Category: In the News

Cloth Face Coverings for Children

Cloth Face Coverings for Children During COVID-19


Why are people wearing cloth face coverings right now?

  • Since so many people who have COVID-19 don’t have symptoms, wearing cloth face coverings reduces the chance of transmitting the virus through the spray of spit or respiratory droplets. This is especially true for when someone with COVID-19 comes within 6 feet of you, which is the range of transmitting infection through acts like sneezing or coughing.​​

Should children wear cloth face coverings?

  • Children under the age of 2 years should not wear cloth face coverings.

When do children need to wear cloth face coverings?

  • There are places where children should wear cloth face coverings. This includes places where they may not be able to avoid staying 6 feet away from others. For example, if you have to take them to the doctor, pharmacy, or grocery store.
  • However, there are other places where children do NOT need to wear a cloth face covering:
    1. At home, assuming they have not been exposed to anyone with COVID-19.
    2. Outside, as long as they can stay at least 6 feet away from others and can avoid touching surfaces. For example, it’s fine to take a walk as long as your children stay 6 feet away from others and do not touch tables, water fountains, playground equipment or other things that infected people might have touched.​
  • Caution: you may need to reconsider the use of cloth face coverings if:
    1. The face coverings are a possible choking or strangulation hazards to your child.
    2. Wearing the cloth face covering causes your child to touch their face more frequently than not wearing it.

Staying home and physical distancing is still the best way to protect your family from COVID-19. Especially for younger children who may not understand why they can’t run up toward other people or touch things they shouldn’t, it’s best to keep them home. Children who are sick (fever, cough, congestion, runny nos​e, diarrhea, or vomiting) should not leave home.

What if my child is scared of wearing a face covering?

  • It’s understandable that children may be afraid of cloth face coverings at first. Here are a few ideas to help make them seem less scary:
    1. Look in the mirror with the face coverings on and talk about it.
      Put a cloth face covering on a favorite stuffed animal.
    2. Decorate them so they’re more personalized and fun.
    3. Show your child pictures of other children wearing them.
    4. Draw one on their favorite book character.
    5. Practice wearing the face covering at home to help your child get used to it.
  • For children under 3, it’s best to answer their questions simply in language they understand. If they ask about why people are wearing cloth face coverings, explain that sometimes people wear them when they are sick, and when they are all better, they stop wearing them.
  • For children over 3, try focusing on germs. Explain that germs are special to your own body. Some germs and good and some are bad. The bad ones can make you sick. Since we can’t always tell which are good or bad, the cloth face coverings help make sure you keep those germs away from your own body.

One of the biggest challenges with having children wear cloth face coverings relates to them “feeling different” or stereotyping them as being sick. As more people wear these cloth face coverings, children will get used to them and not feel singled out or strange about wearing them.

What about children with special health care needs?

  • Children who are considered high-risk or severely immuno-compromised are encouraged to wear an N95 mask for protection.
  • Families of children at higher risk are encouraged to use a standard surgical mask if they are sick to prevent the spread of illness to others.
  • Children with severe cognitive or respiratory impairments may have a hard time tolerating a cloth face covering. For these children, special precautions may be needed.
  • What is the “right way” to wear a cloth face covering?
    1. Place the cloth face covering securely over the nose and mouth and stretch it from ear to ear.
    2. Remember to wash your hands before and after you wear it and avoid touching it once it’s on your face.
    3. When back inside, avoid touching the front of the face covering by taking it off from behind.
    4. Cloth face coverings should not be worn when eating or drinking.
  • Wash cloth face coverings after each wearing.
  • What kind of cloth face covering is best?
    1. Homemade or purchased cloth face coverings are fine for most people to wear.
    2. For children, the right fit is important.
    3. Pleated face coverings with elastic are likely to work best for kids.
    4. Adult cloth face coverings are usually 6×12 inches, and even a child-sized 5×10 inch covering may be too large for small children.
    5. Try to find the right size for your child’s face and be sure to adjust it for a secure fit.

Due to very limited supply now, professional grade masks like N-95 masks should be reserved for medical professionals on the front lines who have increased risk of exposure to coronavirus.

More Information:

For a complete list of COVID-19 content for parents, go to the AAP website and link to the 2019 Novel Coronavirus (COVID-19). Most resources are also available in Spanish.

California’s Law SB277 to End Vaccine Exemption PASSED.

The statement below is from the American Academy of Pediatrics’ (AAP) California chapter website. The AAP, whose members are pediatricians, supports the new law that ends personal belief exemptions for mandated vaccines. The new law signed by Governor Brown takes effect July 1st and impacts the 2016/2017 school year (Gov. Brown’s statement is attached). All children will need proof of vaccination for mandated vaccines to enter school and be unable to opt out of vaccination for personal or religious beliefs. 

According to the website,,

“California Governor Brown signs SB 277 to eliminate personal belief exemptions for school and child care entry in California. We applaud Senator Richard Pan, MD, and Senator Ben Allen, their co-authors and staff for this tremendous accomplishment – a landmark in public health legislation!

Thank you to the hundreds of AAP California member pediatricians who called and wrote in support of SB 277. Special thanks to Vaccinate California, the California Immunization Coalition, the California Medical Association, the Health Officers Association or California, the California Academy of Family Physicians and everyone who joined the effort to advocate, educate, and enact SB 277.

Children and the public health are the clear winners !

Now is a good time to review your child’s vaccine records and discuss with your health care provider to make sure immunizations are up to date before the new school year. 


ZIKA Virus

CDC Outlines Ways to Prevent, Diagnose & Treat Children with Zika Virus Disease

​Noting the rapid spread of the Zika virus, an article to be published in the May 2016 edition of Pediatrics offers health care providers guidance on how to recognize, test and treat children who show signs of infection.

Diagnosis can be challenging, based on limited data that shows that most infants and children with Zika virus display mild symptoms that resemble common childhood illnesses, according to the report, “Zika Virus Disease: A CDC Update for Pediatric Health Care Providers,” by the U.S. Centers for Disease Control and Prevention, published early online March 23.

Zika virus has been identified in 37 countries and territories as of March 9, 2016. No vaccine is available to prevent infection with the virus, which is typically spread by mosquitoes and has also been reported to occur through sexual transmission from male partners.

The Zika virus has been associated with birth defects, including microcephaly, with warnings issued for pregnant women to postpone travel to areas where local Zika virus transmission has been reported. Children and adults who contract the virus may show symptoms of fever, rash, joint pain or conjunctivitis.

Health care providers should suspect mosquito-borne transmission of Zika virus infection in children who have traveled to or resided in an affected area within the past two weeks and exhibit at least two symptoms. Treatment consists of supportive care, including rest and fluids.
 3/23/2016 12:00 AM



Infant Care Guidelines for Home Births

Although still uncommon, the rate of home births has increased during the past several years…
In a new policy statement, “Planned Home Birth,” in the May 2013 Pediatrics (published online April 29), the American Academy of Pediatrics (AAP) makes recommendations for the care of infants born in a home setting.
Regardless of the circumstances of the birth, including location, every newborn infant deserves health care that adheres to AAP standards. The AAP concurs with the recent statement from the American College of Obstetricians and Gynecologists (ACOG) that the safest setting for a child’s birth is a hospital or birthing center, but recognizes that women and their families may desire a home birth for a variety of reasons.
  • Pediatricians should advise parents who are planning a home birth that AAP and ACOG recommend only midwives who are certified by the American Midwifery Certification Board.
  • There should be at least one person present at the delivery whose primary responsibility is the care of the newborn infant and who has the appropriate training, skills and equipment to perform a full resuscitation of the infant.
  • All medical equipment, and the telephone, should be tested before thedelivery, and the weather should be monitored.
  • A previous arrangement needs to be made with a medical facility to ensure a safe and timely transport in the event of an emergency.
  • AAP guidelines include warming, a detailed physical exam, monitoring of temperature, heart and respiratory rates, eye prophylaxis, vitamin K administration, hepatitis B immunization, feeding assessment, hyperbilirubinemia screening and other newborn screening tests.
  • If warranted, infants may also require monitoring for group B streptococcal disease and glucose screening. Comprehensive documentation and follow-up with the child’s primary health care provider is essential.
4/28/2013 7:00 PM

Announcing New Crib Standards

Beginning June 28, 2011, new federal safety standards prohibit the manufacture or sale of drop-side rail cribs. Crib safety standards have not been updated in nearly 30 years and these new rules are expected to improve the quality of cribs and make them safer for babies.

But drop-sides are not the only changes. The new regulations also require that all new cribs have stronger slats and mattress supports, better quality hardware, and to undergo more rigorous testing.

Since 2007, over 11 million cribs have been recalled. In addition, drop-sides were associated with 32 infant suffocation and strangulation deaths since 2000. These new standards will help prevent these tragedies and keep children safe in their cribs.

Child care centers, family child care homes, and places of public accommodation, such as hotels and motels have until December 28, 2012 to comply with these new rules.

What Parents Can Do

Please consider getting a new crib for your baby. If that is not possible, the AAP and the Consumer Product Safety Commission (CPSC) encourage you to check the crib frequently to make sure that all hardware is secured tightly and that there are no loose, missing, or broken parts. Also be sure to:

  • Check CPSC’s crib recall list to make sure that your crib has not been recalled.
  • Stop using the drop-side rail of your crib. If the crib has been recalled, see if you can get a free immobilizer from the manufacturer or retailer (immobilizers vary depending on the crib).
  • Consider using a portable play yard, so long as it is not a model that has been recalled.
  • As always, keep items like pillows, cushy bumper pads, quilts, comforters, stuffed toys, and positioning devices out of the crib.

Re-sale of Cribs

Keep in mind that these new rules also apply to the re-sale of cribs, including at garage and rummage sales, on online auction sites, or even by donation to thrift stores. Unsafe cribs should be disassembled and thrown away.

For more information on choosing a safe crib for your baby, click here.

You can also find more details about the new regulations from the CPSC here.

Important Update on the Use of Car Safety Seats

The AAP has just released new recommendations regarding the use of car safety seats.

Parents are advised to keep toddlers in rear-facing car seats until age 2, or until they reach the maximum height and weight for their seat. Children should transition from a rear-facing seat to a forward-facing seat with a harness, until they reach the maximum weight or height for that seat. Then a booster will make sure the vehicle’s lap-and-shoulder belt fit properly. The shoulder belt should lie across the middle of the chest and shoulder, not near the neck or face. The lap belt should fit low and snug on the hips and upper thighs, not across the belly. Most children will need a booster seat until they have reached 4 feet 9 inches tall and are between 8 and 12 years old. Additionally, children should ride in the rear of a vehicle until they are 13 years old.

Although the Federal Aviation Administration permits children under age 2 to ride on an adult’s lap on an airplane, they are best protected by riding in an age- and size-appropriate restraint.

It’s important that your child use the most appropriate child safety seat.  Here is some information from the AAP that will be helpful to you as you ensure safe car riding for your child.

Helping Children After A Disaster

A catastrophe such as an earthquake, hurricane, tornado, fire, flood, or violent acts is frightening to children and adults alike. Talking about the event with children can decrease their fear.  It is important to explain the event in words the child can understand, and at a level of detail that will not overwhelm them.

Several factors affect a child’s response to a disaster.  The way children see and understand their parents’ responses are very important. Children are aware of their parents’ worries most of the time, but they are particularly sensitive during a crisis. Parents should admit their concerns to their children, and also stress their abilities to cope with the disaster.  Falsely minimizing the danger will not end a child’s concerns.

A child’s reaction also depends on how much destruction and/or death he or she sees during and after the disaster. If a friend or family member has been killed or seriously injured, or if the child’s school or home has been severely damaged, there is a greater chance that the child will experience difficulties.

A child’s age affects how the child will respond to the disaster. For example, six-year-olds may show their worries by refusing to attend school, whereas adolescents may minimize their concerns, but argue more with parents and show a decline in school performance.

Following a disaster, people may develop Posttraumatic Stress Disorder (PTSD), which is a set of symptoms that can result from experiencing, witnessing, or participating in an overwhelmingly traumatic (frightening) event. Children with this disorder have repeated episodes in which they re-experience the traumatic event. Children often relive the trauma through repetitive play. In young children, upsetting dreams of the traumatic event may change into nightmares of monsters, of rescuing others, or of threats to self or others. PTSD rarely appears during the trauma itself. Though its symptoms can occur soon after the event, the disorder often surfaces several months or even years later.

After a disaster, parents should be alert to these changes in a child’s behavior:

  • Refusal to return to school and “clinging” behavior, including shadowing the mother or father around the house
  • Persistent fears related to the catastrophe (such as fears about being permanently separated from parents)
  • Sleep disturbances such as nightmares, screaming during sleep and bedwetting, persisting more than several days after the event
  • Loss of concentration and irritability
  • Jumpiness or being startled easily
  • Behavior problems, for example, misbehaving in school or at home in ways that are not typical for the child
  • Physical complaints (stomachaches, headaches, dizziness) for which a physical cause cannot be found
  • Withdrawal from family and friends, sadness, listlessness, decreased activity, and preoccupation with the events of the disaster

Professional advice or treatment for children affected by a disaster–especially those who have witnessed destruction, injury or death–can help prevent or minimize PTSD. Parents who are concerned about their children can ask their pediatrician or family doctor to refer them to a child and adolescent psychiatrist for an evaluation.

This article was adapted from the American Academy of Child & Adolescent Psychiatry website; Click here to download and print a PDF version of this document.

IRS Ruling on Breast Pumps

IRS Ruling on Breast Pumps

“The American Academy of Pediatrics (AAP) hails the IRS ruling on February 10th that recognizes breast pumps and breastfeeding supplies as medical expenses worthy of reimbursement through Flexible Spending Accounts.

“Today’s IRS ruling providing favorable tax treatment for the purchase of breast pumps and breastfeeding equipment marks an important victory for the health of women and children across the country by making breastfeeding a more practical option for new and working mothers.

“For years, the AAP has been urging the IRS to recognize that breast milk is not just the best and most natural food for infants; it confers well-documented health benefits on both baby and mother that cannot be obtained any other way. The IRS has finally acknowledged this medical fact, and we applaud them for changing their regulations accordingly.

“Due to resounding evidence of improved child health and well-being, the AAP recommends that mothers breastfeed exclusively for the first six months and continue breastfeeding for at least the first year of a child’s life. As many as 45 percent to 50 percent of mothers return to work full time within six months of their infant’s birth; breast pumps allow working mothers to continue breastfeeding. Before today, steep cost burdens could prevent working mothers from purchasing breast pumps and related equipment.

“Now, more women will be able to pass on the health benefits of breastfeeding to their babies, which include protections against asthma and other respiratory illnesses, bacterial and viral infections, and obesity, among other ailments. Pre-tax dollars already cover expenses like immunizations and bandages, and thanks to today’s ruling, women who wish to breastfeed will experience these same cost savings for breastfeeding supplies.”

via – AAP Applauds IRS Ruling on Breast Pumps.

Autism-Vaccine Study

As pediatricians our greatest duty is to care for our patients and look out for their overall well-being and development.   Vaccinating children against preventable childhood illnesses  is part of this duty.  It is not only our responsibility to our individual patients, but to the greater community as well.  Therefore, educating parents about the risks and benefits of  vaccines is essential and allows a family to make  informed decisions.

However, with so much knowledge gleaned from the media and internet, information about vaccines can be quite varied.  Doctors have traditionally been the source of  vaccine knowledge, but more often TV, internet and our friends provide this information. Although these sources are rich in content,  they are not always validated and can be blatantly false.

One of the most widely misrepresented health topics recently has been the concern over a link between Autism and the MMR Vaccine. I would like to share the following article which highlights local experts responses to the recent report that ‘data linking vaccines to autism was fraudulent.’

Santa Barbara News Press

January 7, 2011

Experts hope for better autism research after a British reporter concluded that information was doctored for a 1998 study suggesting a link between the disorder and a childhood vaccine.

When Brian Deer analyzed the study by Andrew Wakefield and his associates alongside the subjects’ medical records, he found several instances of doctored research, The Associated Press reported Thursday, including contradictions between hospital records and reported diagnoses.

The study has long been discredited by the scientific community. Lancet, the medical journal the paper ran in, later retracted it, and 10 of the study’s 13 authors eventually renounced it.

But Mr. Deer’s investigation suggests the paper was not just invalid, but fraudulent.

Robert Koegel, director of the University of California at Santa Barbara’s world-renowned Koegel Autism Center, said he hopes laying to rest suspicion of the MMR (measles, mumps and rubella) vaccine will encourage researchers to investigate other possible causes of autism that have received less attention and funding.

“It might be better for everybody,” Dr. Koegel said, adding that the benefit to research might outweigh the disruption caused by Mr. Wakefield’s study.

“The scientific community is a little bit upset with Wakefield because he’s caused such a big controversy here,” Dr. Koegel said, “but we might find it’s actually a good thing.”

While no one knows what causes autism, new research suggests genetics may be a factor, Dr. Koegel said. One theory is that the disorder may be linked to the same genes that produce genius, suggesting that autistic children may simply have “too much of a good thing.”

Because autistic children tend to be extremely bright, Mr. Koegel said it makes sense that two intelligent parents might potentially have a child with overdeveloped genius and underdeveloped social and communication skills.

In addition to using valuable research time and funding on what turned out to be a false issue, Mr. Wakefield’s article sparked deep mistrust of the MMR vaccine in parents all over the world.

“All of a sudden parents all over the world were reluctant to give their children the MMR vaccines,” said Dr. Koegel. “Then it turned out the study didn’t have any substance to it.”

Dr. Lynn Koegel, director of autism services at the Koegel Autism Center and wife of Robert Koegel, said Mr. Deer’s investigation shows how important good documentation and sound data are to any scientific study.

False research, whether fraudulent or simply badly conducted, costs families of autistic children a great deal of time and stress over treatments that don’t help their children, she sad.

The negative attention also casts doubt on the credibility of valid research, slowing down the process of finding real answers.

In the case of Mr. Wakefield’s study, she said the greatest casualty has been parents’ reluctance to vaccinate their children. Fear of autism has lead many to expose their children to deadly childhood diseases.

She said there was a noticeable rise in occurrences of measles, mumps, and rubella around the world after Mr. Wakefield’s study spooked parents. Some of those cases resulted in deaths that could have been prevented by vaccination.

Dr. Charish Barry, a Santa Barbara pediatrician at Cottage Children’s Hospital and Petite Pediatrics, said she has noticed the effects of that mistrust in her own practice.

“I’ve seen locally that there’s still a general fear that parents have in terms of administering vaccines,” Dr. Barry said.

That reluctance has paved the way for several outbreaks of the measles in California and across the country as recently as last year.

“As a pediatrician, in our community we need to help educate parents that it’s safe and it’s important for children,” Dr. Barry said.

The most recent finding is noteworthy because the information, which she and other pediatricians across the country have long fought, has been proven false to the public, she said.

“I certainly encourage parents to vaccinate their children.”

Fortunately, she has seen a trend among her patients’ parents to seek out correct information about MMR shots and autism in recent years.

“Ultimately it’s the parents’ choice,” she said. “I’m confident in saying that, no, there’s no study proving it does cause autism.”

The Associated Press contributed to this report.


via Santa Barbara News-Press.

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