The COVID-19 pandemic doesn’t stop kids from climbing trees, riding bikes, and doing other activities that may cause a tumble, create a few bruises, or require a trip to the local emergency department (ED).
And with parents trying to balance their own work—inside or outside of the home—while overseeing distance learning for their children, some kids may be less supervised than usual.
“We are all stressed as parents, and maybe we are not watching as carefully as we normally would,” says Marc Auerbach, MD, a Yale Medicine pediatric emergency specialist. “For example, with more household cleaners out, we are experiencing more accidental ingestions.”
Dr. Auerbach also says he is seeing more injuries typical of the summer vacation months and less of the usual spring ailments. With stay-at-home orders in effect, some of this is to be expected. For example, kids are not playing organized sports or riding in cars as much, both of which can cause injuries that lead to a good number of ED visits. But that doesn’t mean they aren’t still experiencing medical emergencies such as appendicitis—and parents should know that it’s safe to bring their kids to the ED when necessary, he says.
“Right now, many families may feel as though they are potentially putting their child’s health at risk by seeking care, but the appropriate use of the emergency department is vital to parents at this time,” Dr. Auerbach adds. “It’s important to call 911 and use the emergency department when your child has a significant injury or illness. We are still here and functioning, and doing our best to keep families safe in the ED.”
From a public health perspective, social distancing makes sense, Dr. Auerbach says, but for emergent health concerns, “we want to make sure there isn’t a delay in diagnosis and that people are using their emergency medical services and emergency departments when they need them,” he adds. “I know part of it is that people may think that coming to the hospital takes resources away from other people who need it, but we have ample resources to take care of those who are sick.”
Pediatric ED volume down, but admissions up
Overall, the emergency department at Yale New Haven Children’s Hospital (YNHCH) is seeing fewer visits, says Beth Emerson, MD, medical director of the department.
“We are equipped and ready to see any pediatric patients who need to come. Families should feel confident in seeking care in the ED as needed; we have processes in place to help keep our patients safe,” says Dr. Emerson, adding that those with mild to moderate COVID-19 symptoms are seen in a tent outside of the pediatric ED.
Three to six months from now, when people start to come back into the hospital more, we may see an increased number of ‘healed’ injuries that went untreated. Patricia Morrell, BSN, RN, coordinator of Pediatric Trauma Program at YNHCH
The overall daily volume in the YNHCH Pediatric ED is down by 75%, says Erika Setzer, MSN, RN, patient service manager in the ED. “Our average daily census was typically 120 to 130, and we are currently seeing about 30 to 40 patients a day,” she says. “Our admission percentage is up—closer to 20%. Our admission rates prior to COVID-19 were at about 10%.”
That higher admission rate is likely because there are fewer visits for minor issues that parents typically used to bring their children to the ED for, explains Dr. Auerbach.
Plus, there have still been some significant injuries since the pandemic started, says Patricia Morrell, BSN, RN, coordinator of the Pediatric Trauma Program at YNHCH. “We have seen an increase in household injuries, including falls,” she says.
From talking to her pediatric trauma colleagues across the country, Morrell has heard of many scenarios where parents have delayed seeking care for their children because they worry about COVID-19.
“The most interesting piece of this will be when the quarantine ends. Three to six months from now, when people start to come back into the hospital more, we may see an increased number of ‘healed’ injuries that went untreated,” Morrell says.
Dr. Auerbach reports seeing broken limbs, laceration, and head injuries at numbers consistent with what he would see during the summer. “This may change as more parks and playgrounds have recently shut down, but I am not seeing as many very sick patients as I typically would at this time of year,” he says. “But we would also normally see more kids with problems related to diabetes, for example. As for COVID-19, we have been seeing about five to 20 patients a day, but we are only testing in the ED if they are being admitted to the hospital for respiratory issues, dehydration, and other more serious concerns.”
For suspected COVID-19 cases, parents should first call the Yale hotline (203-688-1700). “The hotline has pediatric experts who will answer any questions you have,” Dr. Auerbach says. “But if your child is in significant respiratory distress or a shock-like state, you should use your emergency medical services or go to the ED.”
For any other concerns, parents can also call their pediatrician for a telephone or video consultation in order to decide what level of care is needed.
Advice for parents
Given the many challenges families are facing right now, Dr. Auerbach encourages parents to talk to friends and relatives frequently. “Take a break from work if you can. Get your kids to engage with their grandparents over Zoom,” he says. “And now is a good time for all of us to have some gentle reminders about injury prevention during this time of stress.”
James Dodington, MD, a Yale Medicine pediatric emergency physician and medical director of the Injury and Violence Prevention Program at Yale New Haven Health, offers parents the following advice from him and colleagues at Connecticut Children’s Medical Center in Hartford.
Be aware that increased time at home can mean that young children, especially toddlers, have access to dangers within the home:
- Store all medicines and household products up, away, and out of sight, ideally in a locked cabinet where a child cannot reach them.
- Put the Poison Control number, 800-222-1222, on or near every home telephone and save it on your cell phone. The line is open 24 hours a day, seven days a week.
- Review the rooms that children will spend time in to ensure that only age-appropriate toys are within reach, that outlets are covered to protect from electrical shock, and that small objects that can be choking hazards are safely stored away from children under age 4.
- Be on the lookout for hot liquids and household items, such as irons, that could cause burns.
- As the weather warms up and we open more windows, keep furniture that children can climb on away from windows. Also don’t open windows more than four inches.
For school-aged children:
- Require your children to wear a helmet at all times when on a bike, scooter, or skateboard—inexperienced riders may fall if going too fast.
- Hoverboards and electric scooters can cause significant injuries, so make sure to check with the Consumer Product Safety Commission website for recalls and guidance (https://www.cpsc.gov/).
- Uintentional firearm injuries often occur when children find unsecured firearms. It is important that all firearm owners with children in their homes understand Connecticut’s safe storage laws. Keep your firearms locked up or within your control—never leave a firearm unattended.
For teens, getting out to bike, run, or walk while practicing social distancing can be important for their physical and mental health:
- Teen pedestrians are more likely than younger children to be injured or killed by a vehicle, but many teens do not realize that they are at risk. Discuss safe habits with your teen, including their use of electronic devices while they are walking or running.
With no regular school in session and canceled after-school activities, anxiety, fear, and depression may increase for many teens:
- Be attentive to your teens’ talk, mood, and behavior.
- Secure medications and weapons that can be used for self-harm.
- The number for the national suicide hotline is 800-273-8255.
Another issue Dr. Auerbach and his colleagues say they worry about is child abuse and neglect that may be going unnoticed, as those cases are often detected in public spaces, including schools, doctor’s office, and the ED. The Connecticut Department of Children and Families (DCF) has reported that calls about child abuse and neglect to their hotline have been down by 60%, Morrell says.
The DCF hotline (800-842-2288) is open for reports, or children can be taken to the nearest ED when abuse is suspected. In the meantime, supporting families who are struggling right now is one way to help, Dr. Auerbach says. “We need to be there for one another, and if you are concerned about injury or neglect of a child, you can still make an anonymous call to DCF,” he adds.
And no matter the problem, if you do need to take your child to the ED, physicians are ready and able to help.