Is it more infectious? Is it spreading in schools? This is what we know about the Delta variant and kids


Margie Danchin, Murdoch Children’s Research Institute; Archana Koirala, University of Sydney; Fiona Russell, The University of Melbourne, and Philip Britton, University of SydneyThe Delta variant is surging across the globe, and the World Health Organization warns it will rapidly become the world’s dominant strain of COVID-19.

Delta is more infectious than the Alpha variant, and preliminary data suggest children and adolescents are at greater risk of becoming infected with this variant, and transmitting it.

Is this true? And with Sydney school students set to begin term 3 remotely, what’s the best way to manage school outbreaks?

Let’s take a look at the evidence.

Delta in children and young people

In the United Kingdom, where the Delta variant has been predominating since May, infections are rising fastest among 17-29-year-olds, who are mostly unvaccinated. Infections are also increasing in younger age groups, but at a lower rate.

Overall, increased transmission among children and young people may partly be due to Delta. But also, in countries like the UK, these age groups are most susceptible to infection because older groups have been largely vaccinated.

While we don’t yet have data on the severity of illness in children associated with the Delta variant specifically, we know with COVID generally, kids are much less likely to become very unwell.

Research from the Murdoch Children’s Research Institute found children clear the virus more quickly than adults, which might go some way to explaining this.

Read more:
Why is Delta such a worry? It’s more infectious, probably causes more severe disease, and challenges our vaccines

How is Delta affecting transmission in schools?

In 2020, face-to-face learning wasn’t a significant contributor to community transmission in Victoria. Similarly, during the first wave in New South Wales, transmission rates were low in education settings. Concerns children may bring infections home to vulnerable family members weren’t supported by the evidence.

However, the situation is looking somewhat different now with the emergence of new variants and varying levels of vaccine coverage in different countries.

There does appear to be more transmission in schools. In the week ending June 27 there were outbreaks in 11 nursery schools, 78 primary schools, 112 secondary schools and 18 special needs schools in the UK.

While outbreaks in schools are increasing, the vast majority of transmission still occurs in households.

In 2021 in Australia, there have been very few school infections with Delta. In Western Australia, where schools have remained open, an infectious case attended three schools but this didn’t result in any school outbreaks.

During the current NSW outbreak, there have been several schools and early childhood centres with COVID-19 cases, and we have seen one outbreak at a primary school.

Although schools in Australia have largely been spared, transmission rates have been higher than we’ve seen with other variants. Almost all household contacts of cases are becoming infected.

In the recent Melbourne primary school outbreak, our research yet to be published showed that 100% of the household contacts of children who were infected at school went on to test positive.

Fortunately, testing, tracing and isolating were very effective in containing the outbreak, even with the Delta variant.

But these recent school outbreaks highlight why it’s so important adults of all ages, especially parents and teachers, get vaccinated.

Should we vaccinate children?

There are benefits of vaccinating children, particularly teenagers. These include direct protection against the disease, but also reducing transmission to vulnerable adults and enabling continued school attendance.

The risks and benefits need to be carefully calculated in a low transmission setting like Australia. In terms of risks, emerging data suggest the mRNA vaccines Pfizer and Moderna are associated with a very small risk of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the heart lining) in young adolescents and adults, particularly males. Although most cases are mild, it can be a serious condition and is being closely monitored.

Read more:
Let’s hold off vaccinating children and teens against COVID-19. Prioritising adults is our best shot for now

The United States, Canada, and a few countries in Europe are already vaccinating children over 12. Australia’s drug regulator is currently weighing this up.

For now, we should continue to vaccinate adults in priority groups. We have a long way to go to get the most vulnerable vaccinated first, and are still constrained by vaccine supply.

As we grapple with the benefits and risks for teenagers, it’s also worth asking them if they want to be vaccinated and why. Many have been adversely impacted by the pandemic and are desperate to move on with their lives.

What should parents look out for?

With the Delta variant, a headache, sore throat and runny nose are now the most commonly reported symptoms among unvaccinated people.

These symptoms have eclipsed fever and cough, the most common symptoms earlier in the pandemic.

So it’s imperative parents still take their children to be tested if they become unwell, even if the symptoms appear more like the common cold.

A girl with her sleeve rolled up.
Australia hasn’t yet approved COVID vaccines for use in children or adolescents.

Where to from here?

When adults are more widely vaccinated and our borders open, school outbreaks will likely continue to happen. Even in places like Israel, where a high proportion of the population has received two doses, school outbreaks have recently occurred.

Australia needs a clear plan that outlines how best to keep schools open, while preventing transmission and keeping children and teachers safe during any outbreaks.

The Royal Australasian College of Physicians last week called for a national plan to this end.

This should include school staff being prioritised for vaccination.

And until we have high vaccination coverage, there’s evidence that well implemented school-based mitigation measures work to prevent transmission in education settings.

This could include a range of measures, adjusted according to risk, such as keeping non-essential adults off school grounds, mask use in high school students (and possibly primary students too), staggering timetables, reducing class sizes and improving classroom ventilation.

Read more:
The symptoms of the Delta variant appear to differ from traditional COVID symptoms. Here’s what to look out for

By monitoring the effects of new variants on children’s health, coupled with detailed risk-benefit analyses, we will determine the best time for children and adolescents to be vaccinated.

