How Do You Decide if Children Can Play Together Again?

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As some parts of the country “open up” and families venture beyond their households, parents are faced with hard decisions about what children can do. There are no official guidelines, so I asked smart and experienced pediatricians from around the country what questions they are getting from parents, and how they’re answering them. Spoiler alert: There are no easy answers.

“I’m getting it every day in my office: what do we do, we can’t stay home forever, we need some activities,” said Dr. Sally Goza, the president of the American Academy of Pediatrics, who is a primary care private practice pediatrician in Fayetteville, Ga. “I try to explain to parents, this virus is not gone, it’s still here, we need to be smart in how we go about being around other people.”

Despite the “novelty” of the virus, these dilemmas are not entirely new — this is what parents do: weigh risks, look at what the experts say, figure out where your own level of comfort is, and then make decisions that affect the health and safety of the people you love best.

Making these decisions is going to involve choosing other families you feel you can trust. “There’s a certain amount of selecting out families with the same level of risk aversion,” said Dr. David Rubin, director of PolicyLab at the Children’s Hospital of Philadelphia.

“People are wondering how they sort of stick their toe in the water and try to re-engage outside of their homes,” said Dr. Terri McFadden, associate professor of pediatrics at Emory School of Medicine and medical director for primary care at Hughes Spalding Hospital in Atlanta. “I’m getting that especially for teens — the teens feel invincible, they don’t feel like they’re in any danger at all, and they’re itching to get out and interact with their peers.

Still, she said in an email, “I caution families to be very careful about potentially exposing their children or themselves to Covid-19 while infection rates remain high. This is especially true for high risk groups that have been disproportionately affected, which is many of my patients: African-Americans, Hispanics and families with pre-existing conditions or elderly care givers.”

If you are contemplating a play date, taking into account all these risks, you will need good communication with the other parents. “A start would be, hi, our kids have been asking about getting together, and as you know, this is a complicated conversation right now,” said Dr. Dipesh Navsaria, an associate professor of pediatrics at the University of Wisconsin School of Medicine and Public Health. A parent could continue, “I wanted to start with an open conversation, see where you are, tell you where I am, and see if it’s possible to send a consistent message to our kids.”

And then you can get down to the details: indoors, outdoors, duration of contact, masks, food and drink, parental supervision to make sure that rules are observed. “I’m less worried about a parent or a business getting all the rules right, because we don’t know what ‘right’ is,” Dr. Navsaria said, “and more concerned about them being intentionally thoughtful.”

It’s not so different, he said, from the conversations that pediatricians advise parents to have with other parents about whether there are unsecured firearms in the house, or whether the pool is fully fenced and locked; it’s basically a conversation about whether you feel your child is safe at someone else’s home, in someone else’s care.

Don’t frame it so that the more restrictive parent is the bad guy, and try for an honest conversation that respects differences of opinion. Remember that other parents may have reasons you don’t know about to be more wary of possible infections. That’s what it means to present a consistent message to a child: This is about keeping everyone safe, and sometimes that means waiting a little longer. And if there’s going to be a play date with limitations, make sure the child understands what those limitations are, and rehearse the possible activities.

Families should not feel pressure to change their rules, even if they are living in areas that are opening up. If there is a vulnerable adult — or child — in the home, they may want to be more strict, rather than less strict, as others relax their restrictions. And not all children — or adolescents — are necessarily pushing for those in-person social contacts. We need to give each other time, and treat each other gently.

Take it step by step, Dr. Goza said. Start with carefully chosen contacts, and don’t jump right to large gatherings. “You spent all this time trying to isolate and social distance,” she said. “You don’t want to go out there and just blow it all.” The parents she’s talked to, she said, have been very conscientious, planning out social encounters with neighbors getting together outside for a barbecue.

Dr. Goza advised that parents encourage children to spend their time together outside, she said, to wear masks, to wash their hands regularly. Pools are probably relatively safe, she said, according to current thinking about transmission, but supervision is important, both because of water safety and to try to prevent kids from being too close together.

What about when family and friends disagree? “I say, if they don’t wear masks, I would try not to be in an enclosed place,” Dr. Goza said. “Wear a mask yourself, say, ‘I respect your opinion but we feel like we want to keep a bit of distance.’”

To reduce risk, everyone’s No. 1 piece of advice is that if there is going to be socializing, keep it outdoors as much as possible. Keep the time periods limited — maybe a short session outside in the afternoon, rather than a sleepover. Encourage hand-washing, send children with hand sanitizer, and yes, make it clear beforehand that masks are to be worn. If there’s going to be a meal together, meaning that masks will come off, kids need to be sitting far enough apart.

But if you decide you’re ready to relax your isolation, don’t expect the impossible. Dr. Navsaria cautioned parents “not to expect 100 percent hand hygiene and proper mask use, because children are children, and even older kids that quote unquote should know better.”

Dr. Rubin said, “It’s a good moment for teaching kids individual responsibility.” That includes asking older kids to be honest if they have relaxed the rules, which may mean, he said, that parents will want to practice some social distancing at home around adolescents who may be taking risks.

With adolescents, it’s important to review your family stands on alcohol and other substance use, and the ways they can affect judgment, and to talk frankly about sex in the context of social distancing.

  • Frequently Asked Questions and Advice

    Updated May 28, 2020

    • My state is reopening. Is it safe to go out?

      States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • How many people have lost their jobs due to coronavirus in the U.S.?

      More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

    • Is ‘Covid toe’ a symptom of the disease?

      There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing.

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

    • How can I help?

      Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.

Talk to your children about why this all matters, Dr. Goza said. “Give them science so they can understand why it’s so important, to protect them, protect their friend, protect their parents and grandparents and their friend’s parents and grandparents.”

“Not every lapse of self-protection activity is going to necessarily mean that the worst is going to happen,” Dr. Navsaria said. “We need to teach and redirect and guide with kindness and compassion, including our own kids, because everyone is doing the best they can.”

Pediatricians are also concerned that with children looking for summer recreation, but not supervised in camps or formal programs, there may be a higher risk of injuries, including bicycle-related accidents and trampoline mishaps, and especially drownings. No activities are completely risk-free, but taking precautions (bike helmets, locked gates around pools, proper adult supervision) and talking things through with your children can make everyone safer.

So here we all are, parents and pediatricians, trying to keep children as safe as possible, while letting them take some steps out into the world.

“Summer is going to be different,” Dr. Goza said. “We just need to be kind to each other — people are going to have different ideas, and we need to try to be considerate about what other people think, knowing we have to do what’s right for our families.”

Do you have questions for Dr. Perri Klass? Join her and Tara Parker-Pope, the founder of Well, for a New York Times event, “Living Well: Ask a Pediatrician” Monday June 1 at 1 p.m. Eastern. They’ll talk about kids, coping, playtime and more.