During the first year of my child’s life, I told myself that sleep deprivation was normal. And it is, to a certain extent. Night feeds and wake ups are just a part of the initiation process into parenthood. So I did not worry too much …
Raising a toddler is hard enough without having to factor COVID-19 into the picture. As a first-time mom and a bona fide worry wart, I would be anxious about my son’s safety and health under normal circumstances. So, pandemic concerns and all of the unknowns take that anxiety to a whole new level!
While the CDC says that children are less likely than adults to develop severe illness from COVID-19, they also say that children are still at risk. And so of course my mind goes to the worst case scenario… what if my child becomes a part of that very small percentage of kids that gets really sick or has long term complications, or even worse…
So as I try and navigate pandemic life with a toddler and decide what risks I’m willing to take, a number of questions have come up for me.
My Questions about Covid-19 and Risks to My Child
- When will a vaccine for kids be available?
- What kinds of precautions can we take to minimize risk of exposure while traveling?
- What percentage of confirmed COVID-19 cases are in toddlers?
- What percentage of toddlers with COVID-10 require hospitalization? What complications can arise for children?
- What information is there about MIS-C (an inflammatory condition that seems to have a strong link to COVID-19 in children)?
I knew that I would not find definitive answers to some of these questions, but I wanted to gather what information I could. With all of the unknowns and wildly differing opinions that are circulating about COVID-19, I have turned primarily to the CDC as my main source of guidance.
Acknowledging Individual Circumstances & Making Decisions For Our Kids As Best We Can
As a stay at home mom of 1 young toddler, I am in a privileged position where I can relatively easily follow the CDC’s guidelines for the most part. Doing so does not throw a big wrench in my life or in my family’s life. With that being said, I know that many people are not able to have a parent at home with their children at all times.
So I realize that my incessant questions about COVID-19 risks may seem a bit ridiculous or irrelevant to people who are not in this same position, and whose life dictates certain necessities like daycare etc. So I want to fully acknowledge that I am just one person with her own circumstances and level of comfort around COVID-19 issues. We all are just doing the best we can given our individual circumstances. This post is only meant to share my experiences and hopefully some useful information and food for thought.
Now that that’s out of the way, let’s get to the questions.
When Will a COVID-19 Vaccine for Kids Be Available?
In a New York Times article dated 3/30/2021, Debra Kamin writes that a vaccine for kids won’t be available until the end of 2021 at the earliest. Talking with my son’s pediatrician at his recent 15 month old wellness check (April 2021), she said she thinks a vaccine will still be a couple of years away for kids in Orson’s age bracket.
Although a year (and certainly 2 years) seems like a far ways off, it is true what everyone says about time moving a lot faster with kids. So hopefully a vaccine for kids will be available before we know it!
Studies are Underway
A Harvard Health Publishing article posted on 4/1/2021 states that biopharmaceutical companies Pfizer and Moderna are running studies on vaccines for kids right now, and that Johnson & Johnson will be doing the same soon. Pfizer is testing the vaccine on children from 12-16 years old, and Moderna is conducting one study on infants as young as 6 months old and another in children up to 17 years old. These studies are to test the safety and appropriate dosage levels of the vaccines.
COVID-19 Rates in Children: What is the Risk of My Child Becoming Sick with The Coronavirus Disease?
As of 3/17/2021, the CDC states, “Most children with COVID-19 have mild symptoms or have no symptoms at all. However, some children can get severely ill from COVID-19. They might require hospitalization, intensive care, or a ventilator to help them breathe. In rare cases, they might die.” The CDC also explains that infants under 1 year old and children with underlying medical issues are at greater risk for serious illness from COVID-19.
That is all quite vague information and rather terrifying sounding, so let’s take a closer look at some statistics.
As of March 22, 2021, the AAP states that 13.4% of reported COVID-19 cases in the U.S. are children. (3,405,638 of the 25,446,361). This number comes from an AAP report that summarizes data from 49 states.
Ages associated with the term “child” for this report vary somewhat from state to state (eg, Utah defines “child” as 0-14 years old, while Tennesse defines “child” as 0-20 years old). I find this a little bit odd and wanted to make a note of it just to show how even though stats can seem factual and straightforward, they can actually be confusing and misleading when you look into the details.
