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.
For parents of children who need specialty care on top of their typical visits with pediatricians, CHOC’s growing Primary Care Network offers seamless integration with more than 30 specialty areas represented by CHOC’s mighty brigade of pediatric specialists.
Lea, age 4, has seen a CHOC specialist since before she was born. Lea was diagnosed in utero with hydronephrosis – a treatable condition in which urine gets trapped in the kidney and drains slower than it should into the bladder. A routine ultrasound flagged fluid in Lea’s kidney, and her mom was referred to CHOC’s urology program for a fetal consultation.
Dee Dee, Lea’s mom and a longtime CHOC employee, knew her daughter was in good hands.
“The urologist explained everything in a way that was easy to understand,” Dee Dee recalls. “I was comforted knowing that this condition was common, my daughter would be OK, and that they would continue to monitor her and manage the condition after she was born.”
Dee Dee chose to deliver at St. Joseph Hospital in Orange for its proximity to CHOC. Doctors weren’t concerned that Lea’s hydronephrosis would cause her any immediate harm, but it gave the first-time mom peace of mind knowing that CHOC was right across the street.
Specialty care with CHOC’s urology program
Lea returned to CHOC’s urology program after she was born for additional testing and monitoring.
Urologists confirmed the prenatal diagnosis and also diagnosed Lea with vesicoureteral reflux or VUR, where urine flows backward. Lea’s VUR is due to wide ureters – tubes located between the bladder and kidney, and essential to proper urine flow – and valves that are too small to efficiently direct urine flow.
Some children with VUR grow out of it without the need for medical intervention. This is less common in children with higher grade openings between the kidney and bladder, as is Lea’s case. Doctors explained to Dee Dee and her husband Pat that over time, VUR can lead to infections in the kidneys. Eventually, a high number of these possible infections can lead to kidney damage.
“We realized that if we were going to need specialty care for our daughter, we wanted a pediatrician in the CHOC network to fit into that puzzle,” Dee Dee says. “CHOC is the best partner in caring for our child.”
Lea has remained under the care of CHOC urologists, who continue to monitor her VUR. This has included two voiding cystourethrograms (VCUG). With this test, doctors insert a catheter and dye to fill Lea’s bladder, then take X-rays of fluid flowing in real time. Tests of any kind can be stressful for young kids, so child life specialists from CHOC’s Cherese Mari Laulhere Child Life Department have been present for each of these tests with Lea. Child life specialists are experts in normalizing the hospital environment for kids, but by being an extra source of comfort, they often put parents at ease, too.
“Child life has been amazing with Lea,” Dee Dee recalls. “During one VCUG, the child life specialist asked about Lea’s favorite song. At the time, it was “Wheels on the Bus” so that’s what she sang with Lea. I joined in the song, and before I knew it, every single clinician in the room was signing along to “Wheels on the Bus.” I remember thinking that even though the radiologist was so smart and so focused on performing the test, he was not above singing this song. He knew that is what my daughter needed in that moment to feel comfortable.”
Shortly after Lea’s first birthday, she underwent a procedure called a Deflux injection, where, under anesthesia, doctors injected a protein or ureter material to make the wall of Lea’s ureters thicker, hoping to close the gap and ensure proper urine flow, helping to continue avoiding UTIs.
Lea’s care team – including her parents – remain on high alert for a urinary tract infection or UTI, as a high number of these can contribute to kidney damage. Lea took preventive antibiotics until she was potty trained to help avoid UTIs.
As part of CHOC’s growing health system, pediatricians in CHOC’s Primary Care Network not only have full access to any medical records from their patients’ specialty care visits, they can also see notes from recent visits to other providers, meaning they have the latest information on their patients’ medical history.
This coordination was especially beneficial for Lea and her parents on a recent weekend when Lea had a suspected UTI. Although common in children, with Lea’s VUR, potential UTIs are cause for concern.
Thanks to Saturday morning hours at Lea’s pediatrician’s office, they were able to get a last-minute appointment.
“With Lea’s condition being relatively rare, I’m used to explaining it to people,” Dee Dee says. “But when we saw Dr. Ball, he already knew her medical history and was very familiar with her condition. We typically see Dr. Williamson in that office, and she is well-versed in Lea’s health, but seeing Dr. Ball was seamless. It was such a relief not to have to explain anything to a new-to-us provider.”
