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          奧密克戎對兒童有哪些影響,來看看五位兒科醫生的解答

          奧密克戎對兒童有哪些影響,來看看五位兒科醫生的解答

          Jane Thier 2022-01-01
          《財富》雜志采訪了五位兒科醫生,討論了科學、風險,以及如果孩子核酸檢測結果呈陽性應如何照顧。

          隨著奧密克戎變異病毒引發的病例持續激增,住院率也在上升,其中也包括兒童。種種問題也一直存在,比如新病毒給孩子造成的風險有多大,父母如何保護脆弱的孩子,以及保護孩子時應用的規則是否有所不同。

          《財富》雜志采訪了五位兒科醫生,討論了科學、風險,以及如果孩子核酸檢測結果呈陽性應如何照顧。

          有多少孩子生病了?

          這取決于具體地點。新冠疾病專家珍妮佛·萊特醫生在紐約大學蘭貢醫院(New York University Langone Hospital)工作,她表示目前感染流感的兒童比感染新冠的多。

          “紐約州有50家可住院治療的兒科醫院,是紐約州不是紐約市,”萊特告訴《財富》雜志?!皧W密克戎傳染性非常強,目前不管是兒童還是成人,奧密克戎感染率都很高,不過兒童發展為重癥的情況很少見?!?/p>

          加拿大醫學會(Canadian Medical Association)主席、加拿大育空地區兒科醫生凱瑟琳·斯馬特醫生說,當地還沒發現孩子感染密克戎變異病毒。

          然而她指出,加拿大通常比美國落后三到四周,所以預計數字很快就會上升,而且由于奧密克戎傳染性極強,意味著會有更多孩子感染?!昂⒆拥那闆r與所在社區事情一致?!彼柜R特說。

          過去一個半月里,芝加哥柯默兒童醫院(Comer Children’s Hospital)的兒科醫生奇迪瑪·阿科洛努在醫院里看到的兒童比整個疫情期間都多。

          阿科洛努告訴《財富》雜志:“經常有年紀很小的孩子檢測出陽性而且有癥狀,尤其是青少年,需要呼吸機的幾率跟成年人差不多?!?/p>

          “波士頓兒童的感染率肯定在上升,”馬薩諸塞州總醫院(Massachusetts General Hospital)青少年和青年醫學主任斯科特·哈德蘭說?!暗档脧娬{的是,并不是所有的孩子都因為感染新冠病毒入院。孩子因為別的原因去醫院時,會自動接受檢測。在社區里,還有孩子們住的地方,不可避免有大量新冠病毒?!?/p>

          孩子們的病有多嚴重?

          哈德蘭說,目前還沒有正式數據,當前的數據只是傳聞。

          “人們普遍的關注點是,孩子即便感染也不會像其他年齡段的人一樣嚴重,但仍然可能出現重癥,還有可能出現多種并發癥,”他說?!凹词故禽p癥,也存在感染新冠后久病不愈以及多系統炎癥綜合癥的風險?!?/p>

          不過醫生們表示,總體來說感染病毒的兒童狀態比成年人好。免疫反應有兩種形式,一種是人類與生俱來的先天免疫;另一種則是人類接觸疾病后獲得的適應性免疫。萊特說,孩子們更容易抵抗冠狀病毒,因為先天免疫能力比成年人強。

          她補充說,新冠病毒對兒童健康的影響與流感相似。事實上,流感對兒童更致命。

          “疫情爆發以來,548名兒童死于新冠病毒,與流感嚴重的年份里死亡率大致相當,”她說?!皼]人認真討論這一點,因為把新冠跟流感對標屬于禁忌。也確實不該如此對比,因為成年人死亡率并不一樣。不過對孩子來說,新冠與流感的影響相似,重癥非常罕見,死亡率大約是每100萬人出現兩例。

          “不管具體什么情況,只要是感染新冠病毒,孩子總比成年人情況好一些,成年人比老年人情況好一些,”紐約大學蘭貢醫學中心哈森菲爾德兒童醫院(Hassenfeld Children’s Hospital)兒科傳染病科主任亞當·拉特納告訴《財富》雜志?!皢蝹€來看,兒童患重癥的可能性遠低于成年人。如果大量人口感染,兒童會出現更多重癥病例,即使對單個兒童來說比較罕見。

          “雖然新冠病毒對成年人的影響肯定比兒童更嚴重,總體來說并不意味著兒童不會出現重癥,”拉特納說。他還補充說,盡管各年齡段兒童患重癥的幾率都很低,但未接種疫苗的兒童患重癥的幾率要高得多。

          新生兒受保護嗎?

          萊特9月在《美國婦產科期刊》(American Journal of Obstetrics & Gynecology)發表的最新研究稱,如果孕婦接種了疫苗,進入嬰兒體內的臍帶血中含有大量抗體。

          “接種疫苗和加強針的母親可在嬰兒出生頭幾個月提供保護,”萊特說?!澳溉槲桂B也能傳導抗體,但量級趕不上孕期接種疫苗?!?/p>

          不過對于奧密克戎變異病毒來說,情況怎樣還不清楚,哈德蘭表示,“因為我們現在對變異病毒的情況了解太少?!?/p>

          應該帶孩子去看兒科醫生還是去急診室?

