Dr. Danelle Fisher is a practicing pediatrician with over 20 years of clinical experience. She has held numerous positions in leadership including Chairwoman of Pediatrics at Providence Saint John’s Health Center and past President of the Los Angeles Pediatric Society. She is also currently the medical co-director of the Cleft Palate Team at Providence Saint John’s Health Center. Dr. Fisher has extensive media experience, appearing in over one hundred TV, print and online news articles on Pediatrics topics. In this video, she shares her insights on Covid and the pediatric population.
myDoqter: Dr. Fisher, thank you for sharing your expertise and your observations with us regarding Covid-19 and its manifestations in children. So much of it is uncertain and unknown and unfolding before our eyes. Can you tell us what we should be looking out for in children? How can Covid present?
Dr. Fisher: Covid has a variable presentation in children, from asymptomatic to incredibly sick. The most common presentation of Covid infection in children is similar to that in adults, with fever and dry cough. There are other possible symptoms, including stomach pain, diarrhea and rashes which have many different forms. Parents should monitor their children for symptoms and reach out to their pediatrician if they have concerns.
myDoqter: We have all been told to look out for 3 cardinal signs: fever, shortness of breath, and dry cough. How reliable or unreliable are these symptoms in pointing to Covid infection and when should a parent become concerned about possible Covid infection versus allergies or a seasonal viral infection?
Dr. Fisher: The differentiation between Covid and allergies can be blurred but the clear distinction is fever. Allergies to not cause fever. Allergies also cause itchiness in many people and there is no itchiness associated with Covid. Finally, allergy sufferers usually improve with allergy medication including antihistamines, which will not affect Covid.
myDoqter: We know the vast majority of pediatric cases of Covid infection are asymptomatic and short lived. But as this story unfolds, we are seeing some delayed reactions. Can you describe some of the latest observations that we are emerging?
Dr. Fisher: The scary but exceedingly rare delayed reaction in children due to Covid is an emerging syndrome named MIS-C (Multisystem Inflammatory Syndrome in Children). These children will present with symptoms consistent with Kawasaki disease or Toxic Shock Syndrome, including 4-5 days of fever and some hallmark symptoms including red eyes, red cracked lips, strawberry tongue, cervical adenopathy, abdominal pain, rash and general malaise. Some have hypotension (low blood pressure). Many may have coronary artery involvement and most are very sick. If a parent sees their child with at least 4-5 days of fever plus these symptoms, they should contact their pediatrician or reach out to the closest children’s hospital. MIS-C is very rare but small clusters have emerged in New York, Boston, Los Angeles and other cities.
myDoqter: Can you give us some tips for concerned parents on when to schedule a pediatrician visit for their children? When should they schedule an online visit versus an in-office visit or even a trip to the emergency room? And how are we handling routine vaccinations and checkups?
Dr. Fisher: As a parent, I find myself paranoid every time my son coughs or clears his throat, so I know how parents are feeling right now. They should know that pediatricians are there for their children and willing to do video or in person visits in case their child is ill. Also, all children due for Well Child check-ups should proceed on schedule. Pediatricians do not want children to miss vaccinations or the important surveillance of check-ups, especially for developmental and other medical issues. Offices and clinics are doing the utmost to maintain social distance and safety for the patients and their families. Call your pediatrician and schedule needed check-ups!