Starting at birth, children routinely receive immunizations against a variety of dangerous diseases. But due to the COVID-19 pandemic, parents may be waiting to begin—or resume—immunizations. Amy DeMattia, MD, MPH, Clinical Professor in Pediatrics at the Icahn School of Medicine at Mount Sinai, explains why it is important not to delay most immunizations and answers questions about the safety of the doctor’s office.

My child is very healthy. Why do they need to be immunized?

Immunizations are safe, very effective, and a routine part of pediatric health care. There are a number of important reasons to get your child immunized. First—and arguably most important—it can save your child’s life. We immunize children against 14serious diseases, including whooping cough, diphtheria, tetanus, mumps, measles,rubella, rotavirus, polio, chickenpox, hepatitis B, and meningitis.

Some of the conditions we immunize against can cause serious illness, complications such as loss of hearing or brain damage, or even death. The danger is not just in the developing world. In the United States, measles, mumps, and whooping cough infect and cause severe illness in children each year.

In addition, immunizations enable us to help protect each other. Some children cannot be safely immunized, including those who are too young, are immunocompromised, or are taking certain medications. If enough people are immunized against a disease, it means there is significantly less chance anyone will become infected. This is called “herd immunity.” The number of people who must be immunized depends on how contagious that condition is. 

How do immunizations work?

Vaccines work by teaching the human body to recognize and fight off potentially harmful diseases. We give (either by mouth or through injection) a small amount of a weakened or dead virus or bacteria (called a pathogen) into the body. The body recognizes these pathogens as “foreign invaders” and responds by creating antibodies. Because the pathogens in the vaccine are already weakened or dead, they can’t hurt you. But the antibodies your body has developed can fight the infection—and “remember” the pathogen. Then, if the pathogen enters the body again, the antibody is already there, ready and able to fight it off. Some vaccines require more than one full dose to “teach” your child’s body to recognize and defend against the disease.

Can I delay getting my child immunized until after the pandemic?

The U.S. Centers for Disease Control and Prevention (CDC) developed the current immunization schedule based on how children’s immune systems respond to vaccines at various ages and how likely your child is to be exposed to a particular disease. It is important to follow the schedule so that your child is fully protected before possible exposure. Infants, like older people and those who are immunocompromised, are considered especially vulnerable. We want to get them the protection they need when they need it.

Is there any flexibility on delaying or spacing out vaccinations? 

If you have any questions about vaccination scheduling, talk to your pediatrician first. Your doctor will know if there are any conditions that could affect your ability to delay an immunization.

In general, children under the age of two years require timely vaccination without any significant delay. There is more flexibility for children over age two, but this depends on the specific vaccination—not all can be delayed—and your family’s individual situation. For instance, in most cases you can take your child in for their second MMR vaccine anytime after four weeks from their first dose, though most children receive this vaccine between the ages of four and six years. Of note, however, many schools in New York State require two doses of the vaccine in order to attend. After one dose of the MMR vaccine, about 93 percent of people are immune to measles; the second dose raises that to 97 percent. While this might not seem like a big difference, it is significant in the world of immunology. 

Is it safe to take my child to a doctor’s office? 

We are fully committed to the safety of our patients and staff. While we understand that you may feel nervous, please know that we have put stringent protocols in place to protect every person, regardless of age.

As the number of COVID-19 positive cases continue to decrease across New York State, many families are wondering how to resume activities in their children’s lives. We spoke with Catherine Spaulding, MD, a pediatrician at Mount Sinai Urgent Care, to get advice on how parents can safely host playdates, have children attend summer camp, and otherwise get their children outdoors.

Overnight camps have officially been cancelled in New York State for this summer. What precautions should parents take if they are sending children to a day camp?

The New York Health Department has laid out a number of measures for day camps and other child care facilities to follow to ensure children’s safety. These steps include but are not limited to social distancing practices—such as having fewer campers together at a time—staggering drop off and pick up times, limiting non-essential employees and visitors to the camp, and mandating that all employees and campers wear a face mask when they are less than six feet apart. Other mandatory practices include enhanced cleaning and hygiene practices, improved access to hand sanitizer throughout the camp, and encouragement of frequent hand washing during the day.

Camps are also required to screen all employees, vendors, visitors, and children for  symptoms or known exposure to a person with confirmed COVID-19 within the past 14 days. However, you can also keep your children and others safe by watching for signs of illness in your child. If you think they are getting sick for any reason, keep them at home, inform the camp, and talk with your doctor about next steps.

For more information about day camps in New York, check out these guidelines from the New York State Office of Children and Family Services.

How can parents safely organize playdates and trips to the playground?

The Centers for Disease Control and Prevention still recommends against playdates with children from other homes. However, if you choose to host a playdate, it is best to keep the group of kids as small as possible. Encourage outdoor playtime and handwashing for at least 20 seconds with soap and water throughout the day, especially after being in a public setting such as a playground. If the playdate involves transportation, try to space the kids as far from one another as possible in the car and drive with the windows down. As in any public space, it is always recommended that any child above the age of two wears a face covering.