          和其他疾病一樣,父母應該做出最合適的判斷。

          “一些檢測呈陽性的孩子兩處都不必去,”拉特納說?!叭绻麤]出現呼吸困難或持續高燒,不一定需要治療?!辈贿^,當下急診室都很忙,所以最好是先聯系兒科醫生?!昂芏噌t生都很樂意協助做決定,也能實現分診?!?/p>

          斯馬特說,新冠病毒是呼吸系統疾病,也就是說父母應該像對待流感、支氣管炎等其他呼吸道病毒一樣對待新冠病毒陽性的孩子。如果孩子呼吸困難,就該去醫院。

          “如果孩子看起來喘不過氣,或者呼吸急促臉色不好,那就去醫院,”她說。其他有必要去醫院的癥狀包括:孩子昏昏欲睡,反應不正常,或者脫水而且不愿喝水。

          “急診室只會選擇一些方式治療,”阿科洛努說?!叭绻⒆雍粑浅@щy需要用其他肌肉代償,可能需要插管。我們會給鼻腔插管提供更多氧氣,避免呼吸困難?!?/p>

          呼吸減弱的跡象包括喉部、鎖骨附近、腹部或胸腔可見的喘息。孩子如果哭不出眼淚,也可能是脫水的跡象。

          “治療新冠病毒與其他病毒一樣,多數病例只是需要在家認真照顧,”阿科洛努說。

          可以給孩子吃退燒藥嗎?

          疫情初期,一些醫生對感染新冠的兒童服用退熱藥表示擔心。拉特納說,后來發現擔心沒什么根據,用布洛芬或泰諾治發燒是可以的。

          “對大多數人來說,孩子發燒時,通常吃的布洛芬之類的藥,治療新冠也可以,”他說。

          斯馬特說,多數感染新冠病毒的癥狀可以在家服用泰諾或布洛芬,再大量喝水控制?!昂芏嗷疾《拘约膊〉膬和枰参孔o理,而不是急救,”她說?!搬t院提供輸氧和靜脈輸液之類治療手段,孩子通常不需要?!?/p>

          阿科洛努也推薦退燒藥;6個月及6個月以上的兒童可以每三小時交替服用泰諾和布洛芬;如果不到6個月,每6小時服用一次泰諾即可。

          “孩子生病時,最好讓孩子感覺舒服,包括降低體溫,”哈德蘭說。

          學校應該繼續開放嗎?

          《財富》雜志采訪的兒科醫生們認為:學校應該以必要的方式保持開放。

          萊特表示,年紀大一些青少年通常會迅速傳播新冠病毒,小一些的孩子傳播效率不高?!八麄兒舫龅目諝忸w粒更少,”她解釋道。

          拉特納說,最初病例激增時期關閉學校是正確做法。但他補充說,根據現在對病毒和兒童的了解,保持學校開放對社會、家庭和兒童發展極為重要。

          “為了盡可能保持學校開放,有很多事可以做,”他說?!笆紫却_??梢越臃N疫苗的人,也就是所有5歲及以上的人都接種疫苗?!?/p>

          “我把孩子送去托兒所,因為我清楚應該采取哪些措施保證安全,”哈德蘭說?!坝行囊婚_始就知道的方法現在仍然適用。生病時呆在家里。戴口罩。增加通風。勤洗手?!?/p>

          阿科洛努對此表示同意。她說:“大多數學校沒條件虛擬開放,孩子能吸收的內容差別也很大。解決這一問題,我們需要靈活性、調整和大量的開拓性思考,但必須保持學校開放?!?/p>

          如果孩子生病了,如何保護其他家庭成員?

          成年人傳播新冠病毒比兒童快得多。多數感染發生在家中,因此保護兒童的最佳方式是確保每位家庭成員都接種疫苗?!氨M管兒童極少出現重癥,但我們一例都不想看到?!?/p>

          如果有孩子新冠陽性,家庭里身體弱的成員,如祖父母或正在治癌癥的人應該保持距離。

          “很顯然父母會在身邊照顧孩子,”萊特說?!暗鶕膊☆A防控制中心的說法,孩子在5到10天里不應該接觸外部其他人?!?/p>

          阿科洛努說,對有孩子的家庭來說,正確洗手和勤打掃表面格外重要。因為孩子很容易通過接觸的東西吸入病原體。

          孩子應該戴口罩嗎?

          阿科洛努說,能戴口罩的都應該戴口罩?!暗?,如果孩子還在蹣跚學步,不管怎么說都會不停摸口罩,而且總會摘掉,那么強迫戴口罩就弊大于利了?!?/p>

          雖然多數航空公司并不要求5歲以下兒童佩戴口罩,但拉特納表示,數據表明2歲及以上兒童戴口罩效果相當好?!昂⒆觽円蛉硕?,我們必須根據自己的情況來做決定,但某些情況下戴口罩用處很大?!?/p>

          哈德蘭補充說,如果孩子做不到正確佩戴口罩,可能沒法發揮所有益處,但他鼓勵家庭成員共同努力正確使用口罩?!昂⒆涌赡茏霾坏窖杆僬_戴面具,好在學得快?!?/p>

          能約著玩游戲嗎?

