“There will be a period of epic withdrawal,” warned one addiction specialist, once schools, activities and social life return to normal.
It wasn’t until last fall that many parents started to breathe easier, as it became clear that elementary schools, at least, were not cesspools of infection with the coronavirus. But the alarming news of a more contagious version of the virus, first identified in Britain, revived those concerns.
Initial reports were tinged with worry that children might be just as susceptible as adults, fueling speculation that schools might need to pre-emptively close to limit the variant’s spread. But recent research from Public Health England may put those fears to rest.
Based on detailed contact-tracing of about 20,000 people infected with the new variant — including nearly 3,000 children under 10 — the report showed that young children were about half as likely as adults to transmit the variant to others. That was true of the previous iteration of the virus, as well.
“There was a lot of speculation at the beginning suggesting that children spread this variant more,” said Muge Cevik, an infectious disease expert at the University of St. Andrews in Scotland and a scientific adviser to the British government. “That’s really not the case.”
But the variant does spread more easily among children, just as it does among adults. The report estimated that the new variant is about 30 percent to 50 percent more contagious than its predecessors — less than the 70 percent researchers had initially estimated, but high enough that the variant is expected to pummel the United States and other countries, as it did Britain.
Prime Minister Boris Johnson of Britain had promised last year to do all he could to keep schools open. But he changed course in the face of soaring infections and buckling hospital systems, and ordered schools and colleges to move to remote learning. Other European countries put a premium on opening schools in September and have worked to keep them open, though the variant already has forced some to close.
In the United States, the mutant virus has been spotted only in a handful of states but is expected to spread swiftly, becoming the predominant source of infections by March. If community prevalence rises to unmanageable levels — a likely proposition, given the surge in most states — even elementary schools may be forced to close.
But that should be a last resort, after closures of indoor restaurants, bars, bowling alleys and malls, several experts said.
“I still say exactly what many people have said for the past few months — that schools should be the last thing to close,” said Helen Jenkins, an infectious disease expert at Boston University. Keeping schools open carries some risk, but “I think it can be reduced substantially with all the mitigations in place,” she said.
Reports of the new variant first surfaced in early December, and some researchers initially suggested that unlike with previous versions of the virus, children might be just as susceptible to the new variant as adults.
Researchers at P.H.E. looked at how efficiently people of various ages transmitted the variant to others. They found that children under 10 were roughly half as likely as adults to spread the variant.
Adolescents and teenagers between ages 10 and 19 were more likely than younger children to spread the variant, but not as likely as adults. (The range for the older group in the study is too broad to be useful for drawing conclusions, Dr. Cevik said. Biologically, a 10-year-old is very different from a 19-year-old.)
Over all, though, the variant was more contagious in each age group than previous versions of the virus. The mutant virus will result in more infections in children unless schools shore up their precautions, experts said.
“The variant is not necessarily affecting children particularly, but we know that it’s adding on more transmissibility to all age groups,” Dr. Cevik said. “We need to find ways to return these kids back to school as soon as possible; we need to use this time period to prepare.”
In Germany, Chancellor Angela Merkel had vowed that schools would be the last thing to close during the second lockdown that began in November. Schools went to great lengths to keep in-person classes in session, requiring children to wear masks and opening windows to ensure better ventilation even as temperatures plummeted.
But fear of the variant’s spread prompted Ms. Merkel to keep schools closed following the holiday break at least through the end of January.
In France, where the new variant has not resulted in a surge of infections so far, schools reopened earlier this month after the winter break. France was not dealing with a particularly difficult epidemic, and health protocols put in place last September limited transmission in schools, Jean-Michel Blanquer, France’s education minister, has said.
The Italian government, too, has allowed not just elementary schools to open but also high schools, albeit at half capacity. Still, local leaders have implemented tighter restrictions, with some high schools slated to stay closed until the end of the month.
In the United States, the variant has only been spotted in a handful of states, and still accounts for less than 0.5 percent of infections. Schools remain open in New York City and many other parts of the country, but some have had to shut down because of rising virus infections in the community.
“Obviously, we don’t want to get to a point where it seems like we closed schools too late,” said Dr. Uché Blackstock, an urgent care physician in Brooklyn and founder of Advancing Health Equity, a health care advocacy group. “But at the same time, I think that we should try to keep our young children in school for as long as possible for in-person learning.”
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It’s been clear for months what measures are necessary, Dr. Blackstock and other experts said: requiring masks for all children and staff; ensuring adequate ventilation in schools, even if just by opening windows or teaching outdoors; maintaining distance between students, perhaps by adopting hybrid schedules; and hand hygiene.
The new variant, while more contagious, is still thwarted by these measures. But only a few schools in Britain implemented them.
“When we look at what’s happened in the U.K. and think about this new variant, and we see all the case numbers going up, we have to remember it in the context of schools being open with virtually no modification at all,” Dr. Jenkins said. “I would like to see a real-life example of that kind of country or state or location, which has managed to control things in schools.”
There are some examples within the United States.
Erin Bromage, an immunologist at the University of Massachusetts Dartmouth, advised the governor of Rhode Island, as well as schools in southern Massachusetts, on preventive measures needed to turn back the coronavirus. The schools that closely adhered to the guidelines have not seen many infections, even when the virus was circulating at high levels in the community, Dr. Bromage said.
“When the system is designed correctly and we’re bringing children into school, they are as safe, if not safer, than they would be in a hybrid or remote system,” he said.
The school Dr. Bromage’s children attend took additional precautions. For example, administrators closed the school a few days before Thanksgiving to lower the risk at family gatherings, and operated remotely the week following the holiday.
Officials tested the nearly 300 students and staff at the end of that week, found only two cases, and decided to reopen.
“That gave us the confidence that our population was not representative of what we were seeing in the wider community,” he said. “We were using data to determine coming back together.”
The tests cost $61 per child, but schools that cannot afford it could consider testing only teachers, he added, because the data suggest the virus is “more likely to move from teacher to teacher than it is from student to teacher.”
In New York City, students and teachers are randomly tested, and have so far shown remarkably low rates of transmission within schools.
Dr. Blackstock has two children at an elementary school in Brooklyn, and said her son has not been tested all year. Even if the new variant brings a spike in cases, the city’s policy of closing a school if it has two unrelated infections is “too conservative,” she said.
If the number of cases skyrockets and the schools shut down more often, “then I would probably say, ‘This doesn’t feel right, let’s keep them home,’” she said. “But they’re going to be in school as long as I can possibly keep them.”
Emma Bubola contributed reporting from Milan, Melissa Eddy from Berlin, Constant Méheut from Paris and Benjamin Mueller from London.
My 4-year-old daughter is pretty tough when it comes to medical procedures. The flu shot? Not even a flinch. Stitches in her forehead? No big deal. Years earlier, she calmly watched as a nurse pricked her finger and squeezed the blood, drop by drop, into a tiny vial to test it for lead.
But the Covid test was different.
In early September, just before her preschool reopened, she began sneezing and had a sore throat. When her congestion worsened, we knew that she needed to get a coronavirus test. But as the nurse approached her, holding a long stick with a brush on the end resembling a pipe cleaner, she covered her face and backed away. In the end, two people had to hold her down. She screamed as the swab activated her lacrimal reflex, bringing tears to her eyes. It was over quickly, but she cried for half an hour afterward and insisted that she would never visit another doctor again. She now refers to that probe as “the needle.”
In late December she needed another test for her preschool, but this time she wasn’t sick. With the memory of her last experience still fresh in my mind, I immediately started researching. Were there less invasive tests to consider? If so, how would we find one? Would it be accurate enough? And was there an ideal way to prepare a squeamish young child who was averse to getting tested?
As it turned out, none of these questions had simple answers. So I consulted with five doctors and two of the largest urgent care providers in the United States to learn more.
How do I know if my child needs a test?
There are four main reasons a child might need to be tested:
They have symptoms
They have been exposed to someone infected with the virus
Their school, day care or a hospital requires it
They need it as a precaution before and after traveling
If your child has any symptoms of Covid — even mild ones like a runny nose or a sore throat — it’s a good idea for them to get tested and stay home, said Dr. Stanley Spinner, chief medical officer and vice president of Texas Children’s Pediatrics, the largest pediatric primary care group in the country, and Texas Children’s Urgent Care.
“We have seen, time and time again, kids with very mild symptoms with no known exposures who get tested with our very accurate PCR and sure enough, they come back positive,” Dr. Spinner said.
If your child has been in close contact with someone who tested positive for Covid-19 — even if your child does not have any symptoms — they should get tested, the experts said. The Centers for Disease Control and Prevention define close contact as spending at least 15 minutes within six feet of someone who has the coronavirus, or having any type of direct physical contact with an infected person, including kissing or hugging.
If your child is in school or day care, those institutions may have rules on when they must be tested, and how.
It’s safest to stay home, but if you and your children must travel, the C.D.C. recommends getting tested one to three days before your trip and then again three to five days after your trip.
If you’re still unsure if your child needs a test, call their pediatrician, said Dr. Kristin Moffitt, an infectious disease specialist at Boston Children’s Hospital. You can also take the C.D.C.’s clinical assessment tool, which can be used for any family member, including children.
Which types of tests are available for kids?
Virus testing for children is, for the most part, the same as it is for adults. The Food and Drug Administration has authorized the emergency use of two basic categories of diagnostic test. The most sensitive ones are the molecular PCR tests, which detect the genetic material of the virus and can take days to deliver results (some locations offer results in as little as a day). The second type of test, the antigen test, hunts for fragments of proteins that are found on or within the coronavirus. Antigen tests typically yield results quickly, within 15 minutes, but can be less sensitive than the molecular tests.
The way your provider collects your sample can vary. For instance, regardless of whether you get a PCR test or an antigen test, the collection method could be any of the following: nasopharyngeal swab (the long swab with a brush at the end that reaches all the way up the nose toward the throat); a shorter swab that is inserted about an inch into the nostrils; a long swab of the tonsils at the back of the throat; or a short swab swizzled on the gums and cheeks. The new saliva tests, which are still being vetted, require you to drool into a sterilized container, which could be difficult for young children.
FastMed Urgent Care, which has a network of more than 100 clinics in Arizona, North Carolina and Texas, currently uses a long swab to perform the rapid antigen test and a short swab for the PCR test, said Dr. Lane Tassin, one of the company’s chief medical officers. But MedExpress, a different urgent care group with clinics in 16 states, tests all patients with the shorter nasal swab when doing either PCR or antigen tests at its nearly 200 urgent care centers, said Jane Trombetta, the company’s chief clinical officer.
Which diagnostic test should my child get?
