Stuck inside during the coronavirus lockdown, 5-year-old Kian Assad was entertaining himself by dancing around his McAllen, Texas, house a few weeks ago when he fell, hitting his head on a door hinge.
In normal circumstances, it was the type of injury that would likely merit a trip to the emergency room. Blood was gushing out of a cut on Kian’s scalp.
But with hospital ERs teeming with coronavirus patients, Kian’s father, Dr. Christian Assad, was not sure he wanted to go and risk exposing his family, which includes a newborn, to the virus.
So Assad, an interventional cardiologist, weighed his options. After examining his son, he decided he would rather handle the injury himself — despite the fact that he had not treated head wounds since he moonlighted in an emergency department seven years ago.
“Like everything we do in medicine, it’s a calculated risk, and my calculated risk was this is what we have to do,” Assad said, adding that had it not been for the threat of COVID-19, the illness caused by the coronavirus, he would have been more open to going to the ER.
He informed his wife, who was panicking at the sight of so much blood, that he needed her help closing the wound — at home. It was not what she expected to hear.
“She’s looking at me like I’m crazy,” Assad said.
Across the country, parents sheltering in place are trying their best to keep restless children safe at home — not just from the coronavirus, but from anything else that might merit a hospital visit.
And as kids gleefully dive off furniture, climb on dressers and fall off trampolines, their parents are telling them over and over again: Now is not an ideal time to have to go to the emergency room.
Fearful of catching the coronavirus in a crowded hospital — and not wanting to take up health care workers’ precious time for something unrelated to COVID-19 — parents are begging their children to be more cautious.
But kids will be kids, especially if they’re cooped up inside, and their parents’ pleas have gone unheeded.
“I feel like they get worse every time I say it,” Meghan Mojica, a mother of four in Orlando, Florida, said. “They take it as a challenge.”
Mojica said her youngest, who is 2, has been climbing on top of the dining table; her 6-year-old has discovered that if he throws a pencil into the ceiling fan, it shoots across the house; her 3-year-old has started tipping her chair dangerously far backward; and recently, all four kids were climbing inside their play kitchen when part of it fell over, crushing her 8-year-old son’s finger.
The finger bled a lot, but after consulting over the phone with her mother, a retired nurse, Mojica got the bleeding to stop and felt no medical treatment was necessary.
She might have considered an ER visit at a different time, she said.
“We obviously would never put him at risk. It wouldn’t have even been a question if there wasn’t a pandemic — just take him in to see if he needed stitches,” Mojica said.
If you have to go to the emergency room, go
Parents of young children are not the only ones reluctant to go to an emergency department at the moment.
Throughout the United States, ER physicians have reported a decrease in non-coronavirus emergencies at their hospitals. Possible reasons include fewer individuals getting sick or injured while they are staying home, and the chance that some people are putting off going to the hospital for fear of exposure to the coronavirus.
At Children’s Healthcare of Atlanta, one of the largest pediatric clinical care providers in the country, procedures have been implemented to protect staff, patients and their families, Dr. Srikant Iyer, chief of emergency services, said.
“Parents have a lot to worry about right now with staying home and homeschooling. We just want to make sure we minimize the stress of coming to an emergency department,” he said.
Among the new measures: screening everyone upon entry for a fever or other signs of viral illness and only allowing one adult to accompany each pediatric patient.
Like other emergency departments across the country, the three that are part of Children’s Healthcare of Atlanta have seen a decrease in volume since the pandemic started, Iyer said. He saw that as a positive sign that social distancing measures were possibly reducing transmission of other viruses, such as the flu.
But he urged parents not to avoid hospitals if their child needs to go to one, and said they should trust that emergency rooms are taking precautions.
At Children’s, most families are now taken directly to private patient rooms after checking in as opposed to lingering in the lobby, and care areas are divided into two sections — one for patients suspected or confirmed to have infectious diseases, and the other for all other injuries and illnesses.
Even introductions are orchestrated: Iyer greets his patients’ caregivers from 6 feet away, rather than with a handshake like he would have before.
Parents who have had to seek medical care for their child during the pandemic say it was not as bad as they feared.
Javon Johnson of Fairfield, California, has four children ranging in age from 5 to 18. She homeschools them, so she has not had the adjustment of suddenly having them home more than usual.
