your activity, then wait or slow down. Also, maintain adequate sleep of eight hours or more per night, and stay hydrated to help your body perform at its best. Early in conditioning, especially during hot days, watch for signs of overheating. If you feel more tired than everyone else, or experience dizziness or confusion, seek medical care immediately.
  • Open mind. Reset expectations and short-term goals. You may not be able to practice like you usually do. Be mindful of your mental health and well-being during this extraordinary time. Think of ways to cross train or do alternative workouts.
  • Red flags. See your pediatrician, sports medicine physician, athletic trainer or physical therapist if you experience pain in a small, confined area; if you are limping or not able to move normally; if you feel pain/soreness greater than four on a scale of one to 10; if you experience pain or soreness when you are not playing sports; or if you feel pain or soreness that lasts two to three days after activity.
  • Take steps to limit the spread of COVID-19. Never practice or play when you are feeling sick. When possible, train outside to limit the risk of transmitting/catching infections. Wear a mask or face covering when possible (i.e. in team meetings and when on the sideline). Bring hand sanitizer and use on your hands often. Try not to share equipment. If that’s not possible, then limit the number of people using that equipment and plan how to clean between uses. Bring your own water and snacks. And avoid high-fives, fist/chest bumps, and hugs – create your own hands-free celebration. 
  • Stay positive. Sports are fun, social and make us stronger physically and mentally. Playing sports can help us through challenging times.
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The importance of well-checks during COVID-19

An upcoming well-check appointment for her teenage son had slipped Courtney Berney’s mind until her CHOC Children’s pediatrician called her one day with a reminder.

“I didn’t even remember that we had a well-check,” she says. “I did ask if we should still go, even with COVID-19 happening.”

Dr. Eric Ball gave Courtney an overview of the steps CHOC’s Primary Care Network had taken to keep patients, families and staff safe during the pandemic.

Dr. Eric Ball, a CHOC Children’s pediatrician

Reassured, Courtney and her son, Jackson, headed to the appointment. Upon arrival, they both wore masks, had their temperatures checked and were asked about symptoms and possible COVID-19 exposure. The waiting room was kept largely empty and all staff wore masks.

“It felt very safe,” Courtney said. “I was impressed.”

A routine visit takes an unexpected turn

Including tracking growth, checking in on mental health and ensuring current immunizations, the well-check continued like every other routine visit 15-year-old Jackson had experienced before.

But then, Dr. Ball detected an inguinal hernia during his physical exam.

These can occur when the inguinal canal, which extends down the groin, doesn’t close on its own shortly after birth. If this opening is large enough in these cases, the intestine can come into the canal and create a bulge in the groin region.

This can grow dangerous if the part of the body that protrudes from the hernia becomes stuck, which can compromise blood flow to the trapped body part.

“Apparently, Jackson was born with it and always had it and he didn’t know,” Courtney says. “He’s had this exam every year since, but this year it felt different. I wouldn’t have known that, and he wouldn’t know it without having this visit.”

Because inguinal hernias should be repaired by surgery, Dr. Ball referred Jackson to CHOC’s pediatric general and thoracic surgeons for a follow-up appointment, and Jackson recently underwent a successful outpatient procedure to repair the hernia.

“Inguinal hernias are common but should be taken care of promptly,” says Dr. Ball. “They’re also something that often only a doctor can detect during a physical examination, which underscores the importance of regular well-checks for kids – even when they’re healthy.”

Taking a personal approach

Knowing that parents may be wary of healthcare settings during a pandemic but also how critical seeking both sick and well care remains, Dr. Ball and his colleagues earlier into the COVID-19 emergency made personal phone calls to families. Today, Dr. Ball still regularly has conversations with families about the measures in place to keep families safe.

“I’m happy to connect with them and personally reassure our families about the safety of our office,”  Dr. Ball says. “We want to ensure our patients and families know that we are here for them – during a pandemic and otherwise – and how critical it is to seek both routine and regular care.”

