COVID, Obesity, Diabetes and Kids

Pediatricians weigh in on how to talk to parents who are concerned their children's endocrine conditions put them at a higher risk for COVID-19

Diverse children with backpacks getting on a bus

With Alicia Diaz-Thomas MD, MPH and Apisadaporn Thambundit MD

Parents of school age children don't have an easy life these days. Some are overseeing school lessons remotely, waiting for schools to open for traditional sessions or waiting for them to open full time. All are understandably worried about the risks of their children contracting COVID-19.

For parents of children who have obesity or diabetes, there's likely to be extra worry. Both obesity and diabetes are on the list of underlying medical conditions that experts say could put children at higher risk of severe disease and complications if they become infected with the coronavirus.

So how to protect these children? Endocrine Web searched out information from the CDC, the American Diabetes Association and interviewed two pediatric endocrinologists for answers.

Kids and COVID: The Numbers

When the COVID-19 pandemic began in the spring, experts believed that children were largely immune. But as community spread of the virus increased, they found out that hypothesis was not completely accurate.

While fewer children than adults have become ill with COVID-19, the risk is real, the CDC says.  The reassuring news: according to the CDC, most children with COVID-19 have no symptoms or mild ones. In rare cases, they do become ill, and some children have died. As of Oct. 22, 2020, based on data collected from 42 states and New York City, children account for up to .23% of all COVID deaths, according to the American Academy of Pediatrics, which reported on the data. Of these, 16 states reported no child deaths from COVID.

What Is Multisystem Inflammatory Syndrome in Children?

In rare instances, some children have contracted a condition linked with COVID-19, multisystem inflammatory syndrome in children, MIS-C. Experts are still researching that condition to learn more.

According to the American Diabetes Association, people with diabetes do face a higher chance of experiencing serious complications if they become infected, and people with diabetes are more likely to experience severe symptoms and complications when infected with a virus. While viral infections can increase inflammation in people with diabetes, above-target blood sugar levels are what contributes to severe complications with COVID. The better managed blood sugar is, the better for a child's overall health if infected.

When COVID-19 cases began increasing, back in the spring, pediatricians say they were flooded with phone calls from anxious parents, and if children had health issues already, those parents tended to be even more worried.

"In the beginning, I got quite a few phone calls, especially from parents of kids with diabetes and obesity," says Apisadaporn Thambundit MD, a pediatric endocrinologist at UCLA Mattel Children's Hospital and clinical instructor at the UCLA David Geffen School of Medicine in Los Angeles.

Alicia Diaz-Thomas MD, MPH an associate professor of pediatrics and director of the pediatric endocrinology fellowship program at the University of Tennessee Health Science Center in Memphis, also got many phone calls at that time. 

Both doctors communicated an important fact to the worried parents that helped calm anxiety. "What I have been telling them is that obesity and diabetes doesn't necessarily put their children at more risk of contracting the disease," Dr. Thambundit says. "However, if they are infected with the disease, there seems to be more risk of complications."

Once that point is understood, the doctors say one of the best things to do is manage the underlying condition as well as possible. For diabetes, managing blood sugar is critical.

Understanding how the virus is spread can help parents understand the importance of taking precautions. According to the CDC, COVID-19 most commonly spreads during close contact when infected people cough, sneeze, sing, talk or breathe, producing respiratory droplets. COVID can sometimes be spread by exposure to the smaller viral particles that can linger in the air for minutes or hours. This mode of transmission—airborne—is less common, the CDC says, than by close contact. Parents should explain these facts to their children when telling them to wear masks and social distance.

Things to Do With Kids During COVID That Promote Health

The pandemic, with lockdown, quarantine and cancelled events, has been difficult on children and families who were already dealing with obesity, Dr. Thambundit says. She has seen many patients who have gained a moderate amount of weight during the pandemic, due partly to more time indoors and lack of a regular school schedule. "I ask parents, 'What do you do for exercise?' And a lot of them answer that they are afraid to take their child outside due to the virus."

Dr. Thambundit encourages families try outdoor activities together. "I reassure them that it's OK to go outside."

Dr. Diaz-Thomas suggests parents and kids try to form a family team to stay healthy. They might have a family fitness challenge, she says, or find online videos for dancing or other activities.

Returning to School After COVID

As schools reopen for traditional learning, parents can take extra steps to protect their children. "Tell them to be more vigilant about hand washing," Dr. Thambundit says. That's important when they return home, she says, especially for older household members.

For children with diabetes, the American Diabetes Association's "Safe at School" program offers these suggestions:

  • Be sure your child's school nurse has an updated individualized diabetes medical management plan (DMMP).
  • Schedule your child's diabetes visit, in person or by telehealth, to develop or update your doctor's orders for the DMMP.
  • If it's not possible to update, ask the nurse to use the orders on file until you can update.
  • If there are not orders, provide a recent after-visit summary with information about your child's diabetes management.
  • Give your child's doctor your current contact information and that of the school nurse so the updates can be sent.  

The CDC offers additional tips on how to keep children safe. Parents can:

  • Be aware that fever (100.4 degrees F) and cough are the most common symptoms of COVID in kids, but not the only ones. They can also have chills, nasal congestion, loss of taste or smell, sore throat, poor appetite and others.
  • Keep track of who your child is in close contact with.
  • If you suspect you or your child has COVID, stay home and call your doctor and your child's right away. Keep the school personnel informed at every point in the process.
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