The type of test that your child gets will largely depend on what is available in your area, how long it takes to get the results back and why the child needs it, the experts said.
Some day care centers and schools will only accept PCR results for clearance to return to school, so it is best to double check their rules beforehand.
The long-swab molecular test is considered the “gold standard,” but other less-invasive testing methods are also reliable. For routine testing, Dr. Jay K. Varma, senior advisor for public health at the Office of the Mayor of New York City, said the shorter swab “performs basically as well as the longer, deeper swab does. That’s true in both adults and children.” In fact, he added, New York City’s public hospital testing sites began switching from the long swab to the short swab during the summer.
Dr. Jennifer Lighter, a pediatric infectious disease specialist at NYU Langone Health, said she likes the antigen tests because they can quickly identify Covid-positive kids when they are contagious. Antigen tests are most accurate when the amount of virus in the sample is highest — typically around the day that symptoms start.
If you have a preference on which test you’d like your child to get, call your pediatrician’s office first and ask what kinds of tests they perform and how they collect the samples. Clarify whether they use the shallow (anterior) swab or the long (nasopharyngeal) swab. If you want the more comfortable, shallow PCR test but your pediatrician’s office does not offer it, try other testing centers in your area, including pediatric urgent care centers.
Some tests are now available for home use. But if you’re using a home test, check the label. Some aren’t indicated for children.
Confused by the terms about coronavirus testing? Let us help:
- Antibody: A protein produced by the immune system that can recognize and attach precisely to specific kinds of viruses, bacteria, or other invaders.
- Antibody test/serology test: A test that detects antibodies specific to the coronavirus. Antibodies begin to appear in the blood about a week after the coronavirus has infected the body. Because antibodies take so long to develop, an antibody test can’t reliably diagnose an ongoing infection. But it can identify people who have been exposed to the coronavirus in the past.
- Antigen test: This test detects bits of coronavirus proteins called antigens. Antigen tests are fast, taking as little as five minutes, but are less accurate than tests that detect genetic material from the virus.
- Coronavirus: Any virus that belongs to the Orthocoronavirinae family of viruses. The coronavirus that causes Covid-19 is known as SARS-CoV-2.
- Covid-19: The disease caused by the new coronavirus. The name is short for coronavirus disease 2019.
- Isolation and quarantine: Isolation is the separation of people who know they are sick with a contagious disease from those who are not sick. Quarantine refers to restricting the movement of people who have been exposed to a virus.
- Nasopharyngeal swab: A long, flexible stick, tipped with a soft swab, that is inserted deep into the nose to get samples from the space where the nasal cavity meets the throat. Samples for coronavirus tests can also be collected with swabs that do not go as deep into the nose — sometimes called nasal swabs — or oral or throat swabs.
- Polymerase Chain Reaction (PCR): Scientists use PCR to make millions of copies of genetic material in a sample. Tests that use PCR enable researchers to detect the coronavirus even when it is scarce.
- Viral load: The amount of virus in a person’s body. In people infected by the coronavirus, the viral load may peak before they start to show symptoms, if symptoms appear at all.
Are there any downsides to getting my kid tested? Is it safe?
Many testing sites offer drive-through services where you don’t need to leave your car. But if you must walk into a clinic, the experts I spoke with said that the risk of getting Covid while you’re there is low.
“In my experience, everyone that is delivering health care now is being incredibly careful with infection control,” said Dr. Sean O’Leary, the vice chairman of the American Academy of Pediatrics’ committee on infectious diseases. “The risk of going into a health care facility is probably pretty low relative to a lot of the other things people are currently engaging in in the U.S.”
Testing facilities require people to wear masks and to maintain physical distancing, he added.
The experts also said that the tests themselves are not harmful for young children, including infants, even if done repeatedly. The long swab may produce discomfort for a brief period — Dr. O’Leary jokingly calls it the “brain biopsy” — but he is not aware of any long-term risk to the nose or throat.
How can I prepare my child for the test?
To avoid any surprises, ask your provider about which types of tests they offer and how they collect the samples ahead of time.
It’s usually best to be straightforward with your kid about what to expect. For short nasal swabs, explain that a doctor will tickle the inside of their nose with a cotton swab to collect their boogers, and that it won’t hurt.
For the long swab, you may want to prepare your child by explaining that the swab might feel a little uncomfortable, but that it will be over quickly. You can also share that kids of all ages are getting the test, even babies.
Over all, convey that it’s no big deal and it’s something that simply needs to get done, Dr. Lighter said.
“Kids are only as anxious as the information that’s coming to them,” she added.
If your child might be intimidated by the protective gowns, masks and face shields that health providers wear, explain that they wear that clothing to stay safe — kind of like how people wear cloth masks when they go outside.
Some hospitals have created videos like this one from the Children’s Hospital Colorado that show how the Covid test works and what families can expect. If your child is old enough to understand, it might be helpful to watch a video like this together and then talk about it afterward.
Try to find out how long you might need to wait. Many areas have long lines at testing sites, so consider bringing water, snacks and entertainment (crayons, storybooks) for your kids.
If your child’s pediatrician is administering Covid tests, it might be reassuring for your child to have the test performed by someone they are already familiar with. But if not, “try and go somewhere that has experience working with children,” Dr. O’Leary said. Doctors and nurses who test children regularly will most likely know what to do if your child is nervous or scared.
This time of year, my thoughts turn to the DTP vaccine. Last year I wrote about the apocryphal “Christmas miracle” of 1891, in which the newly discovered diphtheria antitoxin may (or more likely, may not) have been used before it had been approved to save a child’s life.
Still, the moral was that bacteriology, that new 19th-century science, had figured out how one of the deadly microscopic bacteria did its damage, with a poison that could choke off children’s airways, and had invented an antidote, and that was miracle enough.
Soon after that column was published, we began to hear about a new microbial threat making it hard for people to breathe in Wuhan, China, and, well, you know the rest of the story. But now, a year later, I am — no surprise — thinking about vaccines, and how far this technology has come.
When I write about diphtheria, I usually mention that I have never seen it; by the time that I went to medical school and trained in pediatrics, it was already a historical disease in this country. My teachers could remember measles, and some of the older ones had seen polio, but no one in the 1980s in Boston was telling war stories about diphtheria.
Pertussis was different — the “P” in the DTP. Pertussis, better known as whooping cough, was still around, still something to worry about when a baby came in with a particularly bad cough, still something we worried we might miss. Once we heard the whoop, our teachers told us, we would never forget it.
And since the immunity did not last forever, either from childhood vaccines or from actual disease, and there was, at that time, no safe adult booster shot for pertussis, there was no way to protect us; whenever a child did turn out to have the disease, all the doctors and nurses and family members who had been exposed to that child would have to take a course of antibiotics, in case they had also been infected, and many pediatric residents ended up taking those antibiotics two or three times.
But you didn’t always know that you’d been exposed. In fact, I managed to catch pertussis in the line of duty and, without knowing it, to expose lots of babies and children, since I went on working when I was sick (in my own not-very-valid defense, I was just behaving in accordance with the fairly idiotic and highly macho rules of medicine, rules we can hope that the experience of Covid-19 will change forever).
The first thing you should know about the DTP vaccine is that all three of the diseases against which it protected a child — diphtheria, tetanus and pertussis — are bacterial diseases, unlike, for example, polio or smallpox, which are viral diseases. And one reason you may have been reading recently about the triumphs of polio vaccine in the 1950s, or the successful campaign to eradicate smallpox worldwide, is that the biological entities that cause those illnesses are more similar to the coronavirus that causes Covid-19 than any bacterial illness.
Still, the story of the DTP vaccine, and in particular the story of vaccinating against pertussis, has some interesting things to tell us, about how brilliant vaccine technology can be, but also how it can be studied and improved over time, and about trade-offs and controversies.
The first pertussis vaccines were developed and tested in the 1920s and 1930s and were in universal use by the end of the 1940s. And they worked. Dr. James Cherry, a distinguished research professor of pediatrics at David Geffen School of Medicine at the University of California, Los Angeles, and an expert on pertussis who has done extensive research both on the disease and on the vaccines, cites more than 36,000 pertussis deaths from 1926 to 1930 in the United States, most in young infants; from 1970 to 1974, there were 52.
While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.
Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.
Yes, but not forever. The two vaccines that will potentially get authorized this month clearly protect people from getting sick with Covid-19. But the clinical trials that delivered these results were not designed to determine whether vaccinated people could still spread the coronavirus without developing symptoms. That remains a possibility. We know that people who are naturally infected by the coronavirus can spread it while they’re not experiencing any cough or other symptoms. Researchers will be intensely studying this question as the vaccines roll out. In the meantime, even vaccinated people will need to think of themselves as possible spreaders.
The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection won’t be any different from ones you’ve gotten before. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. But some of them have felt short-lived discomfort, including aches and flu-like symptoms that typically last a day. It’s possible that people may need to plan to take a day off work or school after the second shot. While these experiences aren’t pleasant, they are a good sign: they are the result of your own immune system encountering the vaccine and mounting a potent response that will provide long-lasting immunity.
No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.
Even so, when I started out in pediatrics, in the 1980s, the DTP was, no question, the shot we least liked giving. Of the shots that we routinely gave, this was the one that kids tended to react to — with fevers, with sore arms, and sometimes, though very rarely, with more serious reactions. “Reactogenic,” we sometimes called it.
The reactions had a lot to do with what went into the vaccine: whole inactivated Bordetella pertussis bacteria. And though bacteria are microscopically small, they are enormous and complex cells compared to viruses, which are just made up of protein and nucleic acid (DNA or RNA). In other words, a whole-cell vaccine contained many different compounds in it that the body might react to — there are more than 3,000 different proteins in the bacterial cell. For diphtheria and tetanus, single “toxoids” were used, inactivated versions of the poisons manufactured by those bacteria, so those components were much less reactogenic.
There were parents who believed that their children had been harmed by the vaccine, and strong sentiment against it in what we would now call the anti-vaccine movement, along with ongoing medical controversy over which problems had been caused by the vaccine and which were coincidences of timing in a vaccine given at 2, 4 and 6 months of age, and then again at around a year and a half.
Since 1999, children in the United States have been vaccinated with DTaP, rather than DTP, with the “a” standing for “acellular.” No more whole cells; these vaccine developers used specific proteins to which the body would manufacture immunity. DTaP shots are significantly less “reactogenic.”
