Keeping children safe

Dr. Jared Bullard, paediatrician and infectious disease expert, will share advice on discussing COVID-19 with children, reducing their anxiety, and tips on helping them safe and healthy.

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About Dr. Jared Bullard

Dr. Jared Bullard is a paediatric infectious disease specialist at the University of Manitoba who works primarily out of the Children's Hospital in Winnipeg. Dr. Bullard is also an Associate Medical Director at the Cadham Provincial Lab in Winnipeg, Manitoba.

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COVID-19 wellness resources Physicians and their families

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Keeping children safe

Dr. Jillian Horton:

Hello, and welcome to the COVID-19 Physician Learning Series brought to you by Joule and the Canadian Medical Association. I'm Dr. Jillian Horton, a general internist, medical educator, writer, and podcaster. And I'm your host for this series.

Many physicians will concur that family life is a balancing act at baseline. COVID-19 has thrown our usual routines into chaos. And not only are we working to care for patients under new conditions and trying to ensure we don't bring home a highly infectious disease, if we're parents, we're also supporting children through a physically and psychologically difficult time.

Today I'm joined by Dr. Jared Bullard, a specialist in pediatric infectious diseases at the University of Manitoba. Dr. Bullard is also married to a hospital-based physician and is the father of two young children. Jared, thank you so much for making the time to join me today.

Dr. Jared Bullard:

No problem at all, my pleasure.

Dr. Jillian Horton:

Jared, children of all ages, even very young children are now aware of COVID-19. They're not in school or daycare. And they can't play with their friends. And for children of physicians, the older they are, the more they realize that their parents are in positions of special risk. Can you talk, first as a pediatrician and then, perhaps as a parent, about principles you would advise us to use when talking to kids about COVID-19?

Dr. Jared Bullard:

No, absolutely. I think this is a common concern that I've had as an infectious disease physician. When I think about COVID-19 and that risk of bringing something home to my family, absolutely. And as a pediatrician, certainly we've received training on how to talk to children at a bunch of different developmental ages, right, because what you say to a toddler or a preschool child is very different than what you would approach a teen with, right?

And I would say at this point, I have seen some really good resources coming out of the Canadian Pediatric Society that give some guidance on how to talk to children specifically about COVID-19, but also give some guidance as to how to talk to them about disasters and how to kind of approach that because this is certainly completely unique in our lifetime.

And what they're thinking about it I can imagine is challenging. And certainly there's many, many different factors that have to come into play. When I think about it, you really have to go with the appropriate developmental age.

So I think that when you're talking about infants, they just really are a bit confused with the situation in general. But I don't think they're absorbing it the same way. I think that they realize that their parents or one of their parents is home a lot more than they would expect. And they're probably relishing the attention that they're getting.

And I think that that does transfer a little bit when we get into our older children and the preschool age group as well. They have a little bit more understanding. And I think that they are more likely to pick up on the stress that their parents might have, whether that's a physician parent or any parent that you can imagine. So you really have to get a sense of how and where on the spectrum of understanding your child fits because one recipe is not going to work for all of them.

And then, again, once you get into more of the school age children, they have a lot more understanding. And I think they're a lot more connected to the world in general. They're on-- they're are at the social media platforms or watching the news. They're hearing a lot of different conversations.

And then teenagers, that's even the next level because they are intimately connected with all of their friends and their peer groups. And so they truly do appreciate that something is going on in an epic proportion. And then they also are having to deal with not having that in-person social connection with their friends to really hash things out. And they're also going through that emotional turmoil that's pretty typical in the adolescent years.

So I said, it's really going to be a combination of one, know your own child and know how to approach them and second, to really appreciate that the question that they have, too, might be different than what you think they would want to know.

Dr. Jillian Horton:

I hear colleagues telling me that they can't sleep because of anxiety. So putting your clinical hat on and thinking again about children, how would you advise parents to support kids who are struggling with anxiety or manifesting appropriate reactive symptoms like a change in behavior?