Now that larger gatherings are allowed, can children attend birthday parties, cookouts, or other get-togethers?

Large gatherings are safest if they can be held outdoors and if social distancing is respected. A face covering should be worn, and everyone should use hand sanitizer or wash hands frequently throughout the event. If your child has any signs of illness, such as a cough or fever, they should stay home and avoid contact with other children. If you are hosting an event, it may be helpful to talk with other parents beforehand and encourage them to keep their kids at home if they have any symptoms.

Also, it is important to keep in mind that different parts of New York are in different phases of reopening, which changes the number of people allowed at one time. For instance, Phase One allowed ten-person gatherings while in Phase Three allows up to 25 people to gather. Before organizing any event, find out what phase of reopening your region is currently in on the New York Forward site.

If parents are uncomfortable connecting with other families for playdates or get-togethers, what outdoor activities can parents arrange to keep their children active?

Keeping your kids active and promoting time outdoors is really important for their physical and mental health. Outdoor activities such as riding a bike, going for a walk or run, or taking a hike are great ways to keep your children healthy and safe while simultaneously encouraging physical activity. It is best to avoid group activities like basketball or football since these sports require close contact with other kids. However, kicking a soccer ball around is a great option for outdoor play—just remember to wipe the ball clean before and after use.

For more ideas about how to safely engage in outdoor activities, check out this piece from HealthyChildren.org, a website from the American Academy of Pediatricians. 

The COVID-19 pandemic is incredibly stressful for adults and can be puzzling and frightening for children. Aliza Pressman, PhD, co-Founding Director and Director of Clinical Programming for the Mount Sinai Parenting Center, shares advice for parents and guardians on how to manage your child’s anxiety as we navigate the uncertain times of COVID-19.

Are there steps I should take to help my child’s mental health?

This is a very confusing time for adults and kids. Typically, when kids are going through a new experience it is one that we, the adults, have been through. We’ve worked through it, we’ve grown up, and we’ve come out the other side. In this case, none of us have ever been through this and so our kids can’t look to us for that safe secure feeling. We don’t have a road map.

Be honest with your kids. Tell them that you know this is a new experience for all of us. Tell them that you understand if it feels scary or if they are worried. Remind them that you are right there with them.  

How should I respond to my child’s anxiety?

Give your child permission to talk about what they are feeling and worrying about. Acknowledge their anxiety even if it has nothing to do with COVID-19 or is only slightly related to the pandemic. For instance, children may feel stress because they miss their friends or aren’t allowed to celebrate an event like a graduation or birthday. Try not to diminish their feelings or say ‘we have bigger things to worry about than your birthday party.’ Instead, tell them that you know it’s really hard. Let them know that you are aware that this is a big change. Assure them that you can figure out how to have celebratory experiences, even if they are not quite how you originally planned them.

This is a very challenging time for everyone. You can explain to children that they are being asked to be health superheroes. Through the practice of social distancing and by washing their hands thoroughly, they are keeping themselves safe and helping to protect others who are more vulnerable. This is a wonderful, empowering message that does not scare children.

Is it important that I keep my child’s routines going?

Although it can be hard to keep routines going during a time that has very few routines, kids and adults thrive on knowing what to expect each day. So, try to set up a flexible routine for the coming weeks or months.

I encourage writing out a plan for your children. If they are younger, you can draw a picture of the routine of the day or use photos from magazines to help them understand what to expect. Ask older children to come up with what they think is a good daytime routine. You want to make sure they are comfortable with the schedule, but you also want to get certain boxes checked about what needs to happen each day. Make sure that it includes something healthy for their bodies, something healthy for their brain, something healthy for their relationships, and so forth.

It’s also important to let children have some enjoyment. Allow them to be happy about getting out of some obligations they had prior to practicing social distancing. Your kids might be a little bit happy about spending more time at home with their parents. Let them know that it’s okay to have mixed feelings.

Also, allow yourself to embrace the new normal and accept that there may not be a completely perfect routine and predictable day-to-day experience. Children need to know what to expect, but they’re also very flexible if you explain clearly that there may come a time when the unexpected will arise. Children can take in new information and, if you are consistent, they will understand that you are there for them. Finally, if you are having any concerns about you or your child’s health and wellbeing, be sure to reach out to your health care provider for guidance and support.

Dr. Pressman is the host of parenting podcast Raising Good Humans. Recently, she and Mariel Benjamin, LCSW, from The Mount Sinai Parenting Center, answered questions from health care providers and staff on the front lines to help support their parenting curing COVID-19. Additionally, The Mount Sinai Parenting Center maintains a COVID-19 resources page for parents, caregivers, and health care workers.