They also tend to be less effective in provoking a long-lasting effective immune response; in a 2019 review, Dr. Cherry wrote that in almost every clinical trial, the whole-cell vaccines were more efficacious than the acellular vaccines. That meant a certain balancing of risks and benefits, and ongoing discussion, as the changeover to DTaP has been linked to recent resurgences in the number of cases, though not necessarily in deaths, and Dr. Cherry argues that the increased number of reported cases may actually be a result of raised awareness and better testing. But even if there is more pertussis around in adults, thanks to the vaccines, this is no longer a deadly disease of young children.
Although a safe adult booster called the Tdap has now been developed, there is still a great deal of pertussis infection in adolescents and adults, and it often goes undiagnosed, even among doctors, because in adults it may not look that different from other coughs and colds.
But it can; for me, it was a miserable disease, though not particularly dangerous — I wasn’t at risk of dying from it, even if it was the worst cough I ever had. Adults don’t even tend to produce the characteristic “whoop,” which comes from sucking in air back across the closed glottis, after a paroxysm of coughing — if I’d been whooping, surely I would have diagnosed myself, or my colleagues at the health center would have diagnosed me.
I see this as a story that should help us appreciate the unending ingenuity of the science that finds ways to turn on our complicated immune responses without making us suffer through a disease that once choked the life out of countless babies.
At the same time we can understand that getting the most out of the body’s immune defenses can take some learning and some study, and that there can be trade-offs that you consider for the good of the individual patient or the good of the community. We vaccinate adults against pertussis now not only to protect them, but also to make sure that the vulnerable — in this case, infants — are less likely to be exposed, and in fact, vaccinating pregnant women with the adult booster turns out to be a good way to protect their newborns.
Dr. Cherry said that vaccinating all pregnant women with Tdap “will prevent virtually all deaths from pertussis in the first two months of life.”
Surely, as we live though this pandemic, we can take a moment to be grateful for the remarkable progress in vaccine technology that has given us vaccines that target Covid-19 so elegantly and specifically, and offers us ways to protect not only ourselves, but also those around us.
Tonight I left my children with our longtime babysitter, who claims she is nine days sober, but is possibly drunk or high.
At the very least, she is exhausted — the kind of exhausted that seeps into your bones and calcifies. I am leaving my children with her because I trust her. Four years, she has cared for my children. She has made them paper crowns and cardboard castles, bathed them and sung them to sleep. She and I have lunched and sipped tea. Together, we have summited mountains of paperwork to secure her health insurance, a new car, a new apartment.
I know her, I trust her. This is the mantra I repeat to myself from my office upstairs, where I am listening to every thump and bump and giggle below.
I am in the house. I didn’t leave. It’s the middle of a pandemic; no one leaves anymore. That’s how I know my children will be alive when I finish working. But as the night goes on, I start checking the baby monitor, because my children are not in bed and it is after 8 o’clock, after bedtime, late and getting later. When they finally appear — my 5-year-old daughter doing a cartwheel, my 3-year-old son dragging his blankies, the babysitter, alert and smiling — I release a breath I had not realized I was holding.
How many days of sobriety do you need to babysit? To be trustworthy? Seven days? Thirty days? Ninety days? Conventional wisdom holds that the physical symptoms of alcohol withdrawal — the nausea and sweating, the shaking and disorientation — usually subside in three to five days.
The babysitter says she has nine days sober, but we all lie, every addict, every alcoholic. I detoxed in the hospital’s drunk tank. On day two of sobriety, I had a seizure. On day six, I had a panic attack. On day nine, I could put on my own pants, barely.
But the struggle doesn’t end with the physical. It’s mental. The misery of protracted withdrawal — dysphoria, depression, irritability — can drag on for weeks. Twelve-step programs refer to this as “the monkey on your back,” because the cravings weigh on you, pick at you, natter in your ear about how much more bearable this conference call, this meal, this round of hide-and-seek might be with a drink. My first sponsor insisted I find a job and keep busy, which I did, and I stayed sober.
Tonight, I’m paying it forward. I am giving the babysitter a job. I am keeping her busy. I am hoping she stays sober.
But what if I weren’t an alcoholic? Would I have asked her to leave? Would I have said I’m not comfortable, and sent her away? This babysitter has become something more akin to family. She has told me stories of being dragged through her childhood like a fiberglass boat through the shallows: a father who left, a mother who did her best, a grim foster care placement, and the briny scrape of countless other dangers, both visible and not. This babysitter — whose heart is miraculously intact despite the damage it has endured, including a recent brush with death and viral cardiomyopathy — could I have asked her to leave?
The Big Book of Alcoholics Anonymous says she should stay. Being of use is important, it says. The fellowship of another alcoholic is crucial, it says. Still, I wish she hadn’t confessed. I wish she hadn’t told me over the kitchen island, in front of the children as they were eating spaghetti, as they were eating her every word, saving their questions for the morning when I know they will ask me, What is drinking? What is sober? Why is her face so fluffy?
They do not know what it is to be bloated. They do not understand edema or addiction. They have never seen me drink alcohol, not once, not ever. I will have to explain it to them. They share my blood, so it’s possible that this thing, this alcoholic affliction may be metastasizing in them, even now, as they lie in their beds, chattering back and forth. I will have to explain at least part of it to them in the morning.
Someday they will want to know all of it. How I stopped drinking. How I writhed as the alcohol and dope leached out of my system. How I was dry. For years I was dry, like a desert, like the air in winter, like a pile of ash. Angry. Pimpled. Thirsty. That first year, I locked myself away in a halfway house where I learned how to shower, how to clean a toilet, how to cook spaghetti, how to wash a dish, how to make a bed, why you should care about making your bed. And AA meetings every day. For three years, every day. I had the Big Book nearly memorized — the acceptance passage, the serenity prayer, How It Works, the steps and traditions. I remember so little now.
I’ve been sober 18 years, so long I don’t even think about drinking and drugs anymore. Not really, anyway. Not often. Definitely not every day. But once in a while, maybe out at dinner with friends, when someone orders a red wine, or a beer, or a vodka tonic.
Vodka. I’d like seven vodka tonics. I’d like to slip inside a bottle of vodka, to bathe in it, to slosh, just for the night, just for a little while.
That’s how I know my addiction is still there, still lurking, still hungry. After 18 years it’s probably ravenous, but it’s not starving. Starvation is something you die of, and addiction cannot be killed. You can’t excise or eradicate it. You have to contain it. Dam it. Barricade it. Even then, it whispers. Through whatever levees you erect, it gurgles. It splashes out a Morse code of desire. You become a certain kind of deaf, a certain level of numb, all the time, every day. That’s the work. That is how you progress from drunk, to dry drunk, to sober human. You’ll never be just human. You’ll always be a sober human — a person almost, but not quite.
My babysitter has nine days sober. When she tells me, she says how proud she is. I have given her my children for the night. When I go downstairs, they will be asleep, or will be in bed contemplating going to sleep. She and I will talk. I will tell her what it was like, what happened, what it’s like today. I will tell her half-truths — not even. She will tell me what it is like for her right now, today, with her nine days sober. I will believe half of what she says — not even.
Tomorrow night, she will watch my children again. She will hold them, and her soon-to-be 10 days, as tightly as she is able. I know her, I trust her. She will keep the children as safe as she knows how. I pray their laughter and shrieks and glee will keep her safe in return. These are the things alcoholics do for each other. These are the things that keep us sober. These are the things I hope someone would do for my children, should they need it.
Sarah Twombly is a writer and mother to two young children.
Like many of us, I stood speechless yesterday as I watched rioters storm the nation’s Capitol. My daughters, ages 10 and 17, watched alongside me and were shocked, too. Feeling rattled and helpless, I wanted someone to look after me much more than I wanted to do any parenting myself.
As a psychologist, I’m used to staying levelheaded in chaotic situations. Last night was different; I was pretty much useless. I left my girls in the care of my calm and capable spouse, and spent the evening on the phone and then Twitter seeking assurance that order would be restored. I wanted the sense that there was, or would soon be, a grown-up in the room.
Today, I remembered: I am a grown-up in the room, at least around here. And focusing on that sphere is making it possible for me to join my husband in being the parent my daughters need and deserve.
I don’t need to be responsible for fixing everything; helping my girls process their sense that everything seems broken is enough. Over breakfast, I asked my 10-year-old what she was thinking about yesterday’s events and reassured her that, even though things got out of control, calmer heads have prevailed and I now feel hopeful that things might be moving in the right direction.
Being the grown-up in the room means making space for my girls’ confusion and their questions. Tonight, I will ask both of them what they heard from their teachers and classmates at school, what they wonder, what they think. I know that I won’t have all the answers to their questions, so I’ll just be honest about what I do and don’t know and everything I am still struggling to understand.
It means I have apologized for checking out last night. Had I alarmed them by reacting to yesterday’s chaos strongly or loudly, I would have apologized for that as well.
Being a grown-up means setting aside my misguided belief that compulsively checking social media or broadcast news reports will help me feel better. I have reminded myself that doing so only unsettles me and pulls me away from what I want to be present for: my kids, my spouse, my own work, myself.
It means that I need to be mindful of what media my daughters are taking in as events continue to unfold. My younger daughter gets most of her news from us or with us. We can and will limit her exposure to graphic images and frightening information. If there is something upsetting she needs to know, we should be the ones to tell her so that we can choose the right moment, share the news in age-appropriate language and be prepared to address her reaction.
My older daughter gets her news from us, with us, and also from a vast, complex and largely opaque-to-adults adolescent discourse that unfolds over social media. With her, we will do more listening than talking, seeking to make sure that she’s a critical consumer of what she’s taking in, that she’s working with facts and that she’s thinking for herself.
Yesterday, we watched TV news together as a family, pausing at one point to ask my younger daughter if the reports felt like too much. She insisted that they weren’t, and that she wanted to see what was happening. We deferred to what she knows about herself, and what we know about her and continued to watch together until we switched the television off to have dinner.
Trying to be an up-to-the-job parent as historical events unfold can leave us feeling doubly overwhelmed. Our own sense of, “Oh my God, what is happening?” quickly gives way to other worrisome questions: “How can I possibly explain all of this and fix it for my kids?”
Well, we can’t — at least not today. But to be good parents, we don’t need to. We just have to remind ourselves of the territory we control right now and be the grown-ups there.
If it feels as if you’ve already explored every last nook and cranny of your cramped lockdown life know this: Right under your nose, there’s a hidden world operating entirely out of view.
That world is geocaching, a no-contact game of hide-and-seek between hundreds of thousands of strangers. Players hide caches — waterproof containers, usually small plastic boxes — in out-of-sight spots for others to discover using GPS technology.
How has this world remained totally hidden from you? The first rule of geocaching is to try to keep your searching a secret. If a runner jogs by, players may pretend to be deeply engrossed in plant identification. (Once you know about geocaching, you may realize just how many other folks are pretending to be fascinated by that patch of ivy.)
