My child has a cough. How do I know if they have COVID-19?
The most common symptoms of COVID-19 are fever, cough, and shortness of breath. Some people's symptoms are severe and others have symptoms of a common cold. In general, children are more likely to have little or no symptoms. This is why Staying at Home is the best way to protect your family and your community, and is even more important if your child is sick.
In general, we will treat all respiratory symptoms the same way we always have, regardless of if it is a cold, influenza, or COVID-19. Rest, fluids, steamy showers and nasal saline are still your best bet. And just like always, we are here to answer your questions (even if it takes a little longer to get to your call!), and we are ready to take further steps if your child gets worse. How we do that has changed; we may start with a telemedicine visit, or if you need to come to the office how you enter and how we are dressed may be different. Regardless, your first step is to call us!
How can I tell if my child is getting worse and I need to call?
While this may look different for every child and every situation, these are the symptoms we would want you to call for right away:
Shortness of breath, having trouble talking
Working hard to breath, stomach and chest heaving with each breath
Retractions: seeing the ribs stick out with each breath
Having trouble eating, talking, drinking
Color change: face is blue or very pale
These videos demonstrate some of the breathing difficulties infants can have. The first one shows an infant working hard to breath with RSV (starts at 0:12). The second video demonstrates many different signs young babies can show if they are having trouble breathing.
I have a family member with COVID-19-like symptoms. How do I keep the rest of the family from getting sick?
The key word is clean, clean, clean! Keep food and personal items separate, wash high-touch surfaces frequently, and keep the sick person away from others as much as is possible depending on age and home situation. A separate bedroom and bathroom would be ideal. The CDC has some more detailed tips. And as always, lots of hand-washing!
Can my child get a COVID-19 test?
While both the Oregon public health lab and private labs are getting more tests, the tests and the supplies needed (swabs, viral media) are still in short supply. Because of the shortage, there are also limitations on who we can test. We do have tests, and we follow OHA's testing guidelines.
Why do we have to wear masks in the office? Why can't I wear one with a valve?
There is solid evidence that masks help limit the spread of the COVID-19 virus. We wear masks to protect ourselves, each other and you, and we ask that you do likewise. When you wear a facial covering you are protecting yourself and your family, and are helping us protect ourselves and all of our patients. Thank you!
We do not allow masks with exhalation valves or vents in the office. Per the CDC, "The purpose of masks is to keep respiratory droplets from reaching others to aid with source control. However, masks with one-way valves or vents allow air to be exhaled through a hole in the material, which can result in expelled respiratory droplets that can reach others. This type of mask does not prevent the person wearing the mask from transmitting COVID-19 to others. Therefore, CDC does not recommend using masks for source control if they have an exhalation valve or vent."
We do not allow wearing a face shield without a mask. You are welcome to wear one along with a mask if you would like. Again, per the CDC, "A face shield is primarily used for eye protection for the person wearing it. At this time, it is not known what level of protection a face shield provides to people nearby from the spray of respiratory droplets from the wearer. There is currently not enough evidence to support the effectiveness of face shields for source control. Therefore, CDC does not currently recommend use of face shields as a substitute for masks."
Remember, infants and children under the age of 2 should not wear masks or face shields.
My family is healthy. Why do we need to practice social distancing? My kids need to get out!
We don't have a cure. We don't have a vaccine. We don't have enough hospital beds and ventilators if too many people get sick too fast. Staying at Home is the best way you can protect yourself, protect others in your community who could easily die from COVID-19, and help the doctors and nurses and many other people working hard to save lives in the hospital. We are all in this together, and we each can make a big difference in flattening the curve.
In the words of Dr Kate Tulenko, a pediatric global health expert, "Every day you stay home is another day the health care system can prepare and can work on treatments and a vaccine."
That being said, playing outside, taking a walk, or going for a hike in areas without many people are good for our physical and mental health.
Below is a video explaining why social distancing is important, and a video story for young children.
Should I keep my child's appointment for their check-up? Is it safe to come to the office?