In the meantime, parents and all eligible adults can do their bit to protect children and reduce the risk of school outbreaks by getting vaccinated themselves.The Conversation

Margie Danchin, Paediatrician at the Royal Childrens Hospital and Associate Professor and Clinician Scientist, University of Melbourne and MCRI, Murdoch Children’s Research Institute; Archana Koirala, Paediatrician and Infectious Diseases Specialist, University of Sydney; Fiona Russell, Senior Principal Research Fellow; paediatrician; infectious diseases epidemiologist; vaccinologist, The University of Melbourne, and Philip Britton, Senior lecturer, Child and Adolescent Health, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Let’s hold off vaccinating children and teens against COVID-19. Prioritising adults is our best shot for now


Fiona Russell, The University of Melbourne; Peter McIntyre, and Shidan Tosif, Murdoch Children’s Research InstituteEighteen months into the COVID-19 pandemic, some countries that have achieved high vaccination coverage in adults have started vaccinating adolescents aged 12-15.

Drivers to vaccinate children and adolescents include building confidence to open schools, preventing severe disease, and reducing transmission in all ages to achieve “herd immunity”.

But in most countries, including Australia, vaccination of the highest-risk groups is not nearly complete. So does it make sense to vaccinate children and adolescents at this stage?

Read more:
What’s the Delta COVID variant found in Melbourne? Is it more infectious and does it spread more in kids? A virologist explains

COVID-19 in children

COVID-19 is less severe in children and adolescents; most have mild infections or are asymptomatic.

Studies have found multisystem inflammatory syndrome and long COVID to be uncommon after COVID-19 infection, especially in young children.

Newborns and children with other medical conditions are at higher risk of severe disease. But with the level of medical care in Australia, even the more vulnerable children have a very low risk of dying.

Given the increased risk in children with underlying health issues, there may be benefit to vaccinating these children over 12, and a strong case for 16- to 18-year-olds.

But as increasing age is the biggest risk factor for severe disease, vaccinating older people should remain the priority.

Read more:
Children, teens and COVID vaccines: where is the evidence at, and when will kids in Australia be eligible?

Are COVID vaccines safe for kids?

Common side-effects seen in a clinical trial of the Pfizer vaccine in 12- to 15-year-olds included injection site pain (up to 86% of participants), fatigue (up to 66%) and headache (up to 65%). These were mild to moderate in severity and short-lived.

However, two more serious, related conditions — myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the heart lining) — have been identified in safety surveillance in the United States, Canada and Israel following mRNA vaccines (Pfizer and Moderna).

The highest rates are in men under 25 after the second dose. Based on US data up to June 11, for boys aged 12-17, the rate was 66.7 cases per million second doses.

This is more than double the estimated risk of thrombosis with thrombocytopenia syndrome (TTS) following the AstraZeneca vaccine, although myocarditis and pericarditis are less severe.

Most of the 323 cases recorded in the US data went to hospital; some needed intensive care, but the vast majority fully recovered.

A young man receives a vaccine.
A heart condition has been seen in some people, particularly young men, following vaccination with mRNA vaccines.

What are other countries doing?

These heart conditions may be triggered by autoimmune responses following mRNA vaccines in susceptible young people. Given immune responses are higher in adolescents than adults after vaccination, experts are considering altering the vaccine dosage or schedule in this age group.

Israel is now weighing up a single dose for adolescents, as one dose produces a good immune response, and almost all cases of myocarditis or pericarditis believed to be associated with the vaccine occurred after the second dose.

In the US, the risk of COVID-19 was judged to render the benefits of the existing adolescent vaccination program substantially greater than the risks from vaccination.

In the United Kingdom, infections with the Delta variant have increased, particularly in older adolescents in hotspots. However, the UK has decided not to vaccinate children under 18 just yet, as there would be little direct benefit in this age group.

Vaccine safety must be paramount, especially where the risk of COVID-19 is low, such as in Australia. Although Australia hasn’t yet approved a COVID-19 vaccine for this younger age group, any risk/benefit calculation would be based on our local context, as we’ve seen with the AstraZeneca vaccine.

Read more:
Yes, we’ve seen schools close. But the evidence still shows kids are unlikely to catch or spread coronavirus

What about outbreaks in schools?

The most profound effect on children and adolescents during the pandemic has been the impact of school closures on learning, socialisation and emotional development, especially in children with special needs or mental health issues.

The US and Canada are vaccinating adolescents partly to build confidence for returning to school.

School outbreaks do occur and are proportionate to the degree of community transmission. In Australia’s current Delta outbreak, we’ve seen very few school-related infections.

But it’s important to understand adult staff are responsible for most transmission in schools. And most transmission — linked to schools or generally — occurs in households. We’ve seen this even in the UK with the Delta variant.

A Scottish study with data up to February found the highest risk factor of infection in people at risk of severe COVID-19 was the number of adults in their household. Living with children was not a risk factor.

Vaccinating adults, parents and school staff will be key to preventing infections in children and schools.

Read more:
We need to prioritise teachers and staff for COVID vaccination — and stop closing schools with every lockdown

Do we need to vaccinate children and teens to control COVID-19?

Vaccinating large numbers of adults will allow us to prevent deaths and serious illness, and therefore reduce the burden on health systems. That’s the primary goal.

But many countries are also aiming to achieve “herd immunity” through vaccination. High coverage in adults will go a long way to achieving this, but the incremental benefit from vaccinating children 15 and under is still unclear.

In Serrana, a small town in Brazil, where 95% of the adult population (about 75% of the total population) were given two doses of Sinovac vaccine, deaths were reduced by 95%, hospitalisations by 86% and symptomatic infections by 80%. Infections in unvaccinated children and adolescents also went down.

