A pediatrician’s recommendation to folks of children underneath 5 on omicron, journey and daycare

In the midst of the Omicron surge, there is understandable fear among parents, especially children under 5 who may not yet receive a COVID vaccine.

They wonder how to cope with life with young children, what this means for travel plans and daycare, and when the vaccine will be available.

Dr. Ibukun Kalu, a doctor in infectious diseases in children at Duke University, says her hospital has seen an increase in child admissions.

“Unfortunately, more children in hospital are not vaccinated. But younger children who cannot be vaccinated also end up in hospital with COVID, “she said.

As the world enters its third year of the pandemic, we have asked parents of children under 5 to send us their questions. Here Dr. Kalu them.

The questions and answers have been edited for length and clarity.

Alex McCarty, Tumwater, WA – 4 year old daughter and 18 month old son

Q: What do we know about the severity and risk of the Omicron variant for children? Does it seem more dangerous than previous variants, is it about the same or less?

What we know so far is that Omicron is milder in both children and adults. In the context of its recent dealings with Delta – which was much worse than the virus that spread in 2020 – Omicron is milder than Delta. But it’s still pretty severe and can cause significant symptoms in a small group of children, not across the board, but a small subgroup that end up with more severe symptoms and end up in the hospital.

In children, in part because COVID appears to cause the initial infection and then just haunted the body and causes post-COVID syndromes, it’s worse than influenza. And right now we’re seeing the flu spread across our community. But COVID exceeds that across the board.

If we see more cases, we will likely see more children end up in the hospital alone.

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Children have become masters in temperature checks.

Hilary Anderson Carter, Austin, TX – 2 year old daughter

Q: I have an almost 3 year old toddler in daycare and they obviously aren’t eligible for a COVID vaccination, but we had several program closings in the fall semester due to COVID cases in the classroom. And I was wondering if there are any studies on the test-to-stay protocols for children under the age of five?

We don’t know enough about test-to-stay in children under five. And the reason is simple: we turned to test-to-stay studies that focused on K-12 environments because they were directly affected by the quarantine guidelines that have kept a lot of children from personal learning. For the Kita setting, Preschool, Pre-K, some of the data in these settings can be used but it is important to understand the context. Masking behavior may be slightly different in younger children, and the ability to meet frequent tests may be slightly different. However I am encouraged by the data. It showed that we have seen less transmission within schools where universal masking exists and we can continue to promote personal education for those who find it helpful and can do so through multiple waves in the community.

Ryan McGhie, Lynnwood, WA – 2 year old son

Q: We had planned a trip to Hawaii to work on masks with our son. But even if he wears his mask reliably, we have concerns about this new variant. Is it safe to take a five hour flight with an unvaccinated 2 year old, or would it be wiser to postpone our trip? And when we get to our hotel, how safe is it to go to the beach or the pools? Should we try to encourage the use of masks when playing in the water?

During the current surge, it may be wise to postpone travel as we have seen such a high rate of penetration in the community. If you can, if it can be done, postpone it for a couple of weeks. If you’re already on your way there, or just can’t possibly postpone that, encouraging masking is great. I think the 2 year olds might have a bit of a problem. However, also make sure that everyone in your group is vaccinated and has received a booster if they are eligible for vaccines. After all, outside is better. We know that transmission of SARS-CoV-2, the virus that causes COVID, is lower outdoors. So play outdoors as much as possible. Masks don’t necessarily work when submerged in water, so I wouldn’t expect masking in this setting.

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Many parents have weighed up travel plans over the holidays.

Alex Benton, Edmonds, WA – 15 month old daughter

Q: I am concerned that with Omicron and other varieties that keep popping up when the vaccine is finally approved for their age group, it won’t be enough to protect them. Can we expect to be able to resume normal life and do activities indoors with other children after the vaccination? Or should we expect to wait for a booster?

I am pretty sure that you will be able to lead a normal life again after the vaccination. It may depend on what “normal” means. In most cases, a 15 month old child will not be able to wear a mask. Even today, you can probably resume some level of play or interaction with others as long as you keep it outdoors and make sure others nearby are vaccinated. So, yes, you can resume normal life however you define it once vaccinated. But even today I think there are some things you can do.

Patti Marriott, Erie, MI – 2 year old daughter

Q: Since the most common symptoms for the newest variant are cold symptoms, when should we worry about testing our child while in daycare? We are used to her having a cold once or twice a month. If their symptoms are mild, is testing taking away resources from populations in greater need?

I hope parents who seek tests for their symptomatic children do not take resources away from adults who are also symptomatic or immunocompromised. I think if there is either a cluster of cases in the day care center or just symptomatic children, it can be helpful to have the child who is in the day care center tested just to see if they have COVID. Just note that we are in the middle of the respiratory virus season, which means our daycare children in particular can get a different viral infection every month and you probably won’t have to test them every time. But COVID is here and COVID is spreading and can certainly spread in daycare. So if you have access to tests and have a child with new symptoms, it may be worthwhile to test them for COVID.

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AFP via Getty Images

Everything from daycare to preschool to school has been disrupted by COVID.

Oriana Perez, Houston, TX – 3 year old daughter

Q: What was the reason the Pfizer vaccine trial for children under five failed?

What I understand about the process so far is that the study was done to make sure that the vaccine is safe and that it actually works so that it will be effective in children under five. And the dose chosen did not necessarily trigger a sufficiently high protective reaction. This was brought to their attention and they decided to go back and adjust the dose to ensure that if they have a viable vaccine option, the legal dose is likely to result in a protective response in children. So I didn’t see it as a mistake. I think this is a good and helpful process for getting a safe and effective vaccine, although it adds a bit of length to the timeline and just a little bit of concern as we are dealing with the omicron surge and we still don’t have a viable vaccine Option for our youngest children.

Mandy McCaslin, Seattle, WA – 6 month old son

Q: How much research has been done on babies who were in the womb when mothers were vaccinated or babies who were breastfed when mothers were vaccinated? How protected are they since they do not wear a mask and cannot be vaccinated?

the CDC has rounded up some of the more recent research, and I will refer to the data they publicly shared as a source of information that might be helpful here, but there are also several published studies dating from 2021 that will help answer this question. In particular, in mothers who recently had babies, vaccinated or unvaccinated mothers who got infected everywhere due to the spread of COVID, they found that those who were vaccinated were able to transfer antibodies or pass protection for the Child. And pass it on in such a way that it was in the blood as well as in the mouth and nose, i.e. in the mucous membrane of the babies. And that’s huge. That’s great. Because if babies are accidentally exposed in the community, they have a protective layer as they cannot assemble their own protection. Some of the infected people also passed some antibodies, but were slightly less than those who were vaccinated. So I think vaccines are safe and effective in pregnant women and they have been able to pass them on, which is very helpful.

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