Geocaching began in earnest in 2000, when the U.S. military adjusted its GPS satellites to improve accuracy for recreational GPS users. An enthusiast in Oregon hid the first cache, said Bryan Roth, president and co-founder of Geocaching HQ, which runs Geocaching.com. Since then, the community has grown steadily, with the pandemic spurring a considerable increase in participation.
“At a time when people are looking for some distraction, getting outside really works well,” said Mr. Roth, who noted that sign-ups for the Geocaching app are up 70 percent compared with last year.
To get started, download an app on your phone, like Geocaching HQ (free download and some free caches, but the $30 annual membership unlocks more); Cachly ($4.99 and free caches, iPhone only); or c:geo (free download and free caches, Android only). You can also geocache with a hand-held GPS device, using online databases like NaviCache.com to find cache coordinates.
Caches are rated 1 to 5 by their difficulty; beginners may want to start with a 1 and work up from there. GPS will usually get you within 30 feet of the cache, and instructions like “look to the north of the roadway” can clue you in on exactly where you should be searching.
Then the real hunt begins.
When you find the cache — be it hidden under a tree, tucked into a log pile or taped to the back of a sign — you can check it off on the app. Most caches have a logbook tucked inside which shows everyone who was there before you, while others will contain a trinket as a treasure. (Putting a few tiny objects in your pocket before you head out gives you options if you think you might want to swap with the trinkets inside.)
One particularly nice benefit of geocaching is that it gets screen-addicted kids outside. And even though geocaching happens outdoors, you needn’t be outdoorsy.
When a friend first suggested that Katie Sweeney and her husband try geocaching in 2007, “I was like, I don’t really like hiking,” she remembered. Ms. Sweeney, a copywriter based in the Netherlands, soon found many caches within a few blocks of her home, in Philadelphia at the time. Today, she takes her 6-year-old daughter out to geocache on their way to or from the grocery store or other errands.
“We’re always discovering new places near where we live,” Ms. Sweeney said, adding that children can really be an asset. Their different vantage points often helps them see things adults might overlook.
Nick Geidner, a University of Tennessee journalism professor, doesn’t mind if a hunt is a bust.
“We don’t always find them,” he said. “But if we fail, we can come back and we can try again.” Henry, his 7-year-old son, wasn’t quite so sure. When asked how he felt after giving up on a recent hunt, he said, “I’m not like angry, but I’m not like happy.”
The thrill of finding a tricky or unique cache, though, far outweighs those not-happy moments. In September, Ms. Sweeney and her daughter found a once-in-a-lifetime cache, which had a gamelike opening with a maze, magnetic ball and secret code.
“It was this little joy,” said Ms. Sweeney, recalling opening the cache. “We’re all just looking for little moments of joy.”
This spring, as the world fell apart faster than we’d expected, I fell in love with trees. Not the crush of my girlhood when I admired them and fancied myself the child at the end of Dr. Seuss’s “The Lorax.” In love like I dreamed about them. I saw their bodies when I closed my eyes. Branches and trunks of different species traced my insides — the arch of the redbud’s trunk in joy and pleasure; the tight winter huddle of the spruce in fear.
Until last May, two slender, sickly Eastern hemlocks grew in a corner of our backyard garden, dying as the invasive woolly adelgid sucked their sap, just as the insect is killing the great hemlock forests of the Appalachians. I took my 2-year-old son, Abraham, out under the trees with me one afternoon and showed him the fuzzy white eggs on the undersides of the needles. I explained the trees were sick.
“He wan’ his Mama,” Abraham said, reaching for the branch closest to his chubby hand. “Mama, I wanna hold his hand.” Clasping the twig, he looked up into the tree. “Hemlock tree, you feel better?” I could scarcely breathe, startled by the sudden clarity that I am teaching my child to love a dying and transforming world, that he will learn to love and lose in the same breath, and that I will learn along with him.
“Yes, the tree wants his Mama,” I managed to say. “He wants to go back to Mama Earth. Honey, our hemlock trees are dying. We will have to cut them down soon, and let them become soil.”
As a rabbi and climate activist, I’d already been grieving a long time. For our trees, for the great Appalachian hemlock forests, as well as for the burning Amazon, the oceans choked in plastic, the hungry people. For the whole beautiful and complex system of life, brought to its knees by a species rich in intelligence and poor in wisdom, the most dangerous apex predator ever to walk the Earth.
Abraham sat under the hemlocks on soil packed hard by his play. Last fall he named this spot Frog and Toad’s corner, and he likes to go on toddler “trips” there before triumphantly rushing back into my arms when he “comes home” to the patio. His little body rocked back and forth quietly. I resisted the urge to distract him, or myself, from our own versions of the same giant and holy grief.
Like so many, my husband and I were working from home and without child care this spring and summer. Caring for Abraham every day and sneaking in work emails where I could, I found myself more consistently outdoors in spring than I had been since my own childhood. Every day, Abraham and I walked the few short blocks from our Boston home to the back of Peters Hill in the Arnold Arboretum, a 281-acre collection of plants from around the world, owned by Harvard University and designed by Frederick Law Olmsted.
Every day we saw, smelled and felt the changes in the trees. The collection nearest our house features the Rosacea family, and we spent hours underneath the flowering crab apples and hawthorns, marking the days by who was in bloom, whose petals had begun to drop, who had started to put out leaves, or fruit. Inspired by the botanist Robin Wall Kimmerer, I began a practice of using personal pronouns when referring to all plants and animals, teaching us both a new grammar that I hoped would be Abraham’s native tongue.
As we walked, Abraham and I spoke about the trees as people — and indeed, for the first month of quarantine, they were the only people besides us he got to see up close. In the absence of human friends, greeting the trees with a reverent shake of a lower branch became an obvious choice. “Hi, European larch tree,” Abraham would say in his toddler dialect, grabbing the feathery needles of the drooping branches.
Since every tree in the Arnold Arboretum has a metal name card, fastened with a screw and a bit of wire somewhere on the base of the trunk, it was an excellent place for me to check my work as I learned to identify tree families and genera. Abraham too began to search for the name card, crouching down to “read” it, his little REI sun hat making him look exactly the part of a miniature naturalist. We developed special relationships with a few trees, like the “White Lying Down Tree,” Abraham’s name for a wild crab apple from Japan with white blossoms and a trunk that grows improbably in four directions parallel to the ground, creating an irresistible little fort.
In the evenings, when I could spare the time from work, I pored over guidebooks and Donald Culross Peattie’s “A Natural History of North American Trees,” better acquainting myself with the trees we had met that day. Do you have alternate or opposite leaves? Smooth or toothed margins? Is your bark deeply furrowed or smooth? What shape do your branches take? Your seeds? Your flowers? What story do you tell about the land? What geologic changes have you already survived? What is our history together? What are you saying?
I wanted to be able to read the trees, to listen to them, to feel the kind of breathy intimacy with them that I had with my grandmother as she lay dying peacefully over the course of a week in my parents’ sunlit house years ago. Crawling next to her in the hospice bed, I would hold her smooth and papery hand, kiss her cheeks, and receive each word she managed to speak as I might a rare heirloom seed placed in my palm.
In our own backyard, Abraham and I greeted our closest tree-neighbors by name over and over, and I felt a great loneliness lift. Rare butternut hybrid. American elm. Norway maple. Arborvitae. Gray birch. Eastern redbud. Arrowwood viburnum. Let me learn your names, your habits, your wisdom — before you die, before I die. My newest friends and most ancient teachers, watch over my son, child of a dying and transforming world — but a world yet alive with belonging and beauty.
Shoshana Meira Friedman is a rabbi, writer, mother and climate activist in Boston.
Lynne Seymour recalls her mother jumping for joy when the polio vaccine rolled out in 1955, when she was eight. “It was like a dark cloud had lifted,” she said.Credit…Rana Young for The New York Times
- Dec. 25, 2020, 5:00 a.m. ET
Lizzo’s “Good As Hell” greeted the arrival of Covid-19 vaccines this month at Boston Medical Center, where the scene of dancing health care workers quickly spread on TikTok. Others shared triumphant selfies of their arms post-injection.
For Americans of a certain generation, the rollout evoked searing memories of an earlier era — one that rescued their childhood from fear and the sudden loss of classmates and siblings.
Lynne Seymour was 8 years old in 1955, when her mother, a nurse, let out a startling noise while listening to the radio at their home in Berkeley, Calif.
“She started jumping up and down, crying and laughing at the same time,” Ms. Seymour said. “It scared me a little because I didn’t know what was happening. So I said, ‘Mom, what is it?’”
Her mother explained that Dr. Jonas Salk, a medical researcher, had developed a vaccine for a dangerous virus. “It meant we wouldn’t have to worry about polio anymore, and children wouldn’t be in iron lungs and we would go back to the swimming pool,” Ms. Seymour said. “It was like a dark cloud had lifted.”
The first polio epidemic in the United States began in Vermont in 1894, an outbreak that killed 18 people and left at least 58 paralyzed. Waves of pernicious outbreaks, targeting children, would mar the next half-century. In the country’s worst single year, 1952, nearly 60,000 children were infected and more than 3,000 died. Many were paralyzed, notably including Franklin D. Roosevelt, who would become president and hide his disability. Others were consigned to life in an iron lung, a type of ventilator that encased a child’s body to ease breathing.
A litany of other celebrated figures also lived with the disease: the songwriter Joni Mitchell, the artist Frida Kahlo, the Olympic sprinter Wilma Rudolph and Senator Mitch McConnell of Kentucky.
Parents anxiously wondered how to keep their children safe from the disease, ordering them to stay away from swimming pools and movie theaters. They practiced the hand-washing routines that have become all too familiar to families this year. (It is now understood that the polio virus spread through consumption of water and food contaminated by fecal matter.)
Dr. Salk made an ambitious bet that he could develop a vaccine for polio using inactivated virus, which was killed using formalin. When his trial was successful in April 1955, church bells rang and households cheered.
American children had been taught for years to dread summer because it so often brought polio outbreaks. A vaccine promised that they could go out and play again, and swim without as much worry.
Stefan Krieger, 74, remembered his family’s enthusiastic reaction to the news. Just a few years earlier, he caught a cold and had to miss a friend’s birthday party; everyone else who attended, including his best friend, contracted polio.
“Many of us had a classmate whose sister or brother had been stricken,” said Arlene Agus, 71.
Ms. Agus’s school in New York City distributed the vaccine in alphabetical order so she was the first to get the shot, with a lollipop as her reward.
“Over half-a-century later, I can still remember the expressions of relief from the long, winding chain of students standing behind me, grateful that they weren’t in my spot,” she said.