In some countries with adult vaccination rates above 50%, such as Israel, infections have declined overall, suggesting adults play a key role in transmission and preventing infections in children.

In fact, one study in Israel found vaccinating adults did prevent infections in unvaccinated children.

A young girl gets a vaccine.
Vaccinating adults can indirectly protect children.

Let’s keep the focus on adults for now

At this stage, the focus of a vaccination program should remain on attaining high coverage in adults, especially the elderly and those with other medical conditions. We should aim for above 90% coverage in these groups to maximise individual protection and prevent transmission to younger age groups.

Another reason to hold off with adolescents is the fact the global COVID-19 vaccine rollout has been slow and highly inequitable.

The World Health Organization has expressed major concern over higher-income countries beginning to vaccinate children while many lower- and middle-income countries have insufficient supply to vaccinate high-priority groups.

Recommendations for vaccination will evolve. But the top priority right now must be maximising vaccination in adults — both in countries that may have the capacity to vaccinate children, and around the world.The Conversation

Fiona Russell, Senior Principal Research Fellow; paediatrician; infectious diseases epidemiologist; vaccinologist, The University of Melbourne; Peter McIntyre, Professor, Department of Women’s and Children’s Health (Dunedin), and Shidan Tosif, Paediatrician/Clinician Scientist, Murdoch Children’s Research Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

My child has been diagnosed with ADHD. How do I make a decision about medication and what are the side effects?


Alison Poulton, University of SydneyIf your child has been diagnosed with attention deficit hyperactivity disorder (ADHD), you might be wondering: what now? And how do I know if medication is warranted?

The answer will depend on circumstances and will change over time. It’s quite OK to leave medication as a last resort — but it can be a very useful last resort.

Here are some questions I typically work through with a parent and child negotiating this issue.

Read more:
ADHD affects girls too, and it can present differently to the way it does in boys. Here’s what to look out for

Five key questions for parents and children with ADHD

1. Is this child underachieving academically in relation to their ability?

Was the child bright as a preschooler but struggled at school for reasons unclear (not, for example, due to vision or hearing problems)? Did they cope OK early in school but didn’t achieve at the level expected when schoolwork got harder?

2. Is this child’s behaviour creating unreasonable levels of stress or disruption at school?

For a child with ADHD to complete a task, it must be sufficiently interesting, short or easy. If a child can’t concentrate in class, they get bored. They might talk in class, create distractions or disrupt class. Obviously, careful judgement is needed to differentiate typical child behaviour from problematic behaviour.

3. Is this child’s behaviour creating unreasonable levels of stress or disruption at home?

At home, is the child able to draw, construct with LEGO, do puzzles or play blocks for longish periods of time? Or do they find the sustained effort needed unachievable? Do they then annoy a sibling to make life more interesting, or constantly ask adults to play with them?

If a child is working on homework for half an hour, how much time is spent concentrating? Are they focused for only ten minutes and the remainder is spent guiding them back on track?

Is the parent tearing their hair out with countless reminders and finding every time they check, the child is distracted again?

Doctors, parents, teachers and the child must work together and regularly ask whether the current approach is actually providing benefit.

4. Is there a significant effect on peer relationships?

Children with ADHD don’t always have the patience to wait their turn or concentrate on what peers say. They may come across as bossy; they find it easier to focus on what’s happening in their own mind but more challenging to listen and process what others say. Their peers may eventually find someone else to play with.

5. Is there an impact on self esteem?

Is this a smart child who doesn’t think they’re smart because they struggle to concentrate long enough to get work done? Do they speak negatively about themselves? It’s important to take self esteem seriously.

There are also diagnostic criteria that need to be checked.

Support strategies at home and in class

What other supports could help? Is the child sitting at the front of class? Is the teacher giving written instructions? Do they sit next to a good role model?

Has the parent done parenting classes? Have they tried home strategies rewarding good behaviour, or giving appropriate consequences for problematic behaviour?

Having a chart for the morning routine can be helpful. Many such strategies work nicely on children without ADHD. But children with ADHD often find the effort needed to earn a sticker isn’t worth it and may try to negotiate ever greater rewards.

If you’ve got to the end of that road and the child is still having problems, you might consider medication.

The first thing to know is these stimulants wear off reasonably quickly — after about four hours.

Read more:
ADHD: claims we’re diagnosing immature behaviour make it worse for those affected

What does medication do?

With ADHD, it’s like your brain is running on a half-charged battery. Your concentration keeps flicking off or winding down. Medication makes it more like your brain is running with a fully charged battery.

The active ingredient in medication is usually a stimulant such as dexamphetamine or methylphenidate. You might know it by the brand name Ritalin.

These stimulants wear off quickly — after about four hours. That may help the child get through the school morning; they may need another dose at lunch and perhaps a third dose if they have after-school activities. There are also capsules that release medication more slowly.

The medication is always wearing off and you are back to square one. On the one hand, that’s a nuisance. On the other, it means you can try medication, then stop and you’ll still have the same child you had at the beginning.

You start low and increase gradually until you find a dose that lasts about four hours. The teacher can help with feedback. The dosage may need to be adjusted as the child grows. These decisions are all made with the support of the clinician.

Generally, you get improvement up to a point where no further benefit is seen. If the dosage is too high, a child may seem aggressive, depressed or “zombie-like”. Nobody wants a dosage that is not leading to a better outcome.

If you decide to use medication, the dosage may need to be adjusted as the child grows.

What about side effects?

The most significant side effect is appetite suppression, so we monitor weight and height closely. Generally, weight stabilises in the long run.