          當然!如果有可能,盡量安排在戶外。

          “作為家長,我不會因為流感而限制孩子做事情,所以也不會因為新冠疫情限制他們,”萊特說。

          阿科洛諾非常鼓勵戶外活動:“我們不希望解決問題的同時制造新問題。體育活動和社交活動都很關鍵?!?/p>

          進入新的一年,斯馬特建議盡可能地減少聚會規模?!艾F在不適合組織50人派對,但如果是兩三個都接種過疫苗的家庭,應該是可以的?!?

          與斯馬特的看法相同,哈德蘭表示:“如果你的孩子想跟班上另一個孩子一起玩,兩個孩子在其他環境里已經交流頻繁,在學校外一起玩的風險可能不會顯著增加?!?/p>

          斯馬特說,許多父母都希望100%確保孩子永遠不會感染新冠病毒?!暗恍业氖?,傳染病就是這樣。只能盡可能降低風險,底線是多數孩子健康?!?/p>

          斯馬特將基本的新冠防護比作基礎駕駛安全?!氨M管清楚導致兒童死亡主要原因是交通事故,我們還是讓孩子坐車,”她說?!八晕覀冇闷囎魏桶踩珟?。買車時買能力范圍內最安全的車型;遵守速度限制。新冠病毒也一樣。各種層層保護只能讓我們盡可能安全,即便永遠不會降為零?!?/p>

          應該給孩子買脈搏血氧計嗎?

          很多成年人聽取建議,隨身攜帶脈搏血氧儀測量血氧飽和度。主要原因是成年人可能容易出現無癥狀缺氧,即血氧水平驟降,直到為時已晚才能感覺到。但對孩子來說,脈搏血氧計作用沒那么大。

          “兒童血氧水平不足時會用附屬肌肉呼吸,”斯馬特解釋說?!叭绻跛较陆?,孩子會在鎖骨上方的頸部,肋骨之間吸氣并快速呼吸。不需要為孩子買脈搏血氧計,因為如果出現血氧水平低的癥狀,很容易發現?!?/p>

          斯馬特有個兒科護理的基本規則,疫情期間同樣適用。即認真觀察就能判斷孩子有沒有問題。孩子們身體好的時候狀態就會很好,生病時狀態就會變差。

          “如果孩子的血氧含量只有80%,就不會到處玩、表現得正常,”她說?!巴瑯右膊粫泻⒆涌雌饋聿皇娣珜嶋H上身體很好。如果孩子躺在床上不愿意玩,拒絕喝水,對周圍環境沒反應,都是危險的跡象?!?/p>

          哈德蘭也鼓勵家長放棄脈搏血氧儀:“多數情況下脈搏血氧儀沒必要,只會讓家長多擔心一件事?!?/p>

          為了孩子安全,最應該做什么?

          每位兒科醫生都認同:接種疫苗。

          哈德蘭說,現在16歲及以上的青少年可以打加強針,這很關鍵,因為防護奧密克戎病毒方面加強針看起來作用巨大。家里所有符合條件的人都要接種疫苗,因為正如萊特所指出的,多數感染都發生在家里。

          斯馬特說,接種疫苗和加強針,限制與未接種疫苗的人接觸,在公共場合佩戴高質量且合適的口罩是當務之急。

          “作為父母,這些都是能控制的事,”她說?!白钪匾氖欠雷o的層級。只確保一層肯定不能高枕無憂,要確保所有防護都實現,做出明智的選擇。

          “我們知道預防病毒方面疫苗并不完美,但在預防重癥和住院方面效果很好。了解這一點非常重要?!彼柜R特說?!翱梢员苊庠愀獾慕Y果,這點非常重要?!保ㄘ敻恢形木W)

          譯者:梁宇

          審校:夏林

          隨著奧密克戎變異病毒引發的病例持續激增,住院率也在上升,其中也包括兒童。種種問題也一直存在,比如新病毒給孩子造成的風險有多大,父母如何保護脆弱的孩子,以及保護孩子時應用的規則是否有所不同。

          《財富》雜志采訪了五位兒科醫生,討論了科學、風險,以及如果孩子核酸檢測結果呈陽性應如何照顧。

          有多少孩子生病了?