The federal government licensed the vaccine within hours of the announcement and manufacturers began their production efforts. “An historic victory over a dread disease,” a newscaster’s voice declared in an April 12 reel from Metro-Goldwyn-Mayer. The announcement includes clips of men in suits rolling carts of vaccine shipments, much like this month’s images of coronavirus vaccine shipments. “Here scientists usher in a new medical age.”
After all of the fanfare, some children remembered getting the vaccine as anti-climactic. Philip McLeod, 77, who was living in Nanton, Alberta, at the time, said he and his classmates were lined up very quickly and then it was over. “It was hard to believe as a 12-year-old that was going to save your life, because it was so routine,” he said.
With distribution of a coronavirus vaccine beginning in the U.S., here are answers to some questions you may be wondering about:
- If I live in the U.S., when can I get the vaccine? While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.
- When can I return to normal life after being vaccinated? Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.
- If I’ve been vaccinated, do I still need to wear a mask? Yes, but not forever. Here’s why. The coronavirus vaccines are injected deep into the muscles and stimulate the immune system to produce antibodies. This appears to be enough protection to keep the vaccinated person from getting ill. But what’s not clear is whether it’s possible for the virus to bloom in the nose — and be sneezed or breathed out to infect others — even as antibodies elsewhere in the body have mobilized to prevent the vaccinated person from getting sick. The vaccine clinical trials were designed to determine whether vaccinated people are protected from illness — not to find out whether they could still spread the coronavirus. Based on studies of flu vaccine and even patients infected with Covid-19, researchers have reason to be hopeful that vaccinated people won’t spread the virus, but more research is needed. In the meantime, everyone — even vaccinated people — will need to think of themselves as possible silent spreaders and keep wearing a mask. Read more here.
- Will it hurt? What are the side effects? The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection into your arm won’t feel different than any other vaccine, but the rate of short-lived side effects does appear higher than a flu shot. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. The side effects, which can resemble the symptoms of Covid-19, last about a day and appear more likely after the second dose. Early reports from vaccine trials suggest some people might need to take a day off from work because they feel lousy after receiving the second dose. In the Pfizer study, about half developed fatigue. Other side effects occurred in at least 25 to 33 percent of patients, sometimes more, including headaches, chills and muscle pain. While these experiences aren’t pleasant, they are a good sign that your own immune system is mounting a potent response to the vaccine that will provide long-lasting immunity.
- Will mRNA vaccines change my genes? No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.
But visibly, the creek and the skating rink by his home, long abandoned out of fear — similar to the scenes today at many communal playgrounds and parks — once again filled with the sounds of children playing.
Among the first children in the country to receive the vaccine were Dr. Salk’s three sons. Peter Salk, the oldest, recalled their father gathering them near the kitchen table and instructing them to roll up their sleeves and expose their triceps. Then Dr. Salk moved from the stove, where he had sterilized needles and syringes, and injected his sons.
“It was an opportunity to demonstrate my father’s confidence in the work he had done,” Peter Salk said. “And to get us kids protected.”
When the shot was later administered in a 1954 field trial at their Pittsburgh elementary school, one of the teachers asked Darrell Salk, who was only 6 at the time, to comfort a crying schoolmate and explain that his father’s vaccine was safe.
“What did I know?” Darrell said. “I was a kid. But I did my best to reassure him it was helping to protect people from a very nasty disease.”
As thousands of children began to receive the vaccine, Dr. Salk’s sons got caught up in the waves of excitement. Five-year-old Jonathan Salk called his best friend to announce the good news: “Billy! I’m famous! And so is my father!”
Still, much like the atmosphere surrounding the debut of this month’s coronavirus vaccines, introduction of the polio immunization was bittersweet for many families who had already lost relatives.
Jean Norville, 72, remembered her older brother Tommy as a “saint,” so gentle-hearted that when she slammed her finger in a car door, he said he wished it were his own instead. Tommy fell sick with polio in October 1951, and his parents drove at speeds exceeding 100 miles per hour to a hospital in Louisville, Ky., where he was put in an iron lung. Their mother, refusing to leave Tommy’s side, slept in the hospital bathtub.
He died soon afterward. The neighbors were so afraid of getting polio that Ms. Norville’s family held Tommy’s funeral with an empty coffin. When the vaccine arrived, Ms. Norville’s mother rushed her children to the health department to get the shot.
“Think of Tommy,” her mother said.
For Catherine Griffice, 79, the cure for polio carries a special legacy. Her father, Frederick Bland, caught the disease in 1948, when he was a third-year medical student. Paralyzed and unable to climb stairs, he was carried out of the house on a chair and taken by ambulance to a hospital, where he died four days later.
Her mother remarried, to another doctor, who then vaccinated all of their neighbors in Wittenberg, Wis. “He did it in honor of my dad,” Ms. Griffice said.
The initial polio vaccine rollout did not go smoothly. Within a month, six cases of polio had been linked to a vaccine manufactured by Cutter Laboratories in Berkeley, Calif. It was soon discovered that Cutter had failed to completely kill the virus in some vaccine batches, a mistake that caused more than 200 polio cases and 11 deaths. The surgeon general asked Cutter to issue a recall, and distribution ground to a halt.
Months later, in the summer and fall of 1955, Boston was hit by a polio outbreak, and Ellen Goodman, then 6 years old, became sick. “I remember being in bed, and I felt this electric current going up and down my arms and legs,” she said. “Then I went to move and my left leg was numb.”
Decades later, Ms. Goodman, 71, suffers post-polio syndrome, with symptoms including chronic fatigue and difficulty walking. “My life has been defined by this disease,” she said. “To think it could have been avoided.”
The vaccine program restarted months later, and polio cases fell sharply. Elvis Presley agreed to be vaccinated on national television to build public confidence in the shot. But the disease didn’t disappear. U.S. case counts rose again beginning in 1958, especially in urban areas. The country’s last case from community spread was recorded in 1979. Though two strains of polio have been eradicated, a third remains and still circulates in Afghanistan and Pakistan.
For those scarred by memories of the polio epidemic, a vaccine against Covid can’t arrive soon enough. Many older Americans, particularly vulnerable to the disease, have been shut in and separated from their children and grandchildren for much of this year.
Ms. Norville hasn’t left her home since February and is eagerly waiting for a shot. “My son said, ‘If I could, I would bring you the vaccine today.’”
For the Salk family, the relief is accompanied by a sense of pride, given their father’s role in advancing scientific understanding of immunization. But the sons are also worried about opposition to inoculation against any disease.
“He would have been delighted,” Darrell Salk said of his father. “But he would be horrified by the number of people concerned about using the vaccine. I can see him closing his eyes and shaking his head.”
A 4-year-old girl coping with the loneliness of the pandemic created a tiny garden, and kindled an unlikely friendship with an enchanted neighbor who moved into her tree.
My life has been filled with uncertainty for a long time, but my son has helped me stay flexible, adjust expectations and persevere.
As we celebrate the rollout of the new Covid vaccines, don’t forget the standard immunizations and other steps to keep children safe.
Watching my 13-year-old son fling himself off a mountain has been keeping me grounded in the pandemic.
Lessons in gratitude from a concert where a gunman opened fire.
Children and adolescents diagnosed with depression may be at increased risk for physical diseases and premature death as young adults, researchers report.
For a study published in JAMA Psychiatry, researchers used Swedish health registries to track a group of 1,487,964 children, of whom 37,185 were diagnosed with depression between ages 5 and 19. The investigators followed the group until they ranged in age from 17 to 31.
Of 69 physical diseases they were able to track, people with depression had a higher risk for 66 of them, even after controlling for other psychiatric illnesses.
For example, compared to their peers who were not depressed, they had eight times the risk of sleep disorders, more than three times the risk of liver disease, and nearly five times the risk of thyroid illness.
Boys had higher risks than girls for most diseases, but both boys and girls with depression had a rate of all-cause mortality six times as high as those without depression. Their rate of suicide was 14 times as high, and deaths from natural causes more than twice as high, as their peers who were not depressed.
“Our observational study can’t address whether this is causal,” said the lead author, Marica Leone, a Ph.D. student at the Karolinska Institute in Stockholm. “We need further research to determine that. But physicians need to look for other diseases, and not just psychiatric disorders, that flow from youth depression.”
There’s no way to sugarcoat it: The pandemic has plunged the world into a crisis of grief. It has caused the deaths of more than 290,000 people in the United States, many of them grandparents and parents. In New York State alone, 4,200 children lost a parent or caregiver to Covid-19 between March and July, according to a study from the United Hospital Fund. (These were the most recent figures available on parental death from Covid.)
For any family who lost a loved one this year, regardless of the cause of death, the pandemic has kept them from being able to properly mourn their loss. And now the holiday season is here, which can be a grief trigger, especially for kids.
Children who lose a parent are at higher risk for lasting mental health issues, including anxiety and depression. Supporting a grieving child involves normalizing their feelings while giving them tools to cope — talking about death, however, can sometimes feel overwhelming. Parents and children may both be reluctant to have conversations that bring up difficult emotions, but it’s important for parents to provide opportunities to acknowledge their child’s feelings.
Film can be a gift in these times. Often, a movie about death can provide just enough distance for a productive discussion. Giving children examples of others’ loss can help them feel less isolated in their own bereavement; watching a character in a film can get the child thinking about their own grief journey and the tools they might use to cope.
The following films, suitable for children ages 6 and older, offer helpful ways to explore death and the accompanying emotions, while providing parents an opening to talk about loss. Content that might be disturbing to young children is noted.
109 minutes; Rated PG; available on Disney+
This colorful, Academy Award-winning Pixar film based around the Mexican holiday of Dia de los Muertos (Day of the Dead), follows 12-year-old Miguel’s journey to the Land of the Dead. While there, he unlocks family secrets and learns that the dead continue to exist in the memory of the living.
The Black Stallion (1979)
118 minutes; Rated G; available on Amazon.
After a young boy named Alec and a horse are washed up on a deserted island from a shipwreck that killed Alec’s father, the orphaned boy and the animal soon form an inseparable bond. The pair are rescued and Alec becomes determined to turn “The Black” into a racehorse with the help of a grizzled old trainer. Alec’s connection with the horse brings him solace, helping him deal with his grief for his father.
Fly Away Home (1996)
107 minutes; Rated PG; available on Amazon.
After her mother dies in a car crash, 13-year-old Amy (played by a young Anna Paquin) is sent from New Zealand to Canada to live with her father. She adopts a nest of abandoned goose eggs, and when they hatch she finds herself in charge of teaching the goslings survival skills — including how to fly south for the winter. In the process of taking on the mother role for the goslings, Amy is able to grieve for her own mother. Please note: The car crash is shown in the film’s opening sequence.