Rebound hyperactivity as the medication wears off and difficulty sleeping can occur. Sometimes this can be managed by changing the dosage or by not medicating too late in the day.

The decision to give medication is made on a daily basis. If you aren’t happy, you can omit it and see how things go.

This medication improves anyone’s concentration, not just children with ADHD, so it’s also sometimes a drug of abuse (among university students, for example). When used for treating ADHD, the risk of addiction is minimal.

But if you have concentration problems, you have more scope for improvement. A child who is concentrating most of the time cannot experience much improvement.

Reviewing progress

I always ask the child: does the medication work? How do you know? I might find out from a teenager that their concentration has improved from 20% to 80% or 90% of classtime. A younger child who prefers to feel in control of their behaviour may actually remind the parent when the next dose is due.

Often I hear from parents the child is now keen to get homework done, has more friends and feels happier and more confident.

All parents want their child to feel they’re functioning and fulfilling their potential. Most will achieve this without medication. That’s plan A. Plan B is that they are fulfilling their potential and living a great life, helped by medication.

Doesn’t every child, every person, with ADHD deserve a plan B?

Read more:
ADHD prescriptions are going up, but that doesn’t mean we’re over-medicating

The Conversation

Alison Poulton, Senior Lecturer, Brain Mind Centre Nepean, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Best evidence suggests antidepressants aren’t very effective in kids and teens. What can be done instead?


Sarah Hetrick, University of Auckland; Joanne McKenzie, Monash University; Nick Meader, University of York, and Sally Merry, University of AucklandEven before COVID-19 lockdowns, school closures and strict social distancing, depression was on the rise in children and teenagers around the globe.

By the age of 19, around 25% of adolescents are estimated to have experienced a depressive episode. By the age of 30, this figure grows to 53%.

A number of studies point to an increasing use of antidepressants in young people.

So, what do we now know about how well antidepressants work in children and young people?

Our new Cochrane review, published today, found that on average, antidepressants led to only small improvements in depression symptoms compared with placebo in children and adolescents (ranging in age from six to 18 years old).

Antidepressants shouldn’t be the first port of call

Our findings highlight antidepressants are no panacea for depression in young people. The small improvements might be so small as to not be very noticeable to the individual person. What’s more, we can’t say to any one young person whether antidepressants will definitely improve their symptoms.

But it’s critical to note there are multiple and complex pathways that lead to the distress and demoralisation that are key in depression.

Read more:
What causes depression? What we know, don’t know and suspect

Different people’s responses to antidepressants are therefore quite specific, and young people may experience anything from marked improvement to deterioration.

Another important finding is that antidepressants are associated with an increased risk of suicidal thinking and self-harm.

These are not necessarily new findings, but they represent the best evidence we have so far. They remain a key consideration for GPs and other health professionals who are considering medications for children and young people.

Boxes of fluoxetine, an antidepressant medication
Our new Cochrane review found, on average, antidepressants lead to only small improvements in depression symptoms compared with placebo in kids and teens.

What is new is our findings on how different antidepressants compare with each other. Many current guidelines recommend fluoxetine as the only first-line medication that should be tried. This is commonly sold under the brand name Prozac.

Fluoxetine is what’s called a “selective serotonin reuptake inhibitor” (SSRI). Serotonin is a neurotransmitter in the brain linked to positive emotions. After it’s used by nerve cells, serotonin is reabsorbed, which is known as “reuptake”. These types of antidepressants work by blocking the reuptake of serotonin, therefore increasing its availability to pass messages between nerve cells.

Our review shows three other antidepressants, including sertraline, escitalopram, and duloxetine, had similar effects to fluoxetine. Though, there’s the caveat that all of these led to only small reductions in depression on average.

However, this finding may extend treatment options for young people with depression. For example, one of these antidepressants may suit one person better than another in terms of side-effects experienced, and the time it takes to work or to wash out of the system.

What other options are there?

Against a backdrop of a global pandemic, there’s a risk we may start to consider depression as the “norm”, passing it over as a given or as insignificant.

But as those with depression, and their parents, families and friends know, depression is anything but. It impacts every facet of life and is often accompanied by a fear it may never improve.

Read more:
Youth anxiety and depression are at record levels. Mental health hubs could be the answer

Depression varies substantially between people with multiple factors at play, so it’s important a range of support and treatments are available for people.

Antidepressants have been, and will remain, only one of many options for young people with depression. Guidelines continue to highlight that antidepressants should not be the first port of call.

When used, they should be used in combination with evidence-based talking therapy, the most common being cognitive behavioural therapy (CBT), and there must be a commitment to ensure close monitoring of their impact.

Kids exercising
Antidepressants should only be considered alongside talk therapy, as well as increased exercise, adequate sleep and good nutrition.

There’s a range of ways in which young people can and need to be supported. There’s good evidence for regular physical activity, good nutrition, and adequate sleep. Support from family, schools and the broader community is also important.

A decision to use antidepressants should be on the basis of shared decision-making. This refers to conversations where the risks and benefits of all treatment options are described to the young person, and their family, who are then meaningfully involved in making the decision.

If the decision is made to use an antidepressant, it’s critical to ensure health professionals conduct regular (weekly at first) checks on depression symptoms and adverse effects. This is particularly important in terms of monitoring the emergence of suicidal thinking and self-harm.

Treatment with an antidepressant should be in the context of talking therapy, and a holistic approach to well-being.