          這取決于具體地點。新冠疾病專家珍妮佛·萊特醫生在紐約大學蘭貢醫院(New York University Langone Hospital)工作,她表示目前感染流感的兒童比感染新冠的多。

          “紐約州有50家可住院治療的兒科醫院,是紐約州不是紐約市,”萊特告訴《財富》雜志?!皧W密克戎傳染性非常強,目前不管是兒童還是成人,奧密克戎感染率都很高,不過兒童發展為重癥的情況很少見?!?/p>

          加拿大醫學會(Canadian Medical Association)主席、加拿大育空地區兒科醫生凱瑟琳·斯馬特醫生說,當地還沒發現孩子感染密克戎變異病毒。

          然而她指出,加拿大通常比美國落后三到四周,所以預計數字很快就會上升,而且由于奧密克戎傳染性極強,意味著會有更多孩子感染?!昂⒆拥那闆r與所在社區事情一致?!彼柜R特說。

          過去一個半月里,芝加哥柯默兒童醫院(Comer Children’s Hospital)的兒科醫生奇迪瑪·阿科洛努在醫院里看到的兒童比整個疫情期間都多。

          阿科洛努告訴《財富》雜志:“經常有年紀很小的孩子檢測出陽性而且有癥狀,尤其是青少年,需要呼吸機的幾率跟成年人差不多?!?/p>

          “波士頓兒童的感染率肯定在上升,”馬薩諸塞州總醫院(Massachusetts General Hospital)青少年和青年醫學主任斯科特·哈德蘭說?!暗档脧娬{的是,并不是所有的孩子都因為感染新冠病毒入院。孩子因為別的原因去醫院時,會自動接受檢測。在社區里,還有孩子們住的地方,不可避免有大量新冠病毒?!?/p>

          孩子們的病有多嚴重?

          哈德蘭說,目前還沒有正式數據,當前的數據只是傳聞。

          “人們普遍的關注點是,孩子即便感染也不會像其他年齡段的人一樣嚴重,但仍然可能出現重癥,還有可能出現多種并發癥,”他說?!凹词故禽p癥,也存在感染新冠后久病不愈以及多系統炎癥綜合癥的風險?!?/p>

          不過醫生們表示,總體來說感染病毒的兒童狀態比成年人好。免疫反應有兩種形式,一種是人類與生俱來的先天免疫;另一種則是人類接觸疾病后獲得的適應性免疫。萊特說,孩子們更容易抵抗冠狀病毒,因為先天免疫能力比成年人強。

          她補充說,新冠病毒對兒童健康的影響與流感相似。事實上,流感對兒童更致命。

          “疫情爆發以來,548名兒童死于新冠病毒,與流感嚴重的年份里死亡率大致相當,”她說?!皼]人認真討論這一點,因為把新冠跟流感對標屬于禁忌。也確實不該如此對比,因為成年人死亡率并不一樣。不過對孩子來說,新冠與流感的影響相似,重癥非常罕見,死亡率大約是每100萬人出現兩例。

          “不管具體什么情況,只要是感染新冠病毒,孩子總比成年人情況好一些,成年人比老年人情況好一些,”紐約大學蘭貢醫學中心哈森菲爾德兒童醫院(Hassenfeld Children’s Hospital)兒科傳染病科主任亞當·拉特納告訴《財富》雜志?!皢蝹€來看,兒童患重癥的可能性遠低于成年人。如果大量人口感染,兒童會出現更多重癥病例,即使對單個兒童來說比較罕見。

          “雖然新冠病毒對成年人的影響肯定比兒童更嚴重,總體來說并不意味著兒童不會出現重癥,”拉特納說。他還補充說,盡管各年齡段兒童患重癥的幾率都很低,但未接種疫苗的兒童患重癥的幾率要高得多。

          新生兒受保護嗎?

          萊特9月在《美國婦產科期刊》(American Journal of Obstetrics & Gynecology)發表的最新研究稱,如果孕婦接種了疫苗,進入嬰兒體內的臍帶血中含有大量抗體。

          “接種疫苗和加強針的母親可在嬰兒出生頭幾個月提供保護,”萊特說?!澳溉槲桂B也能傳導抗體,但量級趕不上孕期接種疫苗?!?/p>

          不過對于奧密克戎變異病毒來說,情況怎樣還不清楚,哈德蘭表示,“因為我們現在對變異病毒的情況了解太少?!?/p>

          應該帶孩子去看兒科醫生還是去急診室?

          和其他疾病一樣,父母應該做出最合適的判斷。

          “一些檢測呈陽性的孩子兩處都不必去,”拉特納說?!叭绻麤]出現呼吸困難或持續高燒,不一定需要治療?!辈贿^,當下急診室都很忙,所以最好是先聯系兒科醫生?!昂芏噌t生都很樂意協助做決定,也能實現分診?!?/p>

          斯馬特說,新冠病毒是呼吸系統疾病,也就是說父母應該像對待流感、支氣管炎等其他呼吸道病毒一樣對待新冠病毒陽性的孩子。如果孩子呼吸困難,就該去醫院。

          “如果孩子看起來喘不過氣,或者呼吸急促臉色不好,那就去醫院,”她說。其他有必要去醫院的癥狀包括:孩子昏昏欲睡,反應不正常,或者脫水而且不愿喝水。

          “急診室只會選擇一些方式治療,”阿科洛努說?!叭绻⒆雍粑浅@щy需要用其他肌肉代償,可能需要插管。我們會給鼻腔插管提供更多氧氣,避免呼吸困難?!?/p>

          呼吸減弱的跡象包括喉部、鎖骨附近、腹部或胸腔可見的喘息。孩子如果哭不出眼淚,也可能是脫水的跡象。

          “治療新冠病毒與其他病毒一樣,多數病例只是需要在家認真照顧,”阿科洛努說。

          可以給孩子吃退燒藥嗎?