Dr. Jared Bullard:

So I think it's finding out what exactly is causing them the anxiety. What is the root cause? And so I'd say that when it comes to physician parents, right, we're not always aware of what we're talking about in front of them at the dinner table because talking about all sorts of nasty things that are entertaining for us might translate into their head very differently, I think, than you would find parents-- or children of doctor-- or children of nonmedical parents, right?

So you have to be aware that their fears are a little bit different. I mean, they have the exact same things that they're dealing with in terms of all the news and all the conversations going on with their friends. But in addition, they have this legitimate concern, I believe, that their parents are going to work every day. And they could be exposed to this. And I think that's a relatively fear.

And certainly, like you said, I can appreciate that there are the physicians amongst us who have had trouble sleeping. And I was one of them, for sure, for the first two weeks, thinking about everything that had to be done and trying to shut off my mind.

And so it's very important to kind of make sure you get to that root cause of what is causing their anxiety because it could be that they're really worried that you're going to go into the hospital or your clinic. And you're going to come back with this disease.

And they're not necessarily thinking about their own safety, though they may be. They're more concerned that what happens if you get sick and how are you going to make sure that we're able to take care of you because kids often do think about how can they take care of their parents.

And then they're also considering because they only hear the bad news on this high case fatality rate that, could you die from this? And I think that it's important to have a real and honest conversation with your child regardless of their age and trying to just make sure that you address those things.

I mean, I can give examples of what my wife and I have done. OK, I mean, it's sort of a little bit different. My son for his grade for science project did a presentation on SARS coronavirus 2. He had a good resource, I guess, available to him. So certainly I think that there's a lot of background knowledge that he already had. And so he certainly had a fair amount of anxiety knowing that.

But he also did appreciate that we were telling him, you know what? When we go to work, we are going to do everything we can to stay as safe as possible. We are going to make sure that we wash our hands carefully. We're going to make sure that when we're interacting with the patient, we're doing all of the things that we should, so putting on gloves, making sure we have gowns and goggles and a surgical mask, and those things. We said we're going to do that every day.

And then my wife and I also talked about-- and made sure that we practiced-- and made sure they knew that we were practicing to remain as safe as possible. It's not unusual for some infectious disease to come into anybody's household. And we're no different. And it's something that we practice anyway, like usually when we have a norovirus infection in my house, I'm usually the last man standing because I'm probably the most careful.

But it's important because it's what I do day in and day out. And I can appreciate that when you have a two physician family. It's not necessarily the same. So my wife and I actually went over like doffing and donning of PPE, practice that over and over until it's routine. And you don't even have to think about it.

And then if you realized that you broke what you should be doing with PPE, stopping and performing hand hygiene are going to correct your step. So we talked about that. We went out of our way to order in special clothes. And we both have a set of surgical scrubs. And our kids know that. And we have as well a lab coat. We have our own goggles. And we've said that we're going to make sure we stay as safe as possible.

We've also said that, you know what? When we come home, we take all of the clothes off. We wash them, throw them in the dryer. And we make sure that we also take those precautions to have a shower and clean up as best as we can. And even when we go out and it's not related to health care, we'll come home and immediately wash our hands. And they see that, right? And I think that reassures them a fair amount, too.

In addition, the other thing that we've done for their anxiety is we've been a lot more cognizant of what we talked about at the dinner table and when we're doing just casual conversation. We make sure that we leave work at work as much as we can. And when we come home, we're as engaged as we possibly can with our kids and say, what was important in your day? What was good? What could we do different tomorrow?

And kind of get them to be invested, too, in kind of the home process and normalize everything for them. So I said it's not straightforward. I think that this is something that we're going to be learning a lot more as we go forward, too, right?