Ensuring access to support and treatment and conveying a sense of hope is crucial.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.The Conversation

Sarah Hetrick, Associate Professor of Youth Mental Health, University of Auckland; Joanne McKenzie, Associate Professor, Biostatistics Unit, School of Public Health and Preventive Medicine, Monash University; Nick Meader, Research Fellow, Centre for Reviews and Dissemination, University of York, and Sally Merry, Professor and Cure Kids Duke Family Chair in Child and Adolescent Mental Health, University of Auckland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

For children, it’s not just about getting enough sleep. Bed time matters, too


Yaqoot Fatima, James Cook University

Adequate sleep is key to good health, well-being and proper functioning across all life stages but is especially critical for children. Poor sleep can inhibit rapid growth and development in early childhood.

And it’s not just about sleep duration; the time one goes to bed also plays an important role in the physical, emotional, and cognitive development of children.

A consistent early bedtime is especially important for young children transitioning from biphasic sleep (where children still nap during the day) to monophasic sleep (where sleep happens at night).

Late sleepers don’t always get the recommended amount of sleep but evidence also suggests late bedtime is associated with sleep quality problems and difficulty falling asleep.

All this can add up to concentration, memory, and behaviour issues in children.

An early bedtime is good for physical health, too

One study of low income preschool-aged children found not getting enough sleep was associated with a higher risk of obesity. A review of academic literature on the question found

Poor sleep is increasingly common in children and associations between short sleep duration in early childhood and obesity are consistently found.

A woman reads to a child in bed.
Adequate sleep is key to good health.

It’s worth noting that most of the studies on this question are cross-sectional, which means they look at data from a population at one specific point in time. That has major limitations that make it hard to say poor sleep habits cause the higher obesity risk.

To know more, we need more longitudinal studies that examine change over time.

That said, emerging evidence from longitudinal studies supports the idea an early bedtime may be worth the battle. One longitudinal study found:

Preschool-aged children with early weekday bedtimes were half as likely as children with late bedtimes to be obese as adolescents. Bedtimes are a modifiable routine that may help to prevent obesity.

My own research, published last year with colleagues in the journal Acta Paediatrica, analysed four years of data from 1,250 Aboriginal and Torres Strait Islander children aged five to eight years old.

The results highlight that even after controlling sociodemographic and lifestyle factors, children who had consistently late bedtimes (after 9.30pm) were on average 1.5kg to 2.5kg heavier at follow up three years later than children who go to bed early (at around 7pm).

Nobody can yet say for sure what the exact relationship is between bedtime and obesity risk. Maybe it’s that staying up late provides more opportunities for eating junk food or drinking caffeinated drinks.

Or there could be more complex physiological factors. The body’s internal clock, which regulates sleep, also plays a crucial role in hormone secretion, glucose metabolism and energy balance.

A man and a child read a book in bed.
Try to stick to the same bedtime.

How late is late?

Sleep habits are shaped by a range of biological and cultural factors. When parents set their child’s bedtime, they’re influenced by cultural norms, lifestyle and what they know about the importance of sleep.

There are clear guidelines for sleep duration for each age group, but the time a child should go to bed isn’t always as clearly defined. For a pre-schooler, I’d recommend a consistent bedtime between 7pm and 8pm to ensure adequate sleep (recognising, of course, that work and caring responsibilities can make this really difficult for some parents).

Develop an early bedtime routine for your child and try to stick to it, even when it’s “not a school night”. Irregular bedtimes disrupt natural body rhythms and, as many parents know from direct experience, can lead to behavioural challenges in children.

Early childhood is a critical time in which the foundations of life-long habits are built. Developing healthy sleep habits can set children on the right path for better future health and well-being.The Conversation

Yaqoot Fatima, Senior Research Fellow, James Cook University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

We asked children around the world what they knew about COVID. This is what they said


Karen Ford, University of Tasmania; Andrea Middleton, University of Tasmania, and Steven Campbell, University of Tasmania

During the pandemic, children have been separated from family and friends, schools have been closed and there have been limitations on important activities, such as play.

We know a good deal about the physical effects COVID-19 has on children. But the impact on their mental and emotional well-being is less well understood – particularly from the perspective of children themselves.

Our recently published research highlights the importance of listening to children, about what they have to say and the information they want about COVID-19.

Read more:
Why do kids tend to have milder COVID? This new study gives us a clue

Here’s what we did

We took part in an international study with children from six countries – the UK, Spain, Canada, Sweden, Brazil and Australia.

We recruited children through our professional and social networks, for example sporting groups and community groups.

We asked children aged seven to 12 years about how they accessed information about COVID-19, about their understandings of the virus and why they were asked to stay at home.

Child's drawing of two coronaviruses.
This drawing from Ben, aged 7, Tasmania, shows children express what they know about the coronavirus in many ways.
Author provided

The survey was open when the highest level restrictions were in place across Tasmania, where the Australian arm of the study was based. In total, 49 children from Tasmania took part in the survey and 390 children internationally.

There were important differences across the countries when we conducted the survey, including the numbers of reported cases and deaths from COVID-19, as well as government responses and levels of restrictions.

For example, the reported deaths and cases were much higher in countries such as the UK and Brazil compared to Australia and children in Sweden continued to attend school, whereas most children in other countries were learning from home.

Read more:
Is it time for Australia to implement kids-only COVID-19 briefings?

Here’s what we found

There were many similarities across the different countries in the things important to children, what they had to say and what they wanted to know. But there were also differences across countries and between children.

More than half the children said they knew a lot or quite a bit about COVID-19. Their comments included:

It is a stupid virus.

It spreads really quickly.

People play it down and tell me it can’t kill people, but I know people are dying each day.