Taking Statistics with a Grain of Salt
I also wonder just how much this percentage of 13.4% of reported cases actually tells us. If children are often asymptomatic or only have mild symptoms as explained by the CDC, I imagine there could be a lot more children who have had COVID-19 than have been tested and confirmed. So going forward, I suggest taking any statistic I share here with a grain of salt. And to acknowledge that things are likely far more complicated than any one number can explain.
What is a Toddler’s Risk of Getting Severely Ill or Dying from COVID-19?
While the above stats gave me a better idea of COVID-19 rates in children on the whole, I was specifically interested in stats for my son’s age bracket (toddlers).
The CDC shares several graphs showing COVID-19 cases and deaths by age, race/ethnicity and sex.
0-4 Year Olds
As of 4/4/2021, The CDC reports that 0-4 year olds make up 2% (475,377) of confirmed COVID-19 cases. And less than .1% of deaths from COVID-19 have been in 0-4 year olds (109 deaths). So this information helps put my mind at ease a little bit.
To see graphs for other demographics, you can visit the CDC.
COVID-19 Hospitalization Rates for Children
While I found it difficult to find any up to date information on hospitalization rates in children due to COVID-19, a report from the CDC posted 12/30/2020 states that while hospitalization rates are low for children compared to adults, they are increasing. They didn’t share any specific numbers with this statement, but they did say that 1 in 3 hospitalized children are admitted to the intensive care unit. This 1 in 3 rate is similar for adults.
I was able to find some specific stats floating around though, for individual states and hospitalization rates among children. For example, New York State reports as of 4/5/2021 that 1% of covid hospitalizations are kids and young adults under 20 years old.
What is MIS-C? How Concerned Should I Be?
While it sounds like chances are that most children will not get severely ill from COVID-19, I was still concerned and knew very little about MIS-C; a condition associated with COVID-19 that has been popping up in the news.
MIS-C is a complication that children can develop from COVID-19 that causes inflammatory problems with organs in the body. According to the CDC most MIS-C cases are in children between the ages of 1 and 14 (but there have been cases in infants less than 1 year old and young adults up to 20 years old).
In 99% of MIS-C cases, children tested positive for the SARS CoV-2 virus, while the other 1% were reported to be around someone with COVID-19. Cal Matters explains that MIS-C is appearing in some children 3-6 weeks after they had coronavirus. Additionally, MIS-C can occur in children even if they were asymptomatic or had very mild symptoms from COVID-19. 68% of cases are in children who are Hispanic or Latino or Non Hispanic Black, and 59% of cases are male children.
In an interview by the New York Times, Dr Jean Ballweg states that it is unknown what effects there will be long term for kids who have been treated for MIS-C. In the same article, Dr. Roberta DeBiasi from Children’s National Hospital in Washington D.C. states that while about half of children with MIS-C needed ICU treatment in the first wave that hit the hospital, now 80 to 90 percent of children need ICU treatment (this is following the spike in cases after the 2020 winter holiday season).
Other key points about MIS-C
- The CDC says that they do not know what causes MIS-C, but that most children get better after getting medical care.
- The CDC reports that MIS-C cases are highest amongst 5-9 year olds at 34%. 1-4 year olds make up 21% of MIS-C cases, and infants under 1 make up 3% of cases. Other age group case rates are available on the CDC‘s site.
- As of 4/1/2021, The CDC reports that there have been 3,185 MIS-C cases and 36 MIS-C deaths in the United States.
Is Risk of Infection and Severe Illness Increasing with Emerging Variants?
In a post from Connecticut Children’s Medical Center dated 2/1/2021, they explain that while new variants of COVID-19 spread more easily among adults and children, 3 of the 4 variants that are of greatest concern do not seem to cause more severe illness or risk of death than earlier strains. More research is needed though, to determine if the UK variant (which is thought to spread 70% more easily) causes more serious illness.
And as of April 2, 2021, the CDC lists 5 variants of concern at present in the US. They also state that it is currently unknown if these variants cause more serious illness than previous strains.
Can Vaccinated People Spread Coronavirus?
I hope that with enough vaccinated adults, there will be some protection against continued spread to children. The CDC explains that there is some evidence suggesting that vaccinated people are less likely to spread the virus or be infected, but that more research is needed. Additionally, they say that they are still learning what kinds of vaccine numbers are needed in order for population immunity.
