Dr. Rachel Pearl: Keeping Kids Safe at School

Sept. 29, 2020 – By SUSAN MINUK

It has been just a few weeks since most students have returned to the classroom under the looming threat of COVID. Teachers and kids alike are navigating new rules, from cohort education, social distancing, hand sanitizing, and the use of masks.

Dr. Rachel Pearl
Dr. Rachel Pearl

Dr. Rachel Pearl works as a pediatric nephrologist at Toronto’s Hospital for Sick Children, and as a general pediatrician and nephrologist in the William Osler Health System at Brampton Civic Hospital. Dr. Pearl spoke with the CJR about kids physically attending school and how best to keep them safe.

Is it safe for a child to be in school?

It’s perfectly safe. A lot of kids during the last six months in quarantine have become very depressed, anxious and restless. There are also some kids who are not going to learn well online because they’re not motivated, or they have a learning disability or an attention problem. 

Yet, for some families, learning online is a really good option. But if I had to choose, I would send my child to school.

The burden of disease in children from COVID has been extremely low in terms of what we see at SickKids.

Should kids get a flu vaccine?

I strongly recommend it. Even though we know that it might be safe and effective [only] for 60 or 70 percent of children, we still recommend it.

Are children less likely to be sick with COVID?

So far, since school has started, I have not seen one admitted school age patient with COVID. 

How do we minimize or prevent its transmission in schools?

Students need to wash their hands before they eat and after, and periodically throughout the day. We have to teach this to them and I think that is something the school can make part of its day. 

Anyone who can wear a mask should be asked to wear one, whether the school is mandating it or not. For the younger children, if they can tolerate a mask, let them wear a mask. 

We should be limiting our bubble when the kids are outside of school to protect elderly parents and grandparents. Those are the ones who need to be protected.

Is there a way to ensure children wear their mask properly?

If the mask looks like it’s comfortable for the child and it seems to cover their mouth and nose, then it’s being worn properly. We have to teach them that when they take the mask off, to touch it by the loops as opposed to in the middle.

How do we encourage smart behaviour?

We recommend layers of protection: hand washing, mask wearing, flu vaccination, and common sense. I think Canadians in general are very compliant and are appropriately concerned, far more than our neighbours to the south. And that’s why we have done a better job at containing this.

Are classrooms of more than 20 students too large to protect children?

Not if they have the space to spread the kids out. We are always looking at the risks of kids not being in school versus the kids being in school. If we had an ideal world, we would have smaller class sizes, bigger schools and better ventilation. If I were the parent of a kid in a class of 25, I would send them to school. I think the risk to them is extremely low.

How can parents protect children if they must take a school bus?

The children are hopefully staying seated and belted and spread out as much as possible. And they should be sitting with kids in their cohort. Students should wear a mask and open their window. 

This is a confusing time for many students. How do we validate kids’ feelings?

They need to know that there is a bad virus out there right now. Kids understand about people getting sick. What they should know is that this is only temporary, and we have to manage this now. But it’s not forever.

Students should be encouraged to express their feelings. If they are anxious or worried, that should be acknowledged, not dismissed. Some kids have become overly worried, especially kids who have the tendency to be anxious or have anxious thoughts. It’s really hard for those kids to switch their thinking, and they have to find ways of distracting their thinking when they feel overwhelmed and sad. I recommend parents make a playlist of songs on their iPad or a watch a video that makes them laugh or smile.

Some children have underlying health problems. Should they stay home?

SickKids has really good guidelines online about going back to school. It is pretty rare there is a kid who really should not go to school. It’s usually someone who is very immune- suppressed or has had a recent transplant or is undergoing therapy for cancer. 

Children with asthma should be going to school. We haven’t seen evidence that children with asthma are worse off if they get COVID. We didn’t see it with the first wave and we still haven’t seen it. There is usually an asthma surge in the middle of September because kids go back to school and share viruses. We haven’t seen the surge yet, maybe because everyone is wearing a mask or maybe because half the people are not back. I don’t know what this winter will bring.

What should a parent do if their child becomes ill at school?

A lot of schools will have public health nurses assigned to them and they will be able to provide advice. No parent will be forced to get their kid tested for COVID, but if your child is sick and you don’t test them, you will be required to stay home for two weeks and self-quarantine.

Has the impact of COVID damaged kids’ mental health?

Families have struggled. People have lost their jobs or the way they work has changed. Some parents’ field of work has become obsolete. There is a big trickle-down effect to the kids who are dealing with parents who are very stressed out and not always in a good place. 

I think it does affect the children. I don’t think there is any way to protect them from that. I am seeing more anxiety and more psychosomatic symptoms, like kids with headaches and abdominal pain that come out when people are not feeling good in their mental health. It overflows into their body, for sure.

The lack of physical activity has also contributed to their mental wellbeing. Some kids have been inside because parents are scared, and they haven’t been allowed to do sports or play outside or even ride a bike. Exercise is so vital for kids’ mental health.

By being back at school, we are giving kids structure and hope that things will go back to normal. This is the way forward.