But they also had questions:

How and where did it start?

What does the coronavirus actually look like?

How does it make you poorly?

Some said they did not want to know any more about the virus:

It is boring.

I don’t want to know about it because it’s killing people and that makes me sad.

Children expressed different emotions about COVID-19. They said they felt “worried”, “scared”, “angry” and “confused”.

Children knew the virus was particularly dangerous for vulnerable people:

It can possibly kill old and unhealthy people.

And they missed their friends and family:

When can we go back to school?

Children obtained information about COVID-19 from different sources, mostly from parents and teachers. Children also sought information from friends, TV shows and the internet, including social media.

Children understood what the community was being asked to do and they had learnt the meanings of new words and terms. So they knew what social distancing meant and that they needed to stay 1.5m apart.

Children also knew key public health messages about washing your hands, not touching your face and needing to stay at home “to save lives”.

Read more:
‘Stupid coronavirus!’ In uncertain times, we can help children through mindfulness and play

Why does this matter?

Children have had an important role in society’s response to COVID-19. Their significant contributions to limiting the spread of the virus have included being separated from family and friends, and limitations on important activities that are part of their “normal” lives.

However, the impacts on children’s lives and well-being are largely unacknowledged. Their contributions should be acknowledged and they should be thanked for their part.

Children have a right to be provided with information in a form that is appropriate for their safety and well-being. Children need to have the opportunity to ask questions and learn about what COVID-19 means for them with adults they trust, including parents and teachers.

Children have questions about COVID-19. Questions are different for each child and not all children want the same amount of information.

Read more:
8 tips on what to tell your kids about coronavirus

What can adults do?

Adults should make the time and space to have conversations with children. They can ask:

  • what would you like to know?

  • what would you like to ask?

This approach means children are empowered to identify their needs and concerns, and the information they are provided is relevant and meets their needs.

Andrea Chelkowski, from the Centre for Education and Research — Nursing and Midwifery, Tasmanian Health Service South and University of Tasmania, Hobart, was part of the Australian research team. The lead author of the research mentioned in this article is Lucy Bray, professor in child health literacy, Edge Hill University, UK.The Conversation

Karen Ford, Adjunct Associate Professor, School of Nursing, University of Tasmania; Andrea Middleton, Lecturer, University of Tasmania, and Steven Campbell, Professor of Clinical Redesign – Nursing, University of Tasmania

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Why do kids tend to have milder COVID? This new study gives us a clue


Joanna Groom, Walter and Eliza Hall Institute

A new Australian study, published overnight in Nature Communications, gives an insight into how kids’ immune systems respond to infection with SARS-CoV-2, the virus that causes COVID-19.

It’s the first study, to my knowledge, that directly compares children and adults with mild COVID.

Children are less likely to become infected, and when they are, they are more likely to be asymptomatic. This is in contrast to other viral and respiratory infections that are more prevalent among young people.

This new research helps explain how kids’ immune systems work when confronted with the coronavirus — and gives us clues as to why they generally seem to fare better than adults.

Read more:
Worried about your child getting coronavirus? Here’s what you need to know

The kids (immune systems) are alright

The researchers studied 48 kids, mostly in primary school, across 28 households during Melbourne’s second wave. All children were exposed to the coronavirus in their households by infected parents.

This study focused on the “innate” immune response in children, which forms the early part of the immune system’s attack on a virus (or bacteria, or other pathogens). The innate immune system plays an important role in viral protection before the body raises antibodies.

The study found there were dynamic changes in kids’ early immune responses, compared with coronavirus-infected adults.

Read more:
Explainer: what is the immune system?

One key innate immune cell that was elevated in children exposed to the virus was a type of white blood cell called “neutrophils”. These cells patrol the body for infections. When they discover a pathogen, they have a unique ability to respond by trapping and killing the invading pathogen (in this case, the coronavirus).

This role may ensure the virus is not able to infect more cells. This potentially decreases the “viral load”, basically the amount of virus in your body.

Neutrophil, shown in white, among red blood cells
The researchers looked at neutrophils, a type of white blood cell.

For some of the kids in the study, the early immune responses kept the viral load so low that they never returned a positive test, despite being tested throughout the study and having been exposed to coronavirus.

One strength of this study is that it was “longitudinal”, meaning it studied families over time, rather than simply at one point in time. The researchers looked at immune responses of the families just after their exposure to the virus, and returned more than 30 days later to see what had changed. This allowed them to identify the key changes induced because of the exposure to the virus.

Kids vs adults

A key question arising from this research is: why did the kids show such strong immune responses, resulting in few or no symptoms, while their parents were very ill?

It’s a difficult question to answer, at least so far. But the key differences in responses are likely to lie in the early responses of the immune system.

There is some previous research that might give some clues.

One theory surrounds the fact that children have less of the receptors called “ACE2” in their respiratory tract. These receptors are the pathway of entry for the virus into our cells. In theory, less ACE2 receptors mean less chance for the virus to break in and infect our cells. Virus’ don’t survive for very long outside a cell. With less ACE2 receptors, it may give more time for the innate immune cells to control the virus as much as it can while waiting for other immune cells to come along and help.

Read more:
ACE2: the molecule that helps coronavirus invade your cells

Another possibility relates to “interferons”, which are alert signals released by cells to tell the body there’s a virus around. Researchers think higher levels of interferons during the early phase of an infection are very important for controlling coronavirus. Potentially, interferons may help promote the increased neutrophils that were seen in children, compared with lower numbers observed in adults.