NPR explains that 70-85% of people in the U.S. need to have immunity in order for community spread to die down. They offer a handy tool to check when your state might reach that 70-85% immunity number. Idaho for example, might reach 70% by September 17, 2021.
What are Guidelines for Traveling with Kids During the Pandemic?
While the CDC has updated their travel guidelines as of 4/2/2021 to say that vaccinated individuals can safely travel within the US, this doesn’t provide much guidance for families traveling with unvaccinated children.
Dr Shruti Gohil (with specialties in infectious disease and internal medicine), interviewed by the New York Times, recommends that parents continue to be cautious if traveling with their children. She explains that this means, “…choosing to drive rather than fly; to not allow unvaccinated children to play unmasked with children from other households; and to remain vigilant about wearing masks and regularly washing hands while on the road”.
While the CDC doesn’t recommend children under 2 wear a mask, they do still encourage hand washing and social distancing. As I thought about trying to keep Orson’s hands clean while on the road, I wondered if hand sanitizer would be a safe option for him.
What to Expect explains that hand sanitizer with alcohol isn’t safe for young kids. The AAP explains that children can get alcohol poisoning from ingesting even a small amount of hand sanitizer (eg by putting their hands in their mouths or playing with the bottle). And that children under 5 need to be closely supervised when it comes to using hand sanitizer. And for those hand sanitizers that are made for kids, Dr Posner interviewed by What to Expect, explains that benzalkonium chloride is in many kids’ hand sanitizers, which is also toxic for kids.
Final Thoughts on Assessing Risk and Life with a Toddler During COVID-19
While there is certainly cause for concern in these unprecedented times, I am feeling less anxious about my toddler’s safety after examining the available information more closely. I am also trying to remember to keep things in perspective, and to acknowledge that I cannot control everything, COVID-19 related or otherwise.
This is not to say that I will be throwing caution to the wind. Not at all. You can still find me googling COVID-19 updates and precautions all day long.
And while I may want a very black and white COVID-19 roadmap in regards to what to do or not to do in any given situation, I know that life can be a bit more complicated than that. I just hope we can all exercise compassion and consideration towards one another, and hopefully move past this pandemic ASAP with the least amount of tragedy, illness and hardship.
I would love to hear your thoughts and feelings on pandemic life with young kids, please share in the comments below. Be well ~
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There is so much going on when you are taking care of a new baby, that it is easy to forget about oral hygiene considerations. I didn’t even start thinking about my son’s oral health until he started eating solid foods around 7 months old and already had a number of baby teeth. So I was inspired to write this post for new parents to provide some practical information about when and how to brush baby teeth.
Please note that this post is based on recommendations from professional associations and other trusted online resources, but parents should discuss their child’s individual dental needs with their pediatrician and dentist.
When to Start Brushing Baby Teeth
ABQ Pediatric Dentistry explains that the time to start brushing is as soon as the first baby teeth emerge, usually sometime around 6 months old (this timeline varies of course from baby to baby).
Even before baby teeth emerge though, the AAPD recommends cleaning newborn’s gums with a soft, damp, clean cloth or an infant toothbrush with water. And The CDC recommends cleaning gums once in the morning and once before bedtime to prevent bacteria buildup.
Toothpaste for Baby Teeth
As soon as the first baby teeth appear, the ADA recommends using a smear of fluoride toothpaste about the size of a grain of rice to brush. And depending on where you live, your pediatrician may also prescribe supplemental fluoride drops. This was the case for my baby, since fluoride is not added to our local public drinking water supply.
Dentistry for Children & Adolescents explains that fluoride plays an important role in preventing tooth decay in children. They explain that mouth bacterias feed on sugars and starches from remaining food after eating and then produce acids. These acids then breaks down protective tooth enamel, leaving the inner part of teeth exposed. This is when tooth decay occurs. Fluoride helps prevent decay by strengthening enamel, as well as inhibiting mouth bacteria from producing acid. It also helps remineralize enamel.
We are using Burt’s Bees fluoride toothpaste for kids for my son. If your child is particular about flavors, you may have to try a couple different types.
Is Fluoride Safe for My Child?