Summer 1993 (2017)
100 minutes (subtitled); available on Amazon.
After her mother’s death, 6-year-old Frida must move from Barcelona to the country to live with her aunt, uncle and younger cousin. The young girl soon struggles with grief and her place in this new family. Often presented from Frida’s viewpoint, with overheard conversations and waist-high camera angles, the film is based on the director’s personal experiences with loss.
A Monster Calls (2016)
128 minutes; Rated PG-13; available on Amazon.
Conor’s mother is gravely ill, and the 13-year-old struggles with anger, sadness, guilt and anticipatory grief. To cope with all the overwhelming emotions, Conor (Lewis MacDougall) conjures a monster who offers up three fables and then demands one from him — it must be his ultimate truth. MacDougall gives an authentic performance as a boy learning to face the truth, even though it is contradictory and complex. Please note: There is some destruction of property, physical bullying and verbal abuse.
When Marnie Was There (2014)
103 minutes; Rated PG; available on HBO Max.
In this feature from Japanese animation powerhouse Studio Ghibli, Anna is sent by her foster mother to visit relatives at the seaside for fresh air after having an asthma attack. Once there, she ventures into an abandoned mansion and discovers a new friend, Marnie, who may or may not be the ghost of her grandmother. Anna is then forced to confront feelings she has been avoiding about the loss of her family.
The Farewell (2019)
98 minutes (subtitled); Rated PG; available on Amazon.
The matriarch of a family in China is diagnosed with terminal cancer, but no one has told her. The family comes together one last time under the guise of a large wedding, but it’s really to say goodbye. The film, based on the writer and director Lula Wang’s personal story, shows profound cultural differences in attitudes about death and grieving.
For parents who did not expect their children to have devices or use social media so young, virtual learning was an unexpected push into the digital deep end.
I teach sex ed. In light of a recent report on exploitation of children on the site Pornhub, I have some talking points for parents.
Alice McGraw, 2 years old, was walking with her parents in Lake Tahoe this summer when another family appeared, heading in their direction. The little girl stopped.
“Uh-oh,” she said and pointed: “People.”
She has learned, her mother said, to keep the proper social distance to avoid risk of infection from the coronavirus. In this and other ways, she’s part of a generation living in a particular new type of bubble — one without other children. They are the Toddlers of Covid-19.
Gone for her and many peers are the play dates, music classes, birthday parties, the serendipity of the sandbox or the side-by-side flyby on adjacent swing sets. Many families skipped day care enrollment in the fall, and others have withdrawn amid the new surge in coronavirus cases.
With months of winter isolation looming, parents are growing increasingly worried about the developmental effects of the ongoing social deprivation on their very young children.
“People are trying to weight pros and cons of what’s worse: putting your child at risk for Covid or at risk for severe social hindrance,” said Suzanne Gendelman, whose daughter, Mila, is 13-months-old and pre-pandemic had been a regular play-date buddy of Alice McGraw.
“My daughter has seen more giraffes at the zoo more than she’s seen other kids,” Ms. Gendelman said.
It is too early for published research about the effects of the pandemic lockdowns on very young children, but childhood development specialists say that most children will likely be OK because their most important relationships at this age are with parents.
Still, a growing number of studies highlight the value of social interaction to brain development. Research shows that neural networks influencing language development and broader cognitive ability get built through verbal and physical give-and-take — from the sharing of a ball to exchanges of sounds and simple phrases.
These interactions build “structure and connectivity in the brain,” said Kathryn Hirsh-Pasek, director of the Infant Language Laboratory at Temple University and a senior fellow at the Brookings Institution. “They seem to be brain feed.”
In infants and toddlers, these essential interactions are known as “serve-and-return,” and rely on seamless exchanges of guttural sounds or simple words.
Dr. Hirsh-Pasek and others say that technology presents both opportunity and risk during the pandemic. On one hand, it allows children to engage in virtual play by Zoom or FaceTime with grandparents, family friends or other children. But it can also distract parents who are constantly checking their phones to the point that the device interrupts the immediacy and effectiveness of conversational duet — a concept known as “technoference.”
John Hagen, professor emeritus of psychology at the University of Michigan, said he would be more concerned about the effect exchanges on young children, “if this were to go on years and not months.”
“I just think we’re not dealing with any kinds of things causing permanent or long-term difficulties,” he said.
Dr. Hirsh-Pasek characterized the current environment as a kind of “social hurricane” with two major risks: Infants and toddlers don’t get to interact with one another and, at the same time, they pick up signals from their parents that other people might be a danger.
“We’re not meant to be stopped from seeing the other kids who are walking down the street,” she said.
Just that kind of thing happened to Casher O’Connor, 14 months, whose family recently moved to Portland, Ore., from San Francisco. Several months before the move, the toddler was on a walk with his mother when he saw a little boy nearby.
“Casher walked up to the two-year-old, and the mom stiff-armed Cash not to get any closer,” said Elliott O’Connor, Casher’s mother.
“I understand,” she added, “but it was still heartbreaking.”
Portland has proved a little less prohibitive place for childhood interaction in part because there is more space than in the dense neighborhoods of San Francisco, and so children can be in the same vicinity without the parents feeling they are at risk of infecting one another.
“It’s amazing to have him stare at another kid,” Ms. O’Connor said.
“Seeing your kid playing on a playground with themselves is just sad,” she added. “What is this going to be doing to our kids?”
The rise of small neighborhood pods or of two or three families joining together in shared bubbles has helped to offset some parents’ worries. But new tough rules in some states, like California, have disrupted those efforts because playgrounds have been closed in the latest Covid surge and households have been warned against socializing outside their own families.
Plus, the pods only worked when everyone agreed to obey the same rules and so some families simply chose to go it alone.
That’s the case of Erinn and Craig Sheppard, parents of a 15-month-old, Rhys, who live in Santa Monica, Calif. They are particularly careful because they live near the little boy’s grandmother, who is in her 80s. Ms. Sheppard said Rhys has played with “zero” children since the pandemic started.
“We get to the park, we Clorox the swing and he gets in and he has a great time and loves being outside and he points at other kids and other parents like a toddler would,” she said. But they don’t engage.
One night, Rhys was being carried to bed when he started waving. Ms. Sheppard realized that he was looking at the wall calendar which has babies on it. It happens regularly now. “He waves to the babies on the wall calendar,” Ms. Sheppard said.
Experts in child development said it would be useful to start researching this generation of children to learn more about the effects of relative isolation. There is a distant precedent: Research was published in 1974 that tracked children who lived through a different world-shaking moment, the Great Depression. The study offers reason for hope.
“To an unexpected degree, the study of the children of the Great Depression followed a trajectory of resilience into the middle years of life,” wrote Glen Elder, the author of that research.
Brenda Volling, a psychology professor at the University of Michigan and an expert in social and emotional development, said one takeaway is that Depression-era children who fared best came from families who overcame the economic fallout more readily and who, as a result, were less hostile, angry and depressed.
To that end, what infants, toddlers and other children growing up in the Covid era need most now is stable, nurturing and loving interaction with their parents, Dr. Volling said.
“These children are not lacking in social interaction,” she said, noting that they are getting “the most important” interaction from their parents.
A complication may involve how the isolation felt by parents causes them to be less connected to their children.
“They are trying to manage work and family in the same environment,” Dr. Volling said. The problems cascade, she added, when parents grow “hostile or depressed and can’t respond to their kids, and get irritable and snap.”
“That’s always worse than missing a play date.”
I worried that at night, when homesickness tends to intensify, my granddaughter would cry for Mommy and Daddy. I was prepared to not get much sleep.
Show me a family that has not been fractured — temporarily or permanently — by a fury-filled rift between two or more members and I might believe in miracles. Just about everyone I know seems to have experienced such a distressing event, often with painful psychological and sometimes physical effects that carried over to relatives who had nothing to do with the precipitating dispute.
Rifts can begin with financial, religious, political, even existential conflicts. Common precipitants include contested wills, disputes over parental care, sibling rivalry and charges of favoritism.
Sometimes the incident may have been imagined. A woman who had been molested as a child falsely accused her mother’s husband of molesting her son and severed all contact between her father-in-law and her children.
As with the molested daughter, rifts can stem from a previous trauma that distorts a person’s perceptions of reality. Or a relationship-severing dispute may reflect years of accumulated resentments that were never expressed or addressed.
In a new book based on the first-ever national survey on estrangement and in-depth interviews with 100 men and women who achieved a reconciliation, Karl A. Pillemer, a family sociologist and professor at Cornell University and Weill Cornell Medical College, discovered that family rifts were surprisingly pervasive and often result in long-lasting emotional and physical distress.
His random survey of 1,340 individuals suggested that “about 25 percent of the population is living with an active estrangement,” he said in an interview. “For some of these approximately 67 million people, it doesn’t make much difference, but most people experience the rupture as aversive.”
As he wrote in “Fault Lines: Fractured Families and How to Mend Them,” published in September, “Even in our rapidly changing society, family relationships matter.” For most people, estrangements are a source of chronic stress that threatens “mental, social and physical well-being,” he concluded.
I know because I’ve been there. A beloved aunt, who became my surrogate mother after my biological mother died while I was in high school, abruptly cut me out of her life when, instead of wedding a fellow Jew, I married a Christian. I made three serious attempts at a reconciliation, each of which she initially accepted, then sabotaged, at which point my husband said, “Never again, she’s hurt you once too often.”
I kept saying “I can’t believe this is happening in my family,” a refrain Dr. Pillemer frequently heard from those he interviewed. And as he also found, there was often “collateral damage” when other family members are drawn into a dispute they had nothing to do with. I lost what had been a warm and loving relationship with my aunt’s daughter, my first cousin. It was never restored.
Among those Dr. Pillemer interviewed were children who never knew their grandparents or who missed out on all manner of family events — holiday celebrations, birthdays and anniversaries, weddings, vacation trips, even funerals — because of a rift between two adult relatives.
Unresolved rifts can precipitate chronic stress in one or both participants that undermines their emotional and physical health. The resulting anxiety or depression can worsen heart disease and diabetes, cause reproductive problems, undermine immunity and even shorten the person’s life, studies have suggested.
On the other hand, rifts can sometimes be health-saving for the person who precipitates them. For example, people may cut a relative out of their lives who is physically or emotionally abusive or engages in criminal activities or other antisocial behaviors they find threatening or abhorrent.
A cousin with whom I had enjoyed many visits growing up disappeared from my life forever when he married and his wife severed all contact with his family because the father-in-law was a crook.