Here’s a look at other ways CHOC is ensuring its primary care practices are safe during COVID-19:

  • separated offices, waiting rooms, exam rooms and times/days for sick visits and well visits;
  • masking for staff, patients ages 2 and older and families;
  • enhanced cleaning practices;
  • screening of all patients for COVID-19 risks, by phone when families make appointments, and upon arrival for well and sick visits;
  • in-vehicle evaluation of children symptomatic or exposed to COVID-19; and
  • limiting the number of people who can accompany a patient to an appointment to one family member.

These extra steps helped reassure Courtney that it was safe to seek routine care for her children, even during a pandemic – and she’ll be coming back.

“My son is really healthy too, but I wouldn’t pass up a well-check,” Courtney says. “I know it might be scary and new, but I trust the doctors. I have to book my appointment for my other son in a couple weeks too.”

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Summer safety tips from your pediatrician

Kids are still kids, even during a pandemic – they play, they get sick and sometimes they get hurt. We spoke to Dr. Angela Dangvu, a CHOC Children’s pediatrician, about what parents can do to keep kids safe this summer.

Dr. Angela Dangvu, a CHOC Children’s pediatrician

COVID-19 precautions

With no vaccine currently available, the best way to prevent illness is to avoid being exposed. In addition to practicing proper handwashing, people should watch for symptoms and avoid going out if they feel ill. When outside the home, people should physically distance from others whenever possible, and wear a face covering. The Centers for Disease Control and Prevention recommends the use of cloth face coverings in public for those over age 2. The governor of California has mandated that face coverings be worn by the general public when outside the home. Read the full order, including exemptions, here.

Be safe around water

A child can drown in as little as 2 inches of water – so keep an eye on all bodies of water like bathtubs and ice chests, in addition to pools. Assign a “water watcher” who knows how to swim and can provide constant, uninterrupted supervision. Learn more about water safety.

Wear your sunscreen

Everyone over 6 months should wear sunscreen when they’re outdoors. Infants younger than 6 months should be kept out of the sun.

Apply a sunscreen with SPF 30 at least 15-30 minutes before you go outside. Reapply every two hours or after swimming or sweating. Wide-brimmed hats and sunglasses offer extra protection. Limit time spent outside between 10 a.m. and 4 p.m. to minimize down on sun exposure. Also be aware that surfaces like sand and water reflect sunlight, so it’s possible to get burnt even when you’re in the shade. This is especially true for infants.

Review family emergency preparedness plans

Emergencies are not on pause just because there is a pandemic. Create and practice a fire escape plan with your family. Double-check smoke alarms and carbon monoxide detectors.

Practice poison precautions

Avoid household poisoning hazards and save the Poison Control Center’s phone number in your cell phone: 1-800-222-1222 for serious emergencies or simple questions. Store medicine and vitamins up high and out of sight. Remind children that medicine is not candy.

Helmet safety

Most serious head injuries can be avoided by wearing a properly fitting helmet. By law in California, everyone under 18 years of age must wear a Consumer Product Safety Commission-approved helmet while bicycling, riding a scooter, skateboard, or using roller-skates or in-line skates. Parents should enforce this rule even when kids are riding in areas where they don’t expect to encounter vehicles.

Learn more about the most common summer injuries that send kids to the emergency department – and how to avoid them.

If your child is ill or injured during the COVID-19 pandemic, rest assured that it is safe to seek the care they need. Here’s a guide on deciding where to go for care during COVID-19.

This article was updated July 22, 2020.

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I’m a pediatrician and parent. Here’s how my family is coping with COVID-19.

By Dr. Marshneil Chavan, a CHOC Children’s pediatrician

After several months under stay at home orders caused by the COVID-19 pandemic, it has become clear that the normal way of life we knew a few months ago is not returning anytime soon.

As a pediatrician I am constantly having to deal with uncertainties at work and adapt to changes brought about by this pandemic. For example, our office has made changes to support physical distancing and implemented other measures to keep our patients, their parents and our staff safe.