Historically, the official recommendation was to use fluoride-free toothpaste on baby teeth until a child turned 2. Today though, the ADA recommends using fluoride toothpaste as soon as baby teeth emerge. And since they recommend using such a small amount of fluoride toothpaste (a rice grain sized smear), they say it isn’t harmful if a child swallows it.
As I was considering the ADA’s recommendation on fluoride toothpaste, I wondered why I have heard so much controversy floating around about fluoride. Some saying it has detrimental health effects, and others saying it is essential for oral health. I never knew the details behind these opposing points of view, so I looked into it.
WebMD states that too much fluoride before the age of 8 can cause fluorosis, but that this is usually just a cosmetic issue (stains and changes to teeth’s surface). They also state that less than 1% of fluorosis cases are considered severe.
The big problem with fluoride occurs when intake is excessive and is ingested from multiple sources; such as drinking fluoridated water, taking supplemental fluoride, and swallowing a lot of fluoride toothpaste.
Healthline explains that problems from excessive fluoride intake usually occur in countries where there are very high levels of fluoride in the drinking water. In these countries, a bone disease called skeletal fluorisis may occur. Fluroide can be found in the groundwater in these countries at levels greater than 8 ppm. This is double the amount of fluoride that is federally regulated and allowed in drinking water in the US. Healthline says that there is inconclusive evidence regarding other illnesses and their potential link to fluoride.
Toothbrushes for Baby Teeth
Silicone Finger Toothbrushes
I use a silicone finger toothbrush with my son.The most helpful thing about this brush for me is that I can feel exactly where I am on his teeth and gums. Since I can feel where I am making contact, I know when I have done a thorough brushing.
Silicone finger toothbrushes are also very gentle on sore gums from emerging teeth. Because they are gentle, brushing with a silicone brush doesn’t cause my son discomfort and he generally stays mostly still while we brush.
Dentaly explains another benefit of silicone toothbrushes is that they are nonporous. This means they are easy to clean and they do not have as much bacteria buildup as regular toothbrushes. They are also a more eco-friendly option, since they do not need replaced as often as regular brushes.
As we continue to rely on a silicone toothbrush though, I have wondered if they are less effective than regular bristled toothbrushes. They are so much softer, so do they do as good of a job?
According to a 2019 Romper article, more research is needed on silicone toothbrushes, but reputable sources say that they seem to do as good of a job as regular nylon bristled toothbrushes. These sources come from interviews with AAPD (American Academy of Pediatric Dentistry) leaders and pediatric dentists.
Traditional Nylon Toothbrushes
We also got a cute kid toothbrush with a small brush head and soft nylon bristles to try out. My son likes to gnaw on it and play with it, but at this stage I do not know how much it is actually cleaning his teeth. We can get a quick brush in with it, but it never feels very thorough. I think the bristles are still a little uncomfortable for his sore gums.
- Silicone Finger Brush and Kid’s Toothbrush
How to Brush Baby Teeth: Strategies and Routine
Even with all the right tools, it can be hard to know exactly how to brush baby teeth. Most parents I talk to say that brushing their babies’ teeth is challenging, if not impossible. There is a lot of squirming, thrashing and general refusal. I would tend to agree, so below are some of the strategies I use to brush my son’s teeth.
I often play Elmo’s Brushy Brush video on my phone as I brush my son’s teeth. It is a fun song and video of Elmo and other adults and children brushing their teeth. For whatever reason, my son is captivated by it and will sit still long enough for me to get a good brush in. We also use other distraction tactics like books, singing, and toys. We hope that over time he will realize that brushing teeth is just a part of daily life and we won’t need to rely on these distractions. And while this never worked for us, I have heard that holding a handheld mirror up to a baby’s face while brushing can keep them happily occupied while brushing.
Modeling Good Teeth Brushing Habits
I also try to make sure my son is seeing me brush my teeth regularly. I make a point to show him how I am moving the toothbrush, then spitting and rinsing. Children are naturally inclined to model the behavior they see around them, so this can be an easy way to encourage your child to jump on board with brushing his teeth.
Developing a Teeth Brushing Routine
Getting on a consistent schedule has helped my son become more comfortable with brushing his teeth. We brush everyday, once after breakfast and once after dinner, and he knows to expect this. I think that once kids know that something is routine, they actually start to like it or at least find it comforting. When it comes to learning how to brush baby teeth, there is no substitute for sticking with it and remaining diligent.