“Estrangements can be adaptive,” Kathleen Smith, a family therapist in Washington, D.C., and author of “Everything Isn’t Terrible,” told me. “Estrangement can be a way to manage unsustainable tension and anxiety.”
But, Dr. Smith added, people should realize that family rifts often have a cost, especially in what Dr. Pillemer calls “loss of social capital”: the people you can rely on for spiritual, physical or even financial support in times of hardship or stress. Who will help care for children or manage the family business when parents are seriously ill or injured?
Reconciliation is often not easy, but the folks Dr. Pillemer interviewed who achieved it said it was well worth the effort. I can attest to that. This summer I helped resolve a fury-filled rift between two relatives — a father and son — who I knew really loved and needed one another but held radically different views of how to live. Though long simmering beneath the surface, the final rift was fueled by unfiltered emails filled with heartbreaking, angry accusations from the son and statements like “You ruined my life, I can’t live with you in it,” prompting the father to email a detailed rebuttal denying any wrongdoing.
Although untrained in psychology, I understand, love and am respected by both father and son yet had enough detachment to remain rational. Happily, my intervention resulted in a heartwarming rapprochement along with tools to help maintain it that happen to match several of Dr. Pillemer’s suggestions. Most important, I told both that for a reconciliation to work, rehashing of past hurts and rebuttals had to cease and the relationship restored on a new footing that goes forward, not backward. Dr. Pillemer calls it “living life forward.”
As he wrote, “People wish to impose their vision of the relationship’s past on others. They insist that the other person must understand what really went on and admit his or her critical failings.” But as two long estranged and now reconciled sisters he wrote about discovered, “Going over the past was just not going to work for us; we learned how to move ahead together.”
As Dr. Pillemer reported, “Cutting someone off may have brought immediate relief from conflict and negativity, but most people longed for a return to the relationship and felt that the rift stood in the way of achieving a life well-lived.” Statements like “I’m done,” “It’s over” don’t always mean done forever. Both Dr. Pillemer and Dr. Smith suggest reaching out periodically to maintain contact and attempt a reconciliation. People and circumstances change, and one day it may become possible to build a bridge across the rift.
“Often when parents present independent play, it’s like slamming a door on the child’s face and saying, ‘Go play outside,’” said Dr. Lawrence J. Cohen, the author of “Playful Parenting.”
Instead, challenge your kids to create a piece of art for you or come up with a surprise for another adult in the home so you stay involved, even if it’s just on the sidelines.
This way, they won’t feel like you’re shutting them out.
The drugmaker Moderna said on Wednesday that it would soon begin testing its coronavirus vaccine in children ages 12 through 17. The study, listed Wednesday on the website clinicaltrials.gov, is to include 3,000 children, with half receiving two shots of vaccine four weeks apart, and half getting placebo shots of salt water.
But the posting says the study is “not yet recruiting,” and Colleen Hussey, a spokeswoman for Moderna, said it was not certain when the testing sites would be listed or start accepting volunteers. A link on the website to test centers is not yet working, and Ms. Hussey said she was not sure when it would become active.
Moderna announced on Monday that data from its study in 30,000 adults had found its vaccine to be 94.1 percent effective, and that it had applied to the Food and Drug Administration for emergency authorization to begin vaccinating adults. If approval is granted, certain groups of high-risk adults, including people in nursing homes, could receive shots late in December.
But no vaccine can be widely given to children until it has been tested in them. Vaccines meant for both adults and children are generally tested first in adults to help make sure they are safe for pediatric trials.
Moderna’s vaccine has not yet been studied in children or pregnant women. In the new clinical trial in adolescents, girls past puberty will be tested before each injection to make sure they are not pregnant.
“Everyone anticipates that when we test this first in adolescents, then older children, then the real small kids, that the Covid vaccine will work,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University and an adviser on vaccines to the Centers for Disease Control and Prevention.
But children have more active immune systems than adults, and may have stronger reactions, including more fever, muscle and joint aches, and fatigue, Dr. Schaffner said.
“They may be more out of sorts than adults for a day or two,” he said. “You really do want to know, if it’s given in adolescents, what can parents expect? You really want to be able to tell them clearly how you might feel for 24 or 48 hours after you receive the vaccine. And obviously, we really want to be able to tell parents it works.”
If a child had intense side effects and parents were not prepared for it, they might be reluctant to go back for the second shot, Dr. Schaffner said.
Dr. Paul A. Offit, a vaccine expert at Children’s Hospital of Philadelphia, said that vaccines “for the most part” work equally well in children and adults. Occasionally, as with the hepatitis B vaccine, different doses are required, he said. Moderna will study the same dose in children that it has tested in adults.
Confused by the all technical terms used to describe how vaccines work and are investigated? Let us help:
- Adverse event: A health problem that crops up in volunteers in a clinical trial of a vaccine or a drug. An adverse event isn’t always caused by the treatment tested in the trial.
- Antibody: A protein produced by the immune system that can attach to a pathogen such as the coronavirus and stop it from infecting cells.
- Approval, licensure and emergency use authorization: Drugs, vaccines and medical devices cannot be sold in the United States without gaining approval from the Food and Drug Administration, also known as licensure. After a company submits the results of clinical trials to the F.D.A. for consideration, the agency decides whether the product is safe and effective, a process that generally takes many months. If the country is facing an emergency — like a pandemic — a company may apply instead for an emergency use authorization, which can be granted considerably faster.
- Background rate: How often a health problem, known as an adverse event, arises in the general population. To determine if a vaccine or a drug is safe, researchers compare the rate of adverse events in a trial to the background rate.
- Efficacy: A measurement of how effective a treatment was in a clinical trial. To test a coronavirus vaccine, for instance, researchers compare how many people in the vaccinated and placebo groups get Covid-19. The real-world effectiveness of a vaccine may turn out to be different from its efficacy in a trial.
- Phase 1, 2, and 3 trials: Clinical trials typically take place in three stages. Phase 1 trials usually involve a few dozen people and are designed to observe whether a vaccine or drug is safe. Phase 2 trials, involving hundreds of people, allow researchers to try out different doses and gather more measurements about the vaccine’s effects on the immune system. Phase 3 trials, involving thousands or tens of thousands of volunteers, determine the safety and efficacy of the vaccine or drug by waiting to see how many people are protected from the disease it’s designed to fight.
- Placebo: A substance that has no therapeutic effect, often used in a clinical trial. To see if a vaccine can prevent Covid-19, for example, researchers may inject the vaccine into half of their volunteers, while the other half get a placebo of salt water. They can then compare how many people in each group get infected.
- Post-market surveillance: The monitoring that takes place after a vaccine or drug has been approved and is regularly prescribed by doctors. This surveillance typically confirms that the treatment is safe. On rare occasions, it detects side effects in certain groups of people that were missed during clinical trials.
- Preclinical research: Studies that take place before the start of a clinical trial, typically involving experiments where a treatment is tested on cells or in animals.
- Viral vector vaccines: A type of vaccine that uses a harmless virus to chauffeur immune-system-stimulating ingredients into the human body. Viral vectors are used in several experimental Covid-19 vaccines, including those developed by AstraZeneca and Johnson & Johnson. Both of these companies are using a common cold virus called an adenovirus as their vector. The adenovirus carries coronavirus genes.
- Trial protocol: A series of procedures to be carried out during a clinical trial.
Pfizer began testing its coronavirus vaccine in children as young as 12 in October. A large clinical trial found its vaccine to be 95 percent effective in adults, and the company has requested emergency authorization from the F.D.A. Britain approved the Pfizer vaccine for adults on Wednesday, the first country to do so.
AstraZeneca has also tested its vaccine in children, but not in the United States.
As vaccine studies have moved forward, rumors have spread on social media, particularly among people who oppose vaccines in general, that President-elect Joseph R. Biden Jr. plans to require vaccination for everyone, including children. His team has denied those claims, and Mr. Biden has said that he will rely on scientists’ advice for the best way to end the pandemic.
Opioids are very effective drugs for managing pain, but they can also be scary drugs, with their potential for misuse and abuse. Given the current opioid epidemic in the United States, some parents worry about whether they are safe for children, while many pain experts worry that fear of opioids among parents and among physicians may contribute to the undertreatment of pediatric pain.
In new guidelines published in November in the journal JAMA Surgery, a panel convened by the American Pediatric Surgical Association Outcomes and Evidence-based Practice Committee set out some guidelines for how to think about — and prescribe — opioids for children to relieve pain after surgery. “It’s important to understand that children undergo a lot of painful procedures,” said Dr. Lorraine Kelley-Quon, a pediatric surgeon at Children’s Hospital Los Angeles, who was the lead author on the guidelines. “They have real pain; opioids can help.”
Matthew Kirkpatrick, an addiction expert who is an assistant professor in the department of preventive medicine at the Keck School of Medicine at the University of Southern California, and who was one of the authors of the new guidelines, said, “We don’t want to contribute to scaring parents and to scaring physicians about undertreating pain.” From the data they reviewed, he said, “kids that use these medications as prescribed are at very low risk for abuse and dependence either in the short term or the long term.”
However, the first six statements in the guidelines discuss the risks of adolescents misusing prescription opioids (misuse is anything other than use exactly as directed by the prescriber, or use without a prescription), diverting them (giving them away or selling them), and possibly having a higher risk of problems with opioids in the future. Dr. Kelley-Quon pointed out that many health care practitioners may not be familiar with the addiction literature. But some pain experts warn that heavy emphasis on that risk as a way of framing the issue may frighten both parents and doctors.
Dr. Elliot Krane, the chief of pediatric pain management at Stanford Children’s Health, who was not an author of the new guidelines, said, “the concern is that the paper is going to discourage the appropriate use of opioids, though I know that wasn’t the intent of the authors — the reason I think that’s the risk is they set up their recommendations with a premise which I think is untrue, that kids are dying and becoming addicts” at an increasing rate.
Dr. Krane disputed some of the statements about the risk: “I think the evidence that opioid abuse is increasing in children is very weak; I think the evidence in children that prescription opioids lead to later abuse isn’t there at all.”
Dr. Scott Hadland, a pediatrician and addiction specialist at Boston Medical Center, who was not involved with the guidelines, said, “While I agree with the recommendations, I agree also with the concern from the pain community that risk may be overstated — may not be as large as some of the earlier studies have suggested.”
The guidelines recommend non-opioid medications as first-line postoperative drugs, including the use of regional anesthesia.