          疫情初期,一些醫生對感染新冠的兒童服用退熱藥表示擔心。拉特納說,后來發現擔心沒什么根據,用布洛芬或泰諾治發燒是可以的。

          “對大多數人來說,孩子發燒時,通常吃的布洛芬之類的藥,治療新冠也可以,”他說。

          斯馬特說,多數感染新冠病毒的癥狀可以在家服用泰諾或布洛芬,再大量喝水控制?!昂芏嗷疾《拘约膊〉膬和枰参孔o理,而不是急救,”她說?!搬t院提供輸氧和靜脈輸液之類治療手段,孩子通常不需要?!?/p>

          阿科洛努也推薦退燒藥;6個月及6個月以上的兒童可以每三小時交替服用泰諾和布洛芬;如果不到6個月,每6小時服用一次泰諾即可。

          “孩子生病時,最好讓孩子感覺舒服,包括降低體溫,”哈德蘭說。

          學校應該繼續開放嗎?

          《財富》雜志采訪的兒科醫生們認為:學校應該以必要的方式保持開放。

          萊特表示,年紀大一些青少年通常會迅速傳播新冠病毒,小一些的孩子傳播效率不高?!八麄兒舫龅目諝忸w粒更少,”她解釋道。

          拉特納說,最初病例激增時期關閉學校是正確做法。但他補充說,根據現在對病毒和兒童的了解,保持學校開放對社會、家庭和兒童發展極為重要。

          “為了盡可能保持學校開放,有很多事可以做,”他說?!笆紫却_??梢越臃N疫苗的人,也就是所有5歲及以上的人都接種疫苗?!?/p>

          “我把孩子送去托兒所,因為我清楚應該采取哪些措施保證安全,”哈德蘭說?!坝行囊婚_始就知道的方法現在仍然適用。生病時呆在家里。戴口罩。增加通風。勤洗手?!?/p>

          阿科洛努對此表示同意。她說:“大多數學校沒條件虛擬開放,孩子能吸收的內容差別也很大。解決這一問題,我們需要靈活性、調整和大量的開拓性思考,但必須保持學校開放?!?/p>

          如果孩子生病了,如何保護其他家庭成員?

          成年人傳播新冠病毒比兒童快得多。多數感染發生在家中,因此保護兒童的最佳方式是確保每位家庭成員都接種疫苗?!氨M管兒童極少出現重癥,但我們一例都不想看到?!?/p>

          如果有孩子新冠陽性,家庭里身體弱的成員,如祖父母或正在治癌癥的人應該保持距離。

          “很顯然父母會在身邊照顧孩子,”萊特說?!暗鶕膊☆A防控制中心的說法,孩子在5到10天里不應該接觸外部其他人?!?/p>

          阿科洛努說,對有孩子的家庭來說,正確洗手和勤打掃表面格外重要。因為孩子很容易通過接觸的東西吸入病原體。

          孩子應該戴口罩嗎?

          阿科洛努說,能戴口罩的都應該戴口罩?!暗?,如果孩子還在蹣跚學步,不管怎么說都會不停摸口罩,而且總會摘掉,那么強迫戴口罩就弊大于利了?!?/p>

          雖然多數航空公司并不要求5歲以下兒童佩戴口罩,但拉特納表示,數據表明2歲及以上兒童戴口罩效果相當好?!昂⒆觽円蛉硕?,我們必須根據自己的情況來做決定,但某些情況下戴口罩用處很大?!?/p>

          哈德蘭補充說,如果孩子做不到正確佩戴口罩,可能沒法發揮所有益處,但他鼓勵家庭成員共同努力正確使用口罩?!昂⒆涌赡茏霾坏窖杆僬_戴面具,好在學得快?!?/p>

          能約著玩游戲嗎?

          當然!如果有可能,盡量安排在戶外。

          “作為家長,我不會因為流感而限制孩子做事情,所以也不會因為新冠疫情限制他們,”萊特說。

          阿科洛諾非常鼓勵戶外活動:“我們不希望解決問題的同時制造新問題。體育活動和社交活動都很關鍵?!?/p>

          進入新的一年,斯馬特建議盡可能地減少聚會規模?!艾F在不適合組織50人派對,但如果是兩三個都接種過疫苗的家庭,應該是可以的?!?

          與斯馬特的看法相同,哈德蘭表示:“如果你的孩子想跟班上另一個孩子一起玩,兩個孩子在其他環境里已經交流頻繁,在學校外一起玩的風險可能不會顯著增加?!?/p>

          斯馬特說,許多父母都希望100%確保孩子永遠不會感染新冠病毒?!暗恍业氖?,傳染病就是這樣。只能盡可能降低風險,底線是多數孩子健康?!?/p>

          斯馬特將基本的新冠防護比作基礎駕駛安全?!氨M管清楚導致兒童死亡主要原因是交通事故,我們還是讓孩子坐車,”她說?!八晕覀冇闷囎魏桶踩珟?。買車時買能力范圍內最安全的車型;遵守速度限制。新冠病毒也一樣。各種層層保護只能讓我們盡可能安全,即便永遠不會降為零?!?/p>

          應該給孩子買脈搏血氧計嗎?

          很多成年人聽取建議,隨身攜帶脈搏血氧儀測量血氧飽和度。主要原因是成年人可能容易出現無癥狀缺氧,即血氧水平驟降,直到為時已晚才能感覺到。但對孩子來說,脈搏血氧計作用沒那么大。

          “兒童血氧水平不足時會用附屬肌肉呼吸,”斯馬特解釋說?!叭绻跛较陆?,孩子會在鎖骨上方的頸部,肋骨之間吸氣并快速呼吸。不需要為孩子買脈搏血氧計,因為如果出現血氧水平低的癥狀,很容易發現?!?/p>

          斯馬特有個兒科護理的基本規則,疫情期間同樣適用。即認真觀察就能判斷孩子有沒有問題。孩子們身體好的時候狀態就會很好,生病時狀態就會變差。

          “如果孩子的血氧含量只有80%,就不會到處玩、表現得正常,”她說?!巴瑯右膊粫泻⒆涌雌饋聿皇娣珜嶋H上身體很好。如果孩子躺在床上不愿意玩,拒絕喝水,對周圍環境沒反應,都是危險的跡象?!?/p>

          哈德蘭也鼓勵家長放棄脈搏血氧儀:“多數情況下脈搏血氧儀沒必要,只會讓家長多擔心一件事?!?/p>

          為了孩子安全,最應該做什么?

          每位兒科醫生都認同:接種疫苗。

          哈德蘭說,現在16歲及以上的青少年可以打加強針,這很關鍵,因為防護奧密克戎病毒方面加強針看起來作用巨大。家里所有符合條件的人都要接種疫苗,因為正如萊特所指出的,多數感染都發生在家里。

          斯馬特說,接種疫苗和加強針,限制與未接種疫苗的人接觸,在公共場合佩戴高質量且合適的口罩是當務之急。

          “作為父母,這些都是能控制的事,”她說?!白钪匾氖欠雷o的層級。只確保一層肯定不能高枕無憂,要確保所有防護都實現,做出明智的選擇。

          “我們知道預防病毒方面疫苗并不完美,但在預防重癥和住院方面效果很好。了解這一點非常重要?!彼柜R特說?!翱梢员苊庠愀獾慕Y果,這點非常重要?!保ㄘ敻恢形木W)

          譯者:梁宇

          審校:夏林

          As the Omicron variant continues surging, hospitalization rates are ticking up, including among children. But questions remain about how much of a risk the new virus poses to kids, how parents can protect vulnerable young ones, and whether the rules are different this time around.

          Fortune spoke with five pediatricians about the science, the risks, and how to care for your child should his or her test come back positive.

          How many kids are getting sick?

          It depends where you are. Dr. Jennifer Lighter, a pediatric infectious disease specialist at New York University Langone Hospital in New York City, said she’s currently treating more children with the flu than with COVID-19.

          “There are 50 pediatric hospitalizations in New York State—not New York City, state,” Lighter told Fortune. “Because it’s so contagious, Omicron cases are sky-high right now, in both children and adults, but children progressing to severe disease is rare.”

          Dr. Katharine Smart, president of the Canadian Medical Association and a pediatrician in the remote Yukon territory of Canada, said she has yet to see a single kid sick with the Omicron variant.

          She noted, however, that Canada typically trails three to four weeks behind the U.S., so she expects numbers to rise soon, and because of the sheer contagiousness of Omicron, that means more kids will catch it. “What happens with kids corresponds with what’s happening in their community,” Smart said.

          But at Comer Children’s Hospital in Chicago, pediatrician Dr. Chidimma Acholonu has seen more children in the hospital in the past month and a half than throughout the entire pandemic.

          “Younger kids are testing positive and having symptoms,” Acholonu told Fortune. “Teenagers in particular are on par with adults in terms of needing respiratory support.”

          “We’re definitely seeing a rise in pediatric infections in Boston,” Dr. Scott Hadland, chief of adolescent and young adult medicine at Massachusetts General Hospital, said. “But it’s worth highlighting that not all kids are admitted because they have COVID; when they come in for something else, they’re automatically given a test. There’s an enormous amount of COVID out in the community, and, inevitably, in the places kids live.”

          How sick are kids getting?

          We don’t have formal data yet, Hadland said, and current figures are anecdotal.

          “There’s been a lot of attention paid to the idea that kids don’t get as sick as other age groups, but they can still get very sick and have enormous complications,” he said. “They’re at risk of long COVID and multisystem inflammatory syndrome, even with mild cases.”

          But on the whole, children who are infected fare better than adults, doctors say. Immune response comes in two forms: innate immunity, which humans are born with; and adaptive immunity, which humans acquire after disease exposure. Kids are better able to combat the coronavirus because their innate immunity is stronger than that of adults, Lighter said.

          The health impact of coronavirus in children is similar to that of the flu, she added; in fact, the flu is more fatal in that age group.

          “Since the pandemic started, 548 children have died of COVID-19; that’s about the same as [die of flu in] a typical flu year,” she said. “No one really talks about that, because it’s taboo to equate COVID-19 to the flu. And you shouldn’t, because in adults, it’s not the same. But with kids, the health impact is similar; severe disease is rare, and the fatality rate is about two per 1 million.”

          “In almost every case, you’d rather be a kid than an adult with COVID, and rather an adult than an elderly person,” Dr. Adam Ratner, director of the pediatric infectious diseases division at Hassenfeld Children’s Hospital at NYU Langone, told Fortune. “On a person-to person basis, kids are much less likely to have severe disease than adults. But when a huge chunk of the population is infected, you’ll see more severe disease in kids, even if it’s a rare outcome for any individual kid.

          “While COVID certainly hits adults harder than children, in the aggregate, that doesn’t mean you don’t end up with very sick children,” Ratner said, adding that while the odds of severe disease for kids of all ages is low, it’s much higher for unvaccinated kids.

          Are newborns protected?

          Lighter’s recent study, published in September by the American Journal of Obstetrics & Gynecology, showed that among pregnant women who received the vaccine, the cord blood that went to their baby was rich in antibodies.

          “Vaccinated and boosted moms will provide their babies protection for the first few months of life,” Lighter said. “Breastfeeding can also transmit antibodies, but not at the level of pregnancy vaccination.”

          But for Omicron specifically, it’s impossible to know, Hadland said, “just because we know so little about the variant at this point.”

          Should I take my kid to their pediatrician or to the ER?

          As with any other ailment, parents should use their best judgment.

          “Some kids who test positive don’t have to go either place,” Ratner said. “If they’re not having trouble breathing or don’t have a persistent high fever, they don’t necessarily need medical attention.” ERs are still concerningly busy, though, so a great way of making the call would be contacting a pediatrician first: “Most are happy to help make the decision and triage concerns.”

          COVID is a respiratory illness, Smart said, which means parents should watch their COVID-positive kids the way they’d watch them with any other respiratory virus, such as the flu or bronchitis. If a child has trouble breathing, it’s time to go to the hospital.

          “If a kid looks like they’re huffing and puffing, or they’re feeling short of breath and turning off-color, go to the hospital,” she said. Other main reasons for a hospital visit: if a child is really lethargic, not responding normally, or is dehydrated and unable to keep liquids down.

          “In the ER, we’re only going to do so many things,” Acholonu said. “When a kid’s breathing becomes so labored that they compensate with other muscles and tire out, they may need to be intubated. We try to avoid that by giving them extra oxygen sooner through a nasal cannula.”

          Signs of reduced breathing include panting visible in the throat or near the collarbone, or in the abdomen or rib cage. Kids may also show signs of dehydration when they cry but aren’t producing tears.

          “Managing COVID is the same as managing other viruses—most of it is just TLC at home,” Acholonu said.

          Can I give my kid a fever reducer?

          At the beginning of the pandemic, some doctors expressed concerns about administering fever-reducing medicines to kids with COVID. Those concerns proved unfounded, Ratner said, and treating fevers with Motrin or Tylenol is fine.

          “Whatever you would normally do for a kid with a fever—and for most people, that means something like ibuprofen—that’s fine to do with COVID,” he said.

          Most COVID symptoms can be managed at home, Smart said, by administering Tylenol or Advil and providing ample clear fluids. “Most of the care children with a viral illness need is comfort care, not emergency care,” she said. “Hospitals are for medical treatments, like oxygen and IV fluids, which kids don’t usually need.”

          Acholonu recommends fever reducers, too; children 6 months and older can alternate between Tylenol and Motrin every three hours; under 6 months, stick with Tylenol every six hours.

          “It’s best to help your kids feel comfortable when they’re ill, and that includes reducing their fever,” Hadland said.

          Should schools stay open?

          The pediatricians Fortune spoke with agree: Yes, schools should stay open, by any means necessary.

          Often, Lighter said, older adolescents can spread COVID-19 quite quickly, while younger kids aren’t as efficient. “They’re just breathing out so many fewer air particles,” she explained.

          Closing schools during the initial surges was the right thing to do, Ratner said. But with all we know now about the virus and kids’ role, he added, keeping schools open is vital for society, for families, and for kids’ development.

          “There are multiple things you can do to try to keep schools open as best you can,” he said. “The primary thing is anyone who’s eligible for vaccination, that’s everyone aged five and up, must get vaccinated.”

          “I’m sending my kids to day care, because I know there are ways we can do this safely,” Hadland said. “There’s a lot we’ve known from the very beginning that still applies now. Stay home when you’re sick. Wear masks. Increase ventilation. Wash your hands.”

          Acholonu agrees. “Most schools just aren’t equipped to operate virtually, and there’s a huge discrepancy in what kids are able to retain,” she said. “It’ll require flexibility, adjustments, and a lot of thinking outside the box, but we’ve got to keep them open.”

          If my kid is sick, how can I protect other members of my family?

          Adults transmit COVID-19 more efficiently than kids do, Lighter said. Most transmissions occur in the home, so the best way to protect children is to ensure every member of the family is fully vaccinated. “Even though severe disease is rare in children, we don’t want any.”

          If a child is COVID-positive, any vulnerable member of the household, such as a grandparent or individual undergoing cancer treatment, should keep his or her distance.

          “The parent will obviously take care of and be around that child,” Lighter said. “But then that child, according to the CDC, shouldn’t be around other people outside the house for five to 10 days.”

          Especially important in households with kids is proper handwashing and wiped down surfaces, Acholonu said; kids are prone to ingesting pathogens through what they touch.

          Should my toddler wear a mask?

          Anyone who can wear a mask should do so, Acholonu said. “But if you have a toddler who’s just going to keep touching it and taking it off anyway, you’re doing more harm than good.”

          While most airlines don’t mandate masks for children under 5, Ratner says data suggests kids age 2 and older do fairly well with mask wearing. “There’s kid-to-kid variability, and you have to choose your battles, but there are places where it can be very valuable.”

          If a child isn’t able to wear a mask appropriately, it probably won’t offer the full benefit, Hadland added, but he encourages families to work together on proper mask usage. “Kids may not immediately do well with masks, but they learn.”

          Can we have playdates?

          Sure! But, if possible, bring them outdoors.

          “As a parent, I don’t restrict my kids from doing things because of the flu, so I don’t do it because of COVID-19,” Lighter said.

          Acholonu strongly encourages outdoor play: “We don’t want to make new problems while trying to solve other ones. Physical activity and socializing are key.”

          Going into the new year, Smart recommends keeping your playdate bubble as small as possible. “Maybe now isn’t the time for a 50-person party. Maybe limit it to two or three other families, also fully vaccinated.”

          Hadland says the same: “If your child wants to have a playdate with another kid from their class, your child and that child have already been mixing in another setting and probably doesn’t substantially increase the risk to hang out with them outside of school.”

          Many parents look for 100% guarantees of never getting COVID, Smart said. “But, unfortunately, that’s now how infectious diseases work. It’s about risk mitigation, and the bottom line is, most kids do fine.”

          Smart likens basic COVID protections to basic driving safety. “Our kids ride in cars even though we know the leading cause of death in kids is motor collisions,” she said. “So we use car seats and seat belts. We buy the best safest vehicle we can afford; we obey the speed limit. COVID’s like that; these layers of protection make us as safe as possible, even though it’ll never be zero.”

          Should I buy a pulse oximeter for my kid?

          Many adults have been advised to keep a pulse oximeter on hand as a tool for measuring oxygen saturation in the blood. This is because adults can be prone to silent hypoxia, which is when blood oxygen levels plummet with no discernible feeling—until it’s too late. But a pulse oximeter isn’t nearly as useful for kids.

          “Kids with low oxygen use accessory muscles to breathe,” Smart explained. “If their oxygen levels are dropping, they suck in at the neck above the clavicle, between the ribs, and breathe quickly. You don’t need to buy a pulse ox for a kid; if they have low blood oxygen, you’ll notice.”

          Smart has a basic rule about pediatric care which remains true even during COVID: You can tell when something’s wrong with a kid by looking at them. Kids look fine when they’re fine, and don’t look fine when they’re not.

          “You won’t have a kid playing around, acting normally, if their blood oxygen is at 80%,” she said. “Likewise, you won’t have a kid who looks really unwell but is okay. If they’re lying in bed, and you can’t get them to play, and they’re refusing fluids and not responding to their environment, those are danger signs.”

          Hadland also encourages parents to forgo the pulse oximeter: “It’s not needed in most cases, and just puts them in the position of worrying about yet another thing.”

          What is the best thing I can do to keep my kid safe?

          Every pediatrician agrees: Get vaccinated.

          Boosters are now available for teens age 16 and older, Hadland said, which is key, as boosters appear to make a huge difference in Omicron protection. Everyone in the household who’s eligible needs to get vaccinated, because, as Lighter points out, most transmissions happen at home.

          Getting fully vaccinated and boosted, limiting contact with unvaccinated people, and wearing high-quality, well-fitting masks in public are top priorities, Smart said.

          “As a parent, those are the things you can control,” she said. “What’s most important are the layers of protection. One thing isn’t a magic bullet; it’s about doing all these things together, and making smart choices.

          “We know the vaccines aren’t perfect in prevention, but they work very well in preventing severe disease and hospitalization; that’s so important to understand,” Smart said. “Bad outcomes can be avoided, and that’s what matters.”

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