Dr. Jillian Horton:

So, Jared, for anyone who wants to reinforce their skills of donning and doffing at home, recognizing that in different jurisdictions, depending on disease activity at that moment, the protocols may be different. Are there still overarching resources that you could direct people towards if they want to reinforce their skills of donning and doffing at home? And also, what does that look like for you? How have you conceptually broken that down to really master that and feel comfortable doing?

Dr. Jared Bullard:

Sure, I would say that it is important to look at the different jurisdictions in terms of what they're advising. And more often than not, you're going to find they draw on the same sort of resources. So here in Manitoba, I mentioned there is a shared health COVID website that actually goes over that. But like you said, it's really something that you have to conceptualize as well and something that you make a routine practice.

So what my wife and I sat down and talked about in practice is really like once you have all of your gear off, you have to remember that the danger zone is your face, right? Any time that you are going to touch your face, you, well, one, should avoid it as much as you possibly can, which is easier said than done.

I think that when you have goggles and a hairnet, which doesn't apply to me, or masks, et cetera, that you want to avoid manipulating those as much as possible because any time you have contamination on your hands, that's going to be an issue, right?

So going through your workday, making sure that you minimize the contact of your face and head is going to be really important. When you are choosing to take the PPE off, one of the first steps is going to be making sure that you take your gloves off and proceed to remove your gown carefully.

What I often suggest is that you kind of undo it from the back, making sure not to get anywhere near your face, bringing your hands around to the back on time and then hunching forward, so that this kind of falls off of you. And that way, you're trying to minimize any additional contact that might occur. Once that's happening, you've got yourself free from the gown.

Performing hand hygiene is going to be important before you can leave the room typically of a patient that you're with. I often do a second step because I don't believe anybody is doing all the things they need to do.

So I will wash my hands or perform a hand hygiene again. Before, I'm very cognizant of how I take off my goggles, making sure I don't reach for the center of my face, going on the side, leaning my head forward and taking the goggles off very carefully.

And likewise with the mask, the same thing, making sure I'm not grabbing from the center, leaning forward and taking off of the elastic band, so that everything is kind of falling forward. If you lift your head or keep it up, it's probably not quite as ideal. And then I perform hand hygiene one more time just because it's an important thing to do.

In addition, what we talked about was our phones. Our phones are filthy. Like if you're-- the best thing to do is try to not even touch your phone during the day if that's possible and at the end of each day, wiping them down. You can find any number of different products in most hospitals and clinics where you would wipe down your stethoscope on a routine basis. That will work just as well for your phone, too.

So I'd say that those are kind of the key steps. And, again, it's practice. It's the more you do it and the more consistently you do it, the better your family is going to be.

Dr. Jillian Horton:

Jared, just to switch gears for a moment, for anyone who doesn't have family providing child care, which, of course, isn't perfect either unless it is in a truly closed loop, what can you say about the fear that many people have of putting their children in emergency daycare or child care with the children of other healthcare workers? Help us walk through the level of risk that you perceive there and how we should be asking those care providers to mitigate it.

Dr. Jared Bullard:

So that's a very good question. I think that my wife and I have had the luxury of having a long standing nanny dedicated to us. And we trust her that she really is just going to be going home and then coming to stay at our house and provide child care. But certainly not everybody has that. And I completely appreciate that.

I mean, you have to consider to some degree that we, as a society, have to be responsible for each other, right? And I think that most people are getting the message in general when they are social distancing. And they're trying to avoid going out of the home as much as possible. I think that applies to daycare workers as well. I think that you have to find someone that you trust. And certainly there are a variety of options.

Like you mentioned, there are daycare providers who are provided specifically for healthcare workers. In addition, I know there's a number of medical students throughout the country who have been looking for all sorts of excuses to do really good work. And they have included child care. And so I think that, again, you have these people who are very dedicated to helping physicians do the work they need to do.

It's also important to go over the exact same thing with those child care providers. So our nanny-- we have gone over that it's important that when you go out, when you come back, first thing, you wash your hands. And that she has a bottle of hand sanitizer that she also uses before she gets into the car.

