Transitioning Children During COVID-19

Posted by Nurse Linda in Life After Paralysis on May 25, 2022 # COVID-19, Health

Many individuals and reduced regulations would make you believe COVID-19 is almost over, but this would be a false assumption. Viral loads in communities go up and down with new variants. The COVID-19 virus is still among us. The COVID-19 virus will still be in the environment and will continue to be there. There are vaccinations and treatments now which help recovery. However, these are not all available to children. Therefore, precautions still need to be in place for especially vulnerable individuals, including children, those who are immunocompromised (those with limited ability to fight infections and viruses) or both.

Children who are not eligible for vaccination and who have neurological issues such as paralysis from trauma or disease are at a higher risk for COVID-19 as well as other types of infections from bacteria, viruses, fungi, and parasites. This is because the autonomic nervous system (ANS), the part of the nervous system that automatically controls immune response, can be affected. How significantly the autonomic nervous system is affected is generally unknown. The ANS can be slow to recognize an invader in the body, slow to respond to the invader, or mount no immune response at all.

In the case of COVID-19, a child with neurological issues may have minimal symptoms or a full-blown COVID infection. There is a noticeable difference in the numbers of children who have less incidence of COVID-19 development than adults. This phenomenon is still under study, but the thought is that children have a more effective immune response, less co-morbidities, and fewer ACE-2 receptors that the COVID virus prefers to attach to for entrance into the body. However, those with neurological issues may have a less effective immune response due to issues of the ANