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Ask a Pediatrician: With the Flu, RSV and COVID Circulating, Should I Let My Kid Do Indoor Activities Right Now? 

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“My daughter is asking to join ballet (which practices indoors) in the new year, but with flu, RSV, and COVID circulating, is it really a good idea to let her do this? I want to return to normal, but I'm nervous!”

After more than two years of ever-changing public health guidelines, scary headlines and grim statistics, it is understandable to crave a safe return to normal yet be hesitant to do so. We want our kids to attend their favorite activities without worrying about COVID-19 or any other disease that might be circulating. I want to address this concern and provide guidance for lowering the risk of infection, and then discuss the need for an overall shift in the way we assess and evaluate situations that may pose an infectious threat. We’ve learned a lot through the pandemic, so we should put that knowledge to good use.

How to Lower the Risk of Infection

While there's no way to guarantee that children won’t catch anything when out and about, there are simple measures we can implement to protect them. It starts with understanding the various infections circulating in our communities during the cold months, such as influenza, RSV (respiratory syncytial virus), enterovirus, rhinovirus and COVID-19. There are many more. Most of these respiratory viruses are spread primarily via droplets. COVID-19 is transmitted in an airborne fashion. Thus, they are passed from person to person by breathing in the particles or touching surfaces with droplets on them and then touching our face, eyes and nose. These germs all cause cold and flu-like symptoms such as fever, runny and stuffy nose, cough, body ache, headache, sore throat, wheezing and more. Most people recover with rest, fluids, fever reducers and supportive care, but some cases may require hospitalization and more intensive therapy.

There are ways to protect your family from infection. Vaccination is the number one preventative measure, so getting all eligible family members up to date on their shots is crucial. Improving ventilation in indoor spaces decreases the chances of infection; talk to event coordinators about ways they ensure proper airflow. If the weather permits, encourage them to conduct activities outside as much as possible—this is you simply advocating for your children’s well-being. Finally, remember that masking is still a terrific mitigating tool to lower the risk of transmission.

Having said all that, we are no longer in the same place we were in March of 2020, and we need to understand that risk assessment isn’t all or nothing. The possibility of getting sick at specific venues and activities depends on the local infection rates within a particular community, a person’s immune system and the nature of the activity itself. These are important factors to consider when deciding whether to allow your child to participate. We need to move beyond the limiting binary perspective that was necessary during the most worrying points of the pandemic.

Should You Let Your Kid Partake in an Activity?

If you’re struggling with the decision to send your child to an activity or event, ask yourselves the following questions:

  • What type of activity is it? Is it conducted indoors only? How crowded does the space get? Are there certain characteristics of the activity that might make participants more exposed? Students in a ballet class may be able to spread out more, whereas something like choir practice, for example, usually involves singers standing rather close to each other, forcefully exhaling and raising the risk of droplet transmission. Is it possible for the class to practice outside? Can the kids distance themselves from one another? Can they wear masks?
  • Are there vulnerable people in my home? Is anyone—children, adults, or elderly family members—immunocompromised or chronically ill? Are there babies under the age of 2, who are most at-risk for severe RSV? Respiratory infections are not usually life-threatening, and the risk of catching something should not necessarily prevent us from living our lives. However, we should be mindful of the people we could expose in our home and make our decisions accordingly.
  • How important is the event or activity to my child? Does the benefit outweigh the risk? If ballet is your child's favorite pastime, if it’s the only thing that gets them excited, then the risk might be worth it—with proper precautions, of course. If you’re just trying to fill up their schedule and make sure that a Wednesday afternoon is filled with a positive activity, it might be a good idea to heed your worries and choose something else.

The Bottom Line

Know the risks, do your research, and talk to your pediatrician, but also don’t be afraid to allow your family to go on living. Find the balance that works well for you and yours. Listen to your gut, and trust in science and medicine. We are now smarter about all of this than we were a few years ago; there’s no doubt that we will continue to grow in our wisdom and understanding, and our lives will be enhanced because of it.

Dr. Christina Johns is a pediatrician + Senior Medical Advisor at PM Pediatric Care, the largest pediatric urgent care group in the U.S. 

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