But play dates and park outings have been canceled, so instead, the kids spend time on their outdoor trampoline. Earlier this month, despite Johnson telling her children to be careful because they don’t want to add extra work for local doctors and nurses, her 5-year-old, Juliana, fell off the trampoline. Her arm immediately swelled up.
“My first reaction was: Put some ice on it, we don’t want to go to the hospital if we don’t have to,” Johnson said.
Johnson called the pediatrician, who told her to bring Juliana in. Johnson’s husband took Juliana and was pleased to see very few other people at the doctor’s office. The pediatrician wanted an X-ray of Juliana’s arm, which they were able to get in the same building.
Juliana had a minor sprain and went home with a splint. Johnson was relieved — and determined not to let the incident change how she parents.
“We don’t want to scare our kids into thinking you can’t live or play or be a kid,” she said. “And we don’t want our kids to be fearful of the doctor or the hospital. So, we’re just trying to balance it.”
A boost for free-range parenting?
That’s a lesson that some are hoping will stick, even after the pandemic.
“I think this is giving lie to the crazy things that we considered dangerous before there was a true danger on our horizon,” said Lenore Skenazy, founder of the “free-range parenting” movement, which calls for a return to a more laid-back style of child-rearing instead of helicopter-style parenting. “Kids waiting five minutes in a car? Kids playing on the front lawn alone? Give me a break.”
The pandemic, she added, is something for parents to be “justifiably worried” about, and she hoped it would highlight how unnecessary it is to sweat the small stuff in a culture where many parents feel like they should be able to fix all of their children’s problems.
But parental guilt is tough to avoid, during a pandemic or otherwise.
Sonya, a mother of two young boys who asked that her last name not be printed to protect her family’s privacy, relocated with her sons and husband from Boston to Durham, North Carolina, on Feb. 28, right before shelter-in-place orders began.
The family moved into temporary housing — a furnished apartment that is not particularly childproof, she said — expecting to look for their permanent house in the weeks that followed.
Instead, they are there indefinitely. And while Sonya and her husband work from the apartment with daycare closed, their 4-year-old and 1-year-old are getting more screen time than she would like — with videos and iPad games serving as a “digital babysitter” for the kids when their parents are swamped with work.
The kids get “zombie-like” after too much screen time, Sonya, a book publicist, said.
“You get your time to do your work, but they’re miserable. They don’t sleep as well, they have all these frustrations they have to get out,” she said.
Her younger son has quickly found areas that are not childproofed. He has been climbing into drawers of a dresser that the rental apartment did not secure to the wall. He and his older brother have also toppled suitcases onto themselves while building forts.
Still, Sonya said she is keeping them home as much as possible so she does not contribute to the overwhelmed health care system.
“We feel like our duty is to stay home and not be idiot parents who would feel horrible if my son broke his arm and we had to take him to the emergency room,” she said.
Not a doctor? Don’t try this at home
Assad, the Texas cardiologist whose son, Kian, cut his head, feels lucky that he had the medical training to help his child at home. He cleaned out the wound and trimmed the hair over it to get a better look at the cut.
It was easy to push the two sides back together, and the cut was not deep, so Assad enlisted his squeamish wife to hold together their son’s scalp while he used Dermabond, a medical super glue, to close it.
In the emergency room, doctors likely would have used staples or sutures on such a wound, Assad admitted. Afterward, he brought Kian to a friend who is a plastic surgeon and asked him to take a look. The surgeon said Assad did a good job but warned that if the cut reopened in the following five days, he would need to take Kian to a clinic.
The cut ended up healing perfectly. Kian did not display any signs of a concussion after hitting his head, so Assad felt comfortable with his decision to keep him home.
While he understands other parents’ reluctance to go to the emergency room, he cautioned that in a true emergency, those without medical backgrounds should go.
“The reason why I did this is I have the experience in my training, and basically I decided to use those skills,” he said. “If you don’t wash it properly, there’s a chance of infection.”
Kian is back to being a happy kid now. Assad said he looks forward to eventually telling the story of how he superglued his son’s head back together during a pandemic at Kian’s wedding.
“My first thought was: You have to choose this God-forsaken time to have a laceration?” Assad said. “I could not believe it.”