Yes! One of the ways we can keep our community healthy is to keep individuals healthy. Check-ups and other preventive care is just as important, and even more so, than it was 2 months ago. We still need our infants and children vaccinated, we still need to screen for other diseases or developmental delays that continue to happen even in a Coronavirus world, and we need to check in on the mental health of adolescents (and their parents!). Chronic diseases such as asthma and diabetes need to be managed proactively. We are also following the CDC's and the Oregon Health Authority's guidance that vaccines are an essential service, as is well-child care as long as it is done in a manner that is safe and separates well patients from those that are ill.
Here are the measures we have taken to ensure safety for patients, families, and staff.
We are physically separating well and sick patients. Our main office (suite 30) is being used for well patients, and our adolescent clinic (suite 32) is being used for any ill patient who need to come in. Suite 32 has its own separate entrance and we can bring patients in straight from a side door in the building.
We are screening patients and family for symptoms of illness before coming into the office.
We are practicing social distancing in the office by not having people stay in the waiting room. You will be asked to call from your car when you arrive and will be directed straight to a room.
We are using telemedicine video visits when appropriate.
We are having staff work from home when possible.
We are wearing masks at all times as do our patients and families.
You can see what these changes look like here.
Why is my appointment getting rescheduled?
It is safe to say that COVID-19 has up-ended our lives in so many ways! It has forced us to make many changes here in the office, and we will continually need to adapt. As an infection control measure we are having one physician at a time seeing the sick patients who need to come in for an in-person appointment. This allows us to provide good medical care while limiting exposure to well patients. We thank you for your patience as we work hard and follow the highest level recommendations from the CDC and the OHA.
I've heard that taking ibuprofen with COVID-19 is dangerous. Is this true?
Like many questions with COVID-19 we still do not have enough information to be able to answer this with absolute confidence. The concern arose because of pre-COVID-19 studies that showed that some people with serious lung infections got worse after taking ibuprofen. However, "it's difficult to say if taking ibuprofen in these instances directly causes worse symptoms and prolonged illness, or if it's because ibuprofen or other anti-inflammatories help manage pain, which may hide how serious the illness is and could stop people from asking for help earlier – delaying treatment. Or, it might be to do with ibuprofen's anti-inflammatory effects. One theory is that anti-inflammatory medicines can interfere with some of the body's immune response, although this is not proven for ibuprofen."
The World Health Organization has stated: “Based on currently available information, WHO does not recommend against the use of of ibuprofen... We are also consulting with physicians treating COVID-19 patients and are not aware of reports of any negative effects of ibuprofen, beyond the usual known side effects that limit its use in certain populations."
Here is what we recommend:
If you are uncomfortable using ibuprofen, acetaminophen (Tylenol) is a good alternative.
Ibuprofen is a safe and effective medication for fever and pain.
Ibuprofen should not be used if the patient is not well-hydrated.
There is no reason to not use ibuprofen unless you have a health condition that prohibits its use.
Not all fever needs to be treated. Fever is helpful in fighting off illness. We do use medications like ibuprofen and acetaminophen to help children feel better when sick.
What can I do if my child has a chronic medical condition or other risk factors?
The best way to protect your child is staying home and practicing strict social distancing. It is also important to keep your child's medical condition well-controlled.
Don't miss doses of maintenance medications. This includes any steroids for asthma.
Make sure you have a month's supply of your child's prescription medications, such as inhalers.
Call us if you have any concerns.
How can I help?
You have all been amazing in your support for us and our community. Your donations to our office help us to continue caring for children while keeping families and staff safe. Thank you! Here are other ways to help.
Stay strong with social distancing... it's working! The curve is flattening which is not only good news for Oregonians, it's allowing us to share resources with New York. Don't let up now!
Keep checking in on family, friends, and neighbors. Can you pick up someone's prescriptions, deliver their groceries, or sew them a mask? Each time you pitch in like that for your community, you are helping avoid a potential exposure.
If you have PPE to donate, contact your local fire station.
If you want to help the larger Portland community, check out the PDX Mutual Aid Network.
How can I get help?
Do you need help with groceries or picking up a prescription? Something else? The PDX Mutual Aid Network may be able to help. Complete a form describing what you need and they will connect you with someone able to help.
Need help with food, utilities, rent or more? Congressman Blumenauer has collected multiple resources all in one place. You can also call 211 from a landline or 503-222-5555 for assistance.
I have so many questions!
You are in good company! Our questions are coming faster than the answers. As we learn more every day, the CDC is updating their FAQ page regularly.