A urine sample is a routine and necessary part of testing for UTI. These can be hard for children and parents alike, but Dee Dee felt grateful that Dr. Ball and his staff were patient with Lea.
“The whole staff was really patient with us, even though we were the last appointment of the day. They just kept coming in and checking on us to see how we were doing,” Dee Dee says. “The office also felt very safe during COVID-19; everyone was masked, and everything was clean.”
Ultimately, Dee Dee and Lea headed home with instructions to drink more fluids to help Lea produce a urine sample, and a plan to head to CHOC’s urgent care in Orange when Lea was ready. During this time, Dee Dee called CHOC’s urology team to confirm their course of action.
“I called the urologist on call, and even though it wasn’t Dr. Stephany, who we typically see and who is most familiar with Lea, the doctor who called us back had already looked at Lea’s chart and read Dr. Ball’s notes from that morning,” Dee Dee says. “He reassured us we were doing the right thing and validated my choice to bring her to CHOC’s urgent care.”
Lea continued drinking fluids to help produce a urine sample. When Dee Dee and Lea got to CHOC’s urgent care, they saw Dr. Vivi Tran, a CHOC pediatrician. Dr. Tran likewise could see Lea’s complete medical history and Dr. Ball’s notes from that morning, as well.
“I didn’t need to explain a thing,” Dee Dee recalls. “Dr. Tran was already up to speed, and that was such a weight off my shoulders.”
CHOC pediatricians know kids, and they know that rushing a child – especially to do something like produce a urine sample – will often have the opposite effect. Dr. Tran checked in with Dee Dee and Lea periodically, and even brought Lea an apple juice to help her produce a urine sample.
“CHOC made this as stress-free as possible for Lea and me. We were there for three hours trying to get Lea to produce a urine sample, and never once did I feel rushed,” Dee Dee recalls.
Lea’s UTI test was ultimately negative, and she had a regularly scheduled appointment with her urologist the next week.
“The seamless coordination of care between Lea’s pediatrician’s office, her specialist and urgent care was unmatched. We could never find that anywhere else. I didn’t have to bring anyone up to speed on what was happening or my daughter’s medical history. They had access to her records and the latest information on her case,” Dee Dee says of her daughter’s experience. “I also know our positive experience wasn’t just because I’m a CHOC employee; everyone receives a high level of care.”
Since joining CHOC’s marketing department in 2013, Dee Dee has had a firsthand look at CHOC’s patient- and family-centered care and has worked closely with a number of CHOC specialists. This recent experience with her daughter gave her a greater understanding of and appreciation for CHOC’s system of care.
“We write about various conditions every day and provide education on CHOC’s coordinated system of care. I already knew these things were true because of my job, but then I experienced it myself as a mom and I truly understood how beneficial these things are,” Dee Dee says. “It seems like the scariest thing in the world, to have a child who needs CHOC’s care, but it’s actually the most comforting thing.”
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, physically distant environment to keep your child and family safe while still delivering high quality preventive care.
As a pediatrician during COVID-19, I get a lot of questions about baby vaccination and vaccines for children. Here are the most common questions I’ve gotten about vaccines during COVID-19– and why maintaining your child’s immunization schedule is more important than ever.
Can I delay my child’s vaccines during COVID19?
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.
Recent data released by the World Health Organization and the Centers for Disease Control and Prevention showed that measles deaths worldwide reached the highest level in 23 years last year. Although no measles deaths were reported in the U.S., the number of measles cases nationwide were at their highest point since 1992. Public health experts have linked the increases in measles cases to insufficient vaccine coverage.
If we don’t keep our kids protected against measles and other fatal diseases, the risk for further emergence is going to be very high. While we are waiting for a COVID-19 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?
It’s important that each member of your family get their flu shot every year. This is especially true this year, amid the COVID-19 pandemic. Since both influenza and COVID-19 can have overlapping symptoms, it may be difficult for doctors to determine which virus is behind your symptoms based on a clinical exam alone, according to pediatric infectious disease experts at CHOC.
These overlapping symptoms may include, but are not limited to: Fever or chills Cough Shortness of breath Fatigue Sore throat Runny or stuffy nose Muscle pain or body aches Headache
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.
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.