As a parent of two young children, I realize that on most days the challenges I face at home far exceed those at work.

With very little time to prepare, we as parents have had to face challenges related to childcare, distance learning, explaining to kids why we cannot go to the park or see their friends, explaining COVID-19 to kids, and helping them make sense of the changing world around them. As we prepare for the coming months, I want to share how my family and I are dealing with this crisis, hoping this helps you to take care of yours.

Create structure where you can

Children thrive on structure and predictability. My family has tried to maintain a reasonable daily schedule for the kids that includes time for schoolwork, educational activities and free play; and we attempt to limit screen time. Ensuring children get a chance to go outside for exercise every day is also important for their physical and emotional well-being. These outdoor breaks could include walks, jogs, bike riding or walking the dog. Here’s more tips on creating structure and routine for kids during COVID-19.

Plan something to look forward to

Planning ahead for special activities with kids during your free time gives them something to look forward to, and they will enjoy the feeling of spending quality time with Mom or Dad. My family has had fun with backyard picnics, singing and dancing together, painting, baking, family movie nights and evening car rides.

One new piece of art that’s come from family art time in our home.

Our children have also enjoyed virtual playdates with friends, connecting with cousins over via phone calls and video chats, and celebrating virtual birthday parties. Since children are spending a lot more time at home than before, this is also a good time to engage them in additional age appropriate household chores. Here’s more activity ideas for kids during COVID-19.
family-movie-night-posterA homemade family movie night poster designed by my child.

How I’m protecting my family

All parents want to do their best to keep their family safe and healthy during this time. In addition to balanced nutritious meals (here’s some recipe ideas!) and exercise, sleep is a great immunity booster. Set reasonable hours for bedtime and waking up to make sure children get at least 9-10 hours of sleep every night. Minimizing outings in public places unless necessary, following face covering guidelines, good handwashing and sanitizing methods and maintaining social distancing in public are all key to ensure we play our part in continuing to limit the spread of COVID-19 in our communities.

 Maintaining well checks

Under the current stay at home orders, it can be tempting to skip your child’s well check if they’re feeling healthy. However, maintaining well child checks and staying up to date on vaccines is essential during this time. I have taken my children to their well check visits to make sure they are growing and developing well and are up to date on their vaccinations. When flu season comes around, I will also make sure our family gets our flu vaccines on time.

Be mindful of mental health

When speaking to children about COVID-19, ask them what they know since they have very likely already absorbed some information from news, elders or social media. It is important to provide reassurance and offer specific directions on what you are doing to keep them safe and what they can do themselves.

As a physician I cannot truly predict how this pandemic will evolve over the next several months. And, hence, there are no straight answers to my children’s questions of, “When can we go to Disneyland again? When can we fly to see Grandpa? When can I have a ”rea”’ birthday party?” If you’re getting the same questions from your kids, be honest and open to discuss possibilities as these can be great opportunities for kids to learn to live with uncertainty and build flexibility and resilience.

CHOC experts have created a variety of guides for parents on how to support their children during the pandemic A few are below, but you can find more resources here.

Practicing self-care

Meeting all these additional demands on our energies and attention for the foreseeable future is only possible if we maintain our physical, emotional and mental stability. Do not forget to take some time for self-care, which includes proper sleep, nutrition and exercise. Here’s more tips on self-care from a CHOC psychologist.

In my family, we avoid spending too much time watching or discussing COVID-related news, especially in front of the children. Amidst constant news of sickness, financial challenges and social upheaval I rely on my daily Heartfulness meditation practice to give me perspective and keep me going. Consciously practicing gratitude is also a great way to boost our self-esteem during these trying times. Personally, taking 5 minutes to list things I am grateful for every day as part of my bedtime routine has worked wonders to bring more optimism and joy to my day. Here’s more tips on practicing mindfulness and meditation.

Eventually, it is important to remember to accept the uncertainty, pat yourself on the back, pick your battles, stay connected and stay positive.

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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, 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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