The wide range of symptoms in COVID are intriguing and frustrating at the same time. Conventional wisdom was that kids are more prone to getting sick with respiratory illnesses than adults — just ask any parent! But with COVID it seems to be the opposite.

Often when we think we’ve nailed down a specific mechanism as to how this new virus works and how our bodies respond to it, it turns out such a mechanism is different across different people. We can see this in the huge range of symptoms that different people display — some get a runny nose, others get a cough, and others suffer extreme exhaustion and respiratory distress or develop “long COVID”, in which symptoms drag on for months.

Coronavirus is still keeping immunologists on their toes. Studies like this one help solve some of the puzzle in understanding who’s at most at risk of severe disease and why.

Read more:
Five life lessons from your immune system

The Conversation

Joanna Groom, Laboratory Head, Walter and Eliza Hall Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Needles are nothing to fear: 5 steps to make vaccinations easier on your kids


Therese O’Sullivan, Edith Cowan University

The COVID vaccine rollout has placed the issue of vaccination firmly in the spotlight. A successful rollout will depend on a variety of factors, one of which is vaccine acceptance. One potential hurdle to vaccine acceptance is needle fear.

In a study that surveyed parents and children in Canada, 24% of parents and 63% of children reported a fear of needles. About one in 12 children and adults alike said they didn’t get all the vaccinations they needed because of their phobia.

Needle phobia generally begins from around age five, and can last through to adulthood. It can be a barrier to health-care access and treatment.

So it’s important to establish positive attitudes towards needle procedures, particularly vaccination, early in life.

An opportunity

Although there’s no one specific reason why people develop needle phobia, people who are anxious and fearful of needles can often relate their concerns back to one poorly-managed needle experience as a child. A bad experience may result from feelings of powerlessness due to being under-informed or being “tricked” into a vaccination.

In Australia, the National Immunisation Program Schedule includes vaccinations during the first 18 months, again at age four, and then in adolescence.

While it’s important to use a respectful approach at all ages, the four-year-old vaccinations present a particularly valuable opportunity for parents to help children feel comfortable with needle procedures.

Read more:
Everyone can be an effective advocate for vaccination: here’s how

The guide below offers a strategy to help make vaccination a positive experience for your child. It’s based on what’s called the respectful approach to child-centred health care. This focuses on the parent and health-care provider developing a cooperative relationship with the child, rather than using authority or incentives.

The aim is to help the child feel in control and reduce anxiety around needle procedures.

The author's son having his four-year-old vaccinations. He's sitting on his father's knee and receiving it in his thigh.
The author’s son is pictured having his four-year-old vaccinations.
Therese O’Sullivan, Author provided

Five steps

1. Prepare

A few weeks beforehand, briefly introduce the topic of vaccinations and why they’re important.

Expect some resistance. This is normal — there’s no need to argue, just acknowledge your child’s feelings. Let them know adults don’t particularly like getting vaccinations either!

About a week out, mention again that they’ll be having a vaccination, and give some details, such as where they will be going. Another reminder the day before is helpful.

2. Be honest and transparent

It’s important to check if your child has any questions each time you discuss vaccination with them. Answer as honestly as possible. Yes, it will hurt. But not for long — most of the pain will be gone by the time 30 seconds is up, perhaps as long as it takes to run around the house or say the alphabet.

Read more:
Children may need to be vaccinated against COVID-19 too. Here’s what we need to consider

3. Give choices

Help children feel like they are actively part of the process by giving choices where possible. For example, can they have a choice of day, or morning or afternoon?

Check with your health-care provider in advance whether children can choose the location of the injection – normally the vaccines are administered on the outside of the thigh, or the upper arm.

In the lead up, the child might like to prod themselves with a toothpick to see the difference between how each site feels. They may also have a preference for the left or right side.

Sometimes it helps to yell out when you feel pain. Kids may find this fun if you give them free rein to call out anything they want (even “rude” words) when the injection goes in. Just let your health-care provider know in advance so they’re not taken by surprise.

A little girl receives an injection in her arm.
Let your child watch the injection, if they want to.

4. Avoid bribes and distractions

Offering a bribe can give the child the impression there’s something terrible about the procedure. As the parent, be confident (or pretend to be confident if you have needle fear yourself). Pain-related beliefs and behaviours can be learnt through observing others, and children are very perceptive.

You can always do a fun activity or have a treat afterwards, but make this a surprise at the end rather than a bribe before the vaccination.

Distractions are common, but can leave the child wondering why they were distracted. “What was going on that was so bad I wasn’t allowed to look at it?”, they might wonder. When children feel they have been deceived, this may erode trust.

Some children may like to watch so they know what’s happening — give them the option. Interestingly, in one study, adults who chose to watch the needle being inserted into their arm reported less pain compared with those who chose to look away.

5. Use mindful parenting

Think of vaccinations as an opportunity to be 100% present, one-on-one with your child. Put aside any multitasking for the morning or afternoon of the vaccination. If you can, take the time off work, turn off your phone, and arrange for any other siblings to be looked after.

Observe your child, aim to listen with your full attention, be compassionate and aware of how you and your child are feeling. All of these things can improve the quality of parent–child relationships and are important for helping children through potentially anxious times.

Read more:
Fear of needles could be a hurdle to COVID-19 vaccination, but here are ways to overcome it

The Conversation

Therese O’Sullivan, Associate Professor, Edith Cowan University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Coronavirus: is it safe for kids to go back to school? And what about the new mutant strain?