So it's going to be kind of those common sense approaches and just making sure that we look out for each other because I think that's going to be important. But I appreciate fully. And it's hard to trust people with your children. That's your most important investment. But finding that person you can trust is essential.

Dr. Jillian Horton:

Jared, another question for you. Many people are weighing the pros and cons of self-isolating in the absence of a clear indication to do so, so for example, exposure to a known case of COVID-19 in the hospital. I know of many physicians, and I'm sure you do as well, who just by nature of providing face-to-face care with patients have made a decision to self-isolate within their homes.

Can you share your thoughts on that? How necessary is it? And what should that look like if people are going to undertake that kind of isolation in the absence of an exposure or illness?

Dr. Jared Bullard:

I think everybody has an abundance of caution, right? They do not want their family to get this. And I think they're very concerned about it. In the absence of knowing that you were exposed to someone with COVID-19 or any infectious disease, to self-isolate doesn't make a lot of sense necessarily, right?

I think that what would end up happening especially if you have children is they would appreciate that. And I think they need to have their parents at home and freely available. That being said, it is prudent. And if you are exposed to someone who is known to have COVID-19 and you think that there is some sort of breach or concern, yeah, maybe it's important to consider that isolation, but day-to-day practice where it's very low risk, probably not required.

I mean, again, it's something that my wife and I have talked about. That in the event we are exposed to someone with COVID-19 or we developed symptoms, I think we've come up with a plan as to one of us basically staying in the bedroom the entire time and having the other provide any support that we can, at the same time, making sure that we don't ignore our children using FaceTime within the same house, which is somewhat ridiculous.

But still it provides that contact time that I think they really need while minimizing the risk to them. But by and large, I'd say the vast majority of clinicians probably are not going to have that high risk COVID-19 exposure that you would expect in an ICU, emergency or maybe OR setting.

Dr. Jillian Horton:

Well, Jared, my last question for you today.

Dr. Jared Bullard:

Mm-hmm.

Dr. Jillian Horton:

Kids are naturally pretty resilient. And we talked a lot about the apex of the COVID curve. But what about the coping curve, parents whose kids are struggling right now in the absence of underlying behavioral or medical challenges? What's your prediction for what the next phase of this looks like for families? When do kids begin to settle into this?

Dr. Jared Bullard:

I think one of the things that drew me to pediatrics was exactly that children are so incredibly adaptable. And they're very plastic. And they become used to changes so much faster than you or I do. And it's admirable. I wish I were more like them.

I think that what it's going to come down to is that schedule and routine. Children really do need that in their life. And that doesn't matter what age they are, right? As long as they kind of have that go to routine and that they do it day in and day out, I think that they'll adapt to this.

And they'll kind of appreciate that, you know what? This is temporary. But, at least, I know this is going to be my day for the most part. And they can kind of look forward to that. It's important that we make sure that we reinforce that sort of scheduling with them and say, it's important to do your schoolwork. You're going to have to get up at the same time. You're going to have to make time to have fun, right, not too much fun, not too much screen time, but enough.

And then make sure, too, that they've got that family time at the end of the day because it's going to be good for them. And most importantly, it's going to be good for you as a practicing physician. You're going to get the bond and get some perspective. And then also have them involved in making that routine, right? The more invested they are, the more likely they are to follow it and more in control they're going to ultimately feel with the whole process.

Dr. Jillian Horton:

Well. I want to end by thanking you, Jared, for helping walk us through these conversations and the practical issues that many of us are having with the children in our lives.

Dr. Jared Bullard:

Oh, you're very welcome. My pleasure.

Dr. Jillian Horton:

I'm Dr. Jillian Horton. Thank you for joining us for this COVID-19 webinar series powered by Joule. Take care of yourselves. Thank you for all that you do. And I'll see you again soon.

Keeping children safe

About Dr. Jared Bullard

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Keeping children safe

About Dr. Jared Bullard

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Keeping children safe