Family & Parenting

Fortunately, COVID-19 illness in children is usually mild and can be treated with supportive care at home, with acetaminophen for fever, if needed.

Children who are hospitalized with severe illness due to COVID-19 may be considered for treatment with the antiviral drug remdesivir within a clinical trial or on a case-by-case basis. The drug is not

FDA-approved but has been granted emergency use authorization by the FDA.

Little is known about the drug’s potential benefits and potential risks, so it would be used in children only after careful consideration by the treatment team and discussion with caregivers. There is no guidance about use specifically in children with rheumatic disease.
 

A: Antibody tests, sometimes called serology tests, evaluate blood samples for the presence of antibodies to the new coronavirus. If your child were to test positive for antibodies, it would mean he or she had been infected with the new coronavirus and now may have immunity to future COVID-19 illness. That would seem to be good news, but there are a few caveats. No one one knows yet if these antibodies will provide lifelong immunity, as happens with some diseases, or give protection only for a limited time.

There is another catch to antibody tests. Even tests that are FDA-approved may not produce reliable results. At this point, a lot more research is needed before these tests will be useful to individual patients. Over time, knowledge will increase, and tests improve. Your son’s doctor will be the best source of advice on the value of testing.
 

A: Pediatric rheumatologists and adult rheumatologists are getting called in to consult on a mysterious new illness thought to be related to COVID-19. It mostly affects children and teens and looks like Kawasaki disease, an arthritis-related rheumatic disease that occurs mostly in children. This new illness, called multi-system inflammatory syndrome, or MIS-C for short, presents with high fever for several days, and leads to a potentially dangerous state of extreme inflammation. It requires emergency care. Learn more here. 

Updated May 1, 2020

A: We don't know yet. At this point we know very little about patients with rheumatic diseases who develop COVID-19. Past experience with flu and other infections would suggest that children and adults on immunosuppressive medications are at higher risk for infection and complications but that may not be the case with this virus.
 
The good news is there are case reports suggesting that these patients do not appear to have more severe disease compared to the general population. Early reports from Italy note that post-transplant patients on immunosuppressive medications did not appear to have worse COVID-related symptoms or disease, which is somewhat reassuring.
 
Pediatric rheumatologists would say that each child with rheumatic disease is unique. Factors such as disease type, disease activity, degree of immunosuppression and organ involvement, will affect the amount of risk from a coronavirus infection. In addition, it is likely that genetic makeup and degree of exposure to the coronavirus also contribute to the risk of infection, as well as the severity of the COVID-19 illness.
 
The Childhood Arthritis and Rheumatology Research Alliance (CARRA) has developed a registry of COVID-19 infections in pediatric rheumatic diseases, where health care providers can report cases of COVID-19 so that we can learn as much as we can about what happens to children and teens with rheumatic diseases during this pandemic. Information about this special registry can be found here https://carragroup.org/research-registry/projects/covid-19-global-pediatric-rheumatology-database. The Arthritis Foundation provides funding to CARRA in order to advance research focusing on pediatric rheumatic disease.
 

A: Luckily, most children with COVID-19 will not develop any symptoms or will or only have mild symptoms similar to those associated with colds and other upper respiratory infections. Symptoms of COVID-19 in both children and adults can include fever (usually low-grade), cough, sore throat, sneezing and runny nose, muscle aches, diarrhea, vomiting and fatigue. Some may lose their sense of smell and taste. These are uncomfortable but not signs of severe disease. If your child is exposed to someone with COVID-19 infection, or develops any of the symptoms listed above, please call your rheumatologist or pediatrician right away for advice about what to do. In the meantime, make sure that your child stays well hydrated. The doctor will likely advise acetaminophen as a pain and fever reducer if needed.
 
In contrast, signs of severe COVID-19 infection include symptoms of lung problems, such as rapid and labored breathing and/or a bluish discoloration of the lips. If you see any of these severe symptoms, get your child to an emergency room as soon as possible.
 

Updated April 24, 2020

A: The most important thing you can do is to follow general prevention advice that applies to everyone. This includes advice from the Centers for Disease Control and Prevention (CDC) website, cdc.gov, which has general and specific advice on how to prevent infection. Some of this advice includes, but is not limited to, common-sense measures such as washing hands often for at least 20 seconds, avoiding touching the face and avoiding close contact with those who are sick. It is updated frequently, so check back regularly.