Asha Bowen, Telethon Kids Institute; Archana Koirala, University of Sydney; Fiona Russell, University of Melbourne; Kristine Macartney, University of Sydney, and Margie Danchin, Murdoch Children’s Research Institute

A year ago, in late January 2020, Australia reported its first cases of COVID-19. Since then, we have seen almost 29,000 confirmed cases and 909 deaths.

As cases climbed in Australian cities in 2020, many students did their schoolwork from home. Australia, including Victoria, came out of lockdowns at the end of last year. But due to outbreaks in New South Wales and Queensland over Christmas and New Year, that impacted on Victoria, restrictions remain in some places.

So what now, for the new school year? Is it safe for students to go back to school?

What we learnt in 2020

Australian health officials, paediatricians, and federal and state education departments worked together to understand how SARS-CoV-2 — the virus that causes COVID-19 — is transmitted in Australian schools.

They also kept updating, as more information came to light, what schools can do to provide a safe learning environment for children and staff.

Up to the end of term 3 in New South Wales, 49 student- and 24 staff- cases were linked to schools and early learning centres. Each of these cases, and their contacts, were followed since the pandemic began. Schools had low rates of transmission — with 51 transmission events (38 students, 13 staff) out of 5,793 contacts traced (<1%) — in terms 1, 2, and 3 when COVID-19 safe measures were in place.

Key measures were:

  • limiting adults in the school and early learning centre grounds

  • staying home when unwell with cold-like symptoms

  • getting tested early.

Most schools and early learning centres in NSW reopened after only a few days.

In Victoria, up until the end of August 2020, 1,635 cases were associated with early learning centres and schools. These consisted of 254 staff, 599 students and 753 household members, out of a total of 19,109 cases in Victoria during their second wave.

Two-thirds of infections in early learning centres and schools did not progress to outbreaks (two or more cases) and more than 90% were small outbreaks (fewer than ten cases).

Read more:
Behind Victoria’s decision to open primary schools to all students: report shows COVID transmission is rare

While transmission has been connected with a Victorian school in the media, transmission events often have a more complex basis than just occurring in the classroom. Schools are often located in a multi-generational community and cases in this large school cluster were linked to high community transmission rates rather than infection in the school.

These studies confirm that when SARS-CoV-2 is detected in a student or staff member, it is very unlikely for other students or staff to be infected at school with the processes put in place in 2020 to provide a safe learning environment.

In Western Australia, almost 14,000 asymptomatic staff and students were swabbed at the school in terms 2 and 3. No cases of SARS-CoV-2 were detected, consistent with the absence of community transmission in that state.

But why are other countries closing schools?

Overseas, studies have shown schools can implement health strategies to safely keep schools open and minimise SARS-CoV-2 transmission risks.

In the US, the Centres for Disease Control and Prevention noted that: “trends among children and adolescents aged 0–17 years paralleled those among adults”. However, the organisation also reported:

as of the week beginning December 6, aggregate COVID-19 incidence among the general population in counties where K–12 schools offer in-person education (401.2 per 100,000) was similar to that in counties offering only virtual/online education (418.2 per 100,000).

In Norway, where testing is strong, schools were open with mitigation measures in place. There was minimal child-to-child (0.9%, 2 out of 234) and child-to-adult (1.7%, 1 out of 58) transmission.

Other countries have chosen to close schools as a last resort in national lockdowns in the face of extremely high rates of community transmission and daily case numbers, which meant only widespread reductions in population movements could be effective. This is not the case in Australia at the start of term 1, 2021.

Read more:
Children may transmit coronavirus at the same rate as adults: what we now know about schools and COVID-19

It is common for viruses to evolve and there have now been several new variants of concern such as those identified in the UK, South Africa and Brazil which are more transmissible. The potential of such variants entering Australia is uncertain, and so is the risk of transmission in schools.

Reassuringly, if community transmission of such a variant occurs in Australia, we have established experience to monitor, and hopefully halt, its spread.

So, what should Australia do?

Remote learning provides considerable challenges to keep students engaged, reduces the close supervision and support in the classroom, and provides an added disadvantage for children with mental-health conditions, disabilities or special needs.

For parents, it is difficult to work effectively, provide for the family and maintain their well-being when their child is learning from home.

Read more:
‘The workload was intense’: what parents told us about remote learning

Based on the above evidence, schools are safe to open. But states should adopt mitigation measures — including when to add masks, reduce attendance or close schools — according to a traffic light system from green (standard measures) to red (close schools) based on the degree of community transmission. The Murdoch Children’s Research Institute has recommended this approach for Victoria. Education departments around Australia can consider a similar approach.

This is consistent with the recommendations of Australia’s National Cabinet and international advice.

It is important schools and early learning centres continue to adhere to their local COVID advice. Parents and guardians should check their contact details are up to date so they can be contacted easily, regularly check what restrictions are in place and, when unwell, get their child tested and stay at home.

In 2020, students and staff rapidly learned to regularly wash their hands, adapt to cleaners in the school throughout the day, socially distance and wear masks when required. These public health interventions, vaccination, and testing and tracing will remain the mainstay for the year ahead in Australia.

Monitoring well-being and building resilience will also be core educational activities in the months ahead.The Conversation

Asha Bowen, Head, Skin Health, Telethon Kids Institute; Archana Koirala, Paediatrician and Infectious Diseases Specialist, University of Sydney; Fiona Russell, Principal research fellow, University of Melbourne; Kristine Macartney, Professor, Discipline of Paediatrics and Child Health, University of Sydney, and Margie Danchin, Associate Professor, University of Melbourne, Murdoch Children’s Research Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.