As therapy centers re-open, parents and caregivers are trying to determine if it’s safe for their child to resume face to face therapy. It’s important to have as much information as possible to make the best decision for your child and family. You are the best advocate for your child. The decision to return to therapy is first and foremost, yours! Below are factors to consider.
Should my child resume face to face therapy right now?
Although many therapy centers are beginning to offer face to face services again, it may or may not be the right time for your child to resume therapy. The spread of COVID-19 has decreased, but it is still present in the community and the potential for infection remains a significant concern among public health officials. You may want to consider the following factors as you make your decision;
• How feasible is it that your child will be able to understand and comply with the precautions listed below? For example;
o Does your child have a lot of sensory seeking behaviors (i.e. touching things, putting things in their mouth)? o Face masks are recommended for all children over two years of age. If your child won’t wear a face mask, your behavior therapist maybe able to work with your child to increase tolerance and compliance. o Can you child tolerate frequent handwashing or use of hand sanitizer?
o Does your child understand physical distancing/maintaining 6 foot distance from therapy/clinical staff?
• Has your child experienced significant regression or problematic behavior without face to face services?
• Could your child benefit from or continue to benefit from telehealth services right now?
• Would your child benefit from a combination of telehealth and face to therapy? This option would reduce the risk of infection by limiting the number of face to face therapy sessions.
• Do you, your child or other individuals living in your home have any medical conditions that increase the risk of severe illness or hospitalization if they contract COVID-19? Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19. Based on what we know now, those at high-risk for severe illness from COVID-19 are:
• People aged 65 years and older
• People who live in a nursing home or long-term care facility
• People of all ages with underlying medical conditions, particularly if not well controlled, including:
• People with chronic lung disease or moderate to severe asthma
• People who have serious heart conditions
• People who are immunocompromised
• Many conditions can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications
• People with severe obesity (body mass index [BMI] ≥40)
• People with diabetes
• People with chronic kidney disease undergoing dialysis
• People with liver disease
• Individuals with disabilities are not a high-risk category in themselves, but those with disabilities who have other medical conditions may be
Specific Considerations for Children;
• Some children do not present with typical symptoms of COVID-19. The CDC is working with state and local health departments to investigate reports of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 and gather more information as quickly as possible about how common it is and who is at risk. MIS-C has been described as inflammation (swelling) across multiple body systems, potentially including the heart, lungs, kidneys, brain, skin, eyes, and gastrointestinal organs. Signs and symptoms of MIS-C include fever and various symptoms such as abdominal pain, vomiting, diarrhea, neck pain, rash, and feeling tired.
What is your provider’s current plan to minimize risk of infection?
Your provider should be aware of local and state public health recommendations regarding COVID-19 prevention. Ask about the plan your provider has for implementing and monitoring safe practices, for staying up to date about changes to current recommendations, and how management will assure all precautions are being consistently and comprehensively implemented across the facility or in the home. Some safe practices include, but may not be limited to;
• Daily screening for staff, children, and caregiver
o Remember, although daily screening, including temperature taking, can be helpful in preventing the spread of infection, it may provide a false sense of security. People who have COVID-19 can be contagious for fourteen days before developing any symptoms.
• Social distancing strategies
• Curb side drop off and pick up
• Closed or limited use of lobby/waiting room
• One child per therapist only
• Use of same therapy room
• Disinfecting and cleaning of the facility
• Access to and correct use of appropriate PPE
AAoM Medical Advisory Board Members
Tisa Johnson, M.D. Medical Director and Developmental Pediatrician, Henry Ford Hospital
Stefani Hines, M.D. Developmental and Behavioral Pediatrics, Beaumont Health
Michael Geheb, M.D. MD, Nephrology, SVP Beaumont Health (ret.)
Janessa Manning, Ph.D. Neuropsychology, Wayne State University
Sarah Mohiuddin, M.D. Psychiatry, University of Michigan
Steven Pastyrnak, Ph.D. Spectrum Health, Helen DeVos Hospital
Jenny Radesky, MD Developmental & Behavioral Pediatrics, University of Michigan
Kara Brooklier, Ph.D Department of Psychiatry and Behavioral Neurosciences, Wayne State University The Children’s Center, Autism Services Program
Neel Soares, M.D., Division Chief, Developmental-Behavioral Pediatrics Western MI University, School of Medicine