But when opioids are used, the guidelines stress careful supervision. “It all boils down to access,” Dr. Kirkpatrick said, and the imperative is to make sure that parents and physicians get the right information “to manage the dispensing of the medication to their kids and the access that their kids have to the medication.” Parents should not be afraid of managing the child’s pain with opioids when they are needed, but should understand the importance of controlling that access in children and through adolescence.
“The parent should be highly engaged in managing the child’s pain, in making sure the child gets the medication to manage the pain, but the child does not have access to the drug on their own.”
Dr. Kirkpatrick said that overprescribing by physicians has contributed to opioid use and misuse in adults. In data from a national survey on drug use and health, he said, kids were most likely to get medication they had misused from friends or family members, but when they were asked where that person had gotten it, it was often from a doctor.
Dr. William Zempsky, the division head of pain and palliative medicine at Connecticut Children’s Medical Center, who was not an author of the guidelines, said that while opioids have been prescribed inappropriately to adults in some settings, there is no clear evidence that it has been a problem in pediatrics.
“We need to do things right, but we don’t need to scare people,” Dr. Zempsky said. “Kids continually are at risk for lack of appropriate postoperative surgical management because of fear of opioid addiction.”
Dr. Eugene Kim, the chief of the division of pain medicine at Children’s Hospital Los Angeles, who was one of the authors of the guidelines, said, “I am aware of the caution that certain pain management experts have,” regarding the dangers of underprescribing and undertreating pain. The guidelines should be the basis for ongoing conversations, he said, as well as for responsible prescribing.
“Parents of children who are undergoing surgeries should be educated as to when to use the medications, how to use the medications, and we, as providers, should be involved in that process from the get-go as far as the education process, as far as responsible prescribing, as far as follow up.”
Some adolescents may be particularly at risk for problems with opioids, especially those who have had substance use problems in the past, and those who have mental health problems.
With patients at higher risk, Dr. Hadland said, such as those with anxiety or depression or those who have had substance abuse issues, opioids can still be prescribed when they’re needed, but “we should take great care.”
When a patient of his, a young adult who had alcohol use disorder, needed surgery, Dr. Hadland said, “I and the patient themselves were both concerned about the potential misuse of opioids because of the history of addiction.” He and the surgeon partnered, he said, and agreed that Dr. Hadland would do the postoperative pain management because he was more readily available and more comfortable working with a patient who had this history. He prescribed very small amounts of oxycodone, he said, discussing at every stage with the patient how it felt to be taking the medication. “We had open communication around it and things went really well.”
The guidelines go beyond the discussion of when opioids should be used and cover the importance of educating both children and their parents and caregivers about the possible side effects of opioids (oversedation and respiratory depression), about the importance of following medical instructions carefully, about the need for storing these medications securely (that is, in a locked area) and getting any unused doses out of the home in a safe and secure way (they should be returned to a secure opioid disposal bin).
None of the other specialists I spoke with suggested changing the specific recommendations for multimodal pain relief, for using opioids when other drugs are insufficient for effective pain control, and for good parent education leading to careful oversight, locked storage and safe disposal of unused doses.
“The spirit behind these guidelines is correct,” Dr. Hadland said. “Prescribing the lowest effective dose for the shortest period of time, use only short acting formulations, and talk to families about risks and monitoring dosing and locking up medication.”
Parents and physicians can feel safe that if kids are using these medications as prescribed to manage their pain, Dr. Kirkpatrick said, they are “not at significantly greater risk for developing opioid use related problems.”
“If your child needs surgery, talk to your doctor, ask questions about what pain should be expected,” Dr. Kelley-Quon said. Ask if opioids will be used, and if so, how should they be used, and how can they be safely disposed of, she said. “We want to be at the sweet spot, treating pain appropriately, maximizing benefit and minimizing risk.”
As any parent overseeing homeschool knows: Zoom P.E. is hardly a hard-driving Peloton class. It’s more like your kid lying on the floor of the living room doing halfhearted leg-lifts by the light of her laptop.
Many students, particularly tweens and teens, are not moving their bodies as much as they are supposed to be — during a pandemic or otherwise. (60 minutes per day for ages 6 to 17, according to the Centers for Disease Control and Prevention.) A March 2020 report in The Lancet offers scientific evidence as to why your kids won’t get off the couch: As children move through adolescence, they indeed become more sedentary, which is associated with greater risk of depression by the age of 18. Being physically active is important for their physical health as well as mental health.
Yet with many organized team sports on hiatus and athletic fields, playgrounds and climbing gyms closed or restricted to smaller groups during shorter hours, what’s an increasingly lazy child to do? More accurately: What’s a mother or father of an increasingly lazy child to do?
Many parents are taking charge, finding informal and creative ways to entice their isolated tweens and teens off their screens and outside — with others, safely. To get your own younger ones moving, here are a few ideas from families around the country, all almost-guaranteed hits, even with winter coming.
A SENSE OF CAMARADERIE
Start a small running club.
In San Francisco, under rain, fog or blue skies (or even the infamous orange one), a group of sixth graders have been gathering in Golden Gate Park two times a week to run two miles. Their unofficial motto: “Safe Distance, Minimal Distance.” Masks are required and photo breaks are frequent, as is post-run ice cream. Started on a whim by local parents in late-August, the club has been such a hit, attracting anywhere from six to 20 kids each run, that some occasionally call for a third afternoon per week, even a 7 a.m. before-school meet-up (in which case they serve doughnuts). But treats are not the ultimate draw.
“I like the experience of being with my peers and actually doing something, all at the same time,” 11-year-old Henry Gersick said. “Instead of just sitting there.”
IT’S COOL ON TIKTOK
Jump! Jump! Jump!
One of the most accessible, inexpensive, socially distanced sports is something you may not even realize is a sport. Since the pandemic began, jump-roping has become “a TikTok craze,” according to Nick Woodard, a 14-time world-champion jump-roper and founder of Learnin’ the Ropes, a program designed to teach kids and adults the joy of jumping. “All you need is time, some space and a $5 jump rope, and you’re good to go,” Mr. Woodard said.
Based in Bowling Green, Ky., Mr. Woodard and his wife, Kaylee (a six-time world champion in her own right), have been leading virtual workshops for children as young as 6, from Malaysia to Germany. A 30-minute class costs $35 for one child, and includes spiderwalk warmups, instruction, and challenges. (How many jumps can you do in 30 seconds?)
“They have so much fun, they don’t even realize they’re getting exercise,” Ms. Woodard said. But a selling point right now is that jumping rope — unlike team sports — is something you can do together, apart.
A DOSE OF ADVENTURE
Take a hike with family and a friend.
“My kids are reluctant to do anything outdoors, unless we’re meeting up with another family, then they’re totally into it!” said Ginny Yurich, founder of 1000 Hours Outside, a family-run Instagram account with over 112,000 followers that challenges youth to spend an average of 2.7 hours a day outdoors per year. “Make sure you have food, a first-aid kit and friends — friends are the linchpin,” she said. (Masks, too.)
Ms. Yurich, a Michigan mother of five, drags her children on day hikes, yes, but also on evening lantern-lit hikes, rainy hikes and snowy walks. She was inspired, she said, by the 2017 book “There’s No Such Thing as Bad Weather,” by the Swedish-American author-blogger Linda McGurk, who espouses the Scandinavian concept of friluftsliv, or “open-air living.” For Ms. Yurich and Ms. McGurk, experiencing the outdoors is paramount to children’s development and well-being.
If you prefer not to pod during the pandemic, follow the lead of Dave Rubenstein, a father of two in Lawrence, Kan., by enacting “Forced Family Fun Time.”
“We call it F.F.F.T.,” Mr. Rubenstein said of the weekly activity. “It usually involves a hike around the lake in town, but it could be any outdoor activity teenagers typically hate. And if they complain, the punishment is more F.F.F.T.”
EXPERIENCING COMMUNITY — AND FREEDOM
Form a friendly neighborhood bike gang.
“Kids are biking like never before,” said Jon Solomon, a spokeman for the Aspen Institute’s Sports & Society Program, the nonprofit’s initiative to help build healthy communities through sports. Over the year, leisure bike sales grew 203 percent year over year, he said.
In one neighborhood in Denver, one neighbor has opened up a half-mile dirt bike track on his property to all the kids on the block. Wyatt Isgrig, 14, and his friends tackle it often by mountain bike, scooter or motorized dirt bike.
Ali Freedman, a mother of two in Boston’s Roslindale neighborhood, has loved watching children of all ages on her street playing together. “Every day around 3:30 p.m., kids we never knew before Covid come biking by our house asking ‘Can you play?’” Ms. Freedman said.
The young crew all wear masks — “Moms have a text thread going to check on enforcement when masks become chin diapers,” said Ms. Freedman, who peers out the window every so often — and best of all: “They stay out until dinner.”
CREATING SOMETHING NEW, TOGETHER
Invent your own game.
In a September survey conducted by the Aspen Institute and Utah State University in response to the coronavirus pandemic, 71 percent of parents said “individual games” (like shooting baskets solo) were the form of sport with the highest comfort level for their kids, followed by classic neighborhood pickup games like basketball or tennis.
But inventing your own game has its own rewards. One otherwise boring day in suburban Maryland, Mr. Solomon and his son, 11, came up with something they call hock-ball. It involves a hockey stick and a tennis ball and an empty sidewalk or street.
Mr. Solomon attempted to explain. “You roll the tennis ball like a kickball — it could be smooth, or slow, or bouncy — and the person with the stick tries to hit it past the pitcher, then runs back and forth to home plate.” There are points and innings and it’s apparently fun for all ages. “Only problem is, the ball inevitably rolls under a parked car, ” Mr. Solomon said.
A (COLD) SURGE OF HOMETOWN PRIDE
Bundle up for snow yoga.
In Milwaukee, where daily high temperatures in winter often hover below freezing, Kendra Cheng said her seventh grader will be doing much of the same as she did over the summer, only wearing more clothes: kickball, trampoline tag or even “water-skiing on land” — which calls for two kids, a broken hammer, a rope, and Rollerblades (or cross-country skis).
But the hot new thing in Ms. Cheng’s neighborhood, she said, will be snow yoga, led by a certified yogi friend. Once it starts snowing, 10 to 20 people will gather twice a week at a safe distance in a private backyard with a backdrop of Lake Michigan. “In Wisconsin, we love the cold,” Ms. Cheng said. “We love snowpants. We love barely being able to move because we have five layers on. And we’re all excited to do downward dog outdoors to create our sweat.”
If all else fails, bribe them.
Pay your kid — a dollar, a quarter, a penny — per minute to walk the pandemic puppy you just got.
“It gets them out of the house and out of my hair — and they earn some money,” said Murray Isgrig, parent of Wyatt in Denver. “Even though they don’t have anywhere to spend it.”