COVID-19: On Masks for Kids, Hand Sanitisers, School Holidays, and More

This article was written by Dr Mohana as a contribution to Singapore Motherhood magazine at the start of the Covid-19 pandemic in March 2020.

Singapore has repeatedly been lauded by international health officials for its ‘gold standard’ response to COVID-19 detection. However, there is no doubt that the virus forges on undeterred, both locally and globally. So, let’s not let complacency set in. We ask Dr Mohana D/O Rajakulendran, a paediatrician at Parkway East Hospital, some questions ahead of the March school holidays to find out what parents should take note of.

1. My children take public buses and trains to school and back each day. Should they wear masks?

Wearing masks isn’t a foolproof measure for protecting our children, as there is always surface spread to think about. The risk of travelling on public transport holds a similar risk as walking through a crowded shopping centre. It’s only when your child is unwell should they wear a mask to prevent the spread of viruses.

Furthermore, I would consider several factors in deciding how to use masks appropriately in children. The shortage of masks that some countries are already facing is worrying. Couple this with the fact that many international experts foresee that COVID-19 will last several months or longer. Masking up all the time is just not sustainable.

2. What if they are taking the school bus? Should they mask up then?

There is even less to worry about if your child takes the school bus. ECDA and MOH have taken stringent screening measures in preschools and schools. Hence unwell children should not even be on school buses to begin with.

Locally, mortality rates for even those with severe disease are promising, and overall worldwide mortality rates are not high. Also, our children who do get COVID-19 are mostly manifesting mild disease. I hope these facts are sufficient to reassure parents to use masks responsibly.

3. I can’t find surgical masks for my kids because they are sold out everywhere. Can they wear adult ones?

Masks are generally not suitable for infants and toddlers below the age of three years. When masks are worn, they increase the resistance against breathing, and increases the levels of carbon dioxide in the dead space contained behind the mask. This may result in hypoventilation in young children who have smaller lung capacities.

An effective face mask seal requires moulding of the top of the mask over the nasal bridge, and the bottom of the mask pulled down over the chin. Hence it will not be effective to use masks made for adults on young children.

4. Then should I let them wear N95 masks? What about washable/reusable masks?

Most N95 masks are suitable only for children aged 12 and above as they are catered for an adult fit. There is limited availability of specialised N95 masks for children aged 7 to 12 years.

I would caution against the use of cloth masks. Studies have shown that cloth masks are not as effective as medical-grade masks. Even more worryingly, the rates of respiratory illnesses with the use of non-medical masks may be higher. This is due to moisture retention, reuse of masks and poor filtration of droplet particles.

However, there is no need to despair. Simple hygiene measures such as washing your hands with soap and water has been proven to be more effective than the use of surgical masks or N95 masks in preventing viral transmission.

5. Many children have extra classes outside of school. E.g. group tuition, piano lessons (in a music school or a teacher’s home), ballet classes, swimming lessons, and other sports lessons from taekwondo to tennis. What is your advice on continuing to attend such activities?

Your child can continue with these activities if they are well. Parents can check that the enrichment centres and teachers take adequate measures for your child’s safety. These include obtaining travel declarations, keeping those returning from high-risk areas — both teachers and students — away for the stipulated leave of absence, and temperature screening for all staff and students.

Additional precautions to help curb the spread of viruses include opening windows in the classroom to improve ventilation, making hand sanitisers available for in-classroom use, and wiping down desks and other equipment between classes. For outdoor activities, there is a lower risk of transmission of COVID-19 in open-air areas with good ventilation.

6. The March school holidays are approaching. Is it safe to bring the kids to their favourite play zones, such as indoor and outdoor playgrounds and water parks?

Avoid crowded and confined indoor areas during the holidays. Yes, monitored indoor playgrounds are likely to implement temperature screening measures. However, it is hard to screen for contact and travel history in all attending patrons and their families. Play area surfaces can also spread viruses among children, who seem to have milder and less noticeable symptoms to begin with.

Outdoor play in well-ventilated areas can continue if your child can be compliant to hygiene measures. This means frequent hand washing after touching play equipment, and not touching their faces. While the virus is not water-borne, similar concepts need to be considered for water play areas in malls and parks. In fact, several play areas in malls have been closed temporarily due to concerns about COVID-19.

Remember that this advice also holds true to prevent the spread of many other childhood viral illnesses, such as the common flu, HFMD, etc. The most important step in prevention of these illnesses — and COVID-19 — is social responsibility. Keep unwell children at home until they have completely recovered from all their symptoms. Adults who are unwell should also not accompany well children to these play areas. Healthy children should continue practising good hygiene habits.

7. Is it safe to go on family vacations overseas? If it’s not safe to fly, what about taking a ferry to nearby resort islands like Bintan?

The main concern about air or sea travel is being confined in enclosed premises (plane or ferry) in close proximity with a crowd of people over an extended period of time. There is always a risk of catching viruses from other travellers who are unwell, through droplet spread or surface contact.

If travel is non-essential, it may be best to postpone it for now. If you do decide to go ahead with any mode of travel, then be vigilant for signs of illness in your child. Seek appropriate medical attention and evaluation.

8. Do I need to keep my home disinfected to keep my family safe from COVID-19?

Other than regular handwashing with soap and water, there is no need for constant home disinfection. If a family member has been recently unwell with viral symptoms, COVID-19 or otherwise, it is then advisable to disinfect home surroundings daily and after they have recovered. This will help reduce spread through contaminated surfaces to other members of the household.

9. What’s your take on those homemade hand sanitisers? Yay or nay?

Nay! It is important to note that not all cleaning products or sanitisers are made the same. The most effective sanitisers against viruses are those containing ethanol at high concentrations (e.g. 95%). Next best (in order of preference) are those with lower concentrations of ethanol (60-85%), isopropanol (60-80%), or n-propanol (60-80%).

It has been proven that ‘natural’ products are less effective against viruses and other pathogens as compared to commercial disinfectants. While homemade sanitisers may be safe to use, they are likely to lack efficacy, compared to the more concentrated and commercially formulated hand sanitisers.

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