Other tips for your child include:

• Teach proper handwashing methods. We can’t stress this one enough. Frequent handwashing is arguably one of the more important measures your child can take to keep safe. This video can help teach your child proper handwashing measures.
• Limit outside exposure. The less contact your child and entire family has with the outside world right now, the better. Even as stay-at-home orders are being lifted in some states, it’s important to remember that many people are asymptomatic (that means they have the virus but don’t show any signs) and testing is not readily available for people without symptoms. Being away from friends may be distressing for your child, but express that it’s only temporary and come up with alternatives in the meantime. This may include setting up virtual play dates or “game nights” with friends. Older children, with the supervision of a parent, can participate in online hangouts or Facetime chats. This also means putting a pause on time spent with extended family members and if possible, avoiding the use of child-care services. If you have a job that still requires you to return to work and need to help of a daycare, make sure that the staff adheres to these CDC guidelines. If your child needs a babysitter, be sure that they are practicing strict social distancing and prevention measures, and ask them to wear a mask.
• Be prepared. If your child does contract the virus, have a plan ready. Contact your child’s doctor and ask them what to do if you suspect your child has the virus, and when to see a doctor.
• Protect yourself. Take measures to prevent infection and limit your exposure to protect your child. You can find a comprehensive list of measures to prevent infection for you and your family here.

A: Medications should be continued as prescribed. Stopping or changing the dose without consulting your doctor can put your child at risk of a flare and other health problems. This applies to all medications, including nonsteroidal anti-inflammatories, or NSAIDs, such as ibuprofen and naproxen (Aleve), and immune-suppressing drugs, including the following:

Disease-modifying antirheumatic drugs, or DMARDs, such as methotrexate, hydroxychloroquine and sulfasalazine.

Biologics, such as abatacept (Orencia), adalimumab (Humira), canakinumab (Ilaris), etanercept (Enbrel) or tocilizumab (Actemra). 

Corticosteroids, such as prednisone.

Stopping or changing medication dose is not recommended because we know that uncontrolled rheumatic disease puts patients at increased risk of infections, in general.

A: Even if you’re diligent with safety and prevention measures, there’s still a risk of contracting the virus. Designate a “sick room” and keep it stocked in case of infection – enough toilet paper, towels, sheets, clean clothes, etc. – to limit the times you or a loved one need to leave the room or need to wash contaminated items. If infected, isolate yourself for at least 14 days and if possible, use a separate bathroom and avoid sharing items like dishes, towels and bedding. If you must handle or touch objects shared objects, wear gloves.

Cough and sneeze into the crook of your elbow, not your hands. Buy masks for the whole family and wear them when you must leave the room. Everyone should wash their hands thoroughly and frequently (using separate sinks if possible). Have your loved ones leave food and beverages outside your room during mealtime. If you require care, select one person to help you. You should both wear masks when in the same room. For more tips on what to do if you or a family member gets sick, click here.

A: “Start by talking to your child's doctor to help you better understand the risk,” says Karen Onel, MD, chief of the Division of Pediatric Rheumatology at Hospital for Special Surgery. “If you are able and willing to take a medical leave, this is worth discussing with your child's doctor as well. However, lots of essential workers will have to work or may need to work to provide necessary financial support and insurance benefits for their family. If that is the case, there are things that you can do to protect your loved ones. Wear a mask if possible that covers your nose and mouth and do not touch your face! Wear gloves if possible.Wash your hands throughout the day, especially when coming home and upon entering the house. Change and wash your clothing when you come home and take a shower if possible. Finally, leave your shoes at the door. We can't do all of these things all the time but they can help to decrease your risk of bringing COVID-19 into your house.”
 
You may be eligible for benefits under the Families First Coronavirus Response Act (FFCRA) or the Coronavirus Aid, Relief and Economic Security Act (CARES), federal relief packages that extend and broaden family medical leave and unemployment benefits. The FFCRA provides relief for employees who are under a quarantine or isolation order by a local government or under the advice of your health care provider; those who care for someone in quarantine; those who have COVID-19 symptoms; and those who must care for a child as a result of school closings, shelter-in-place mandates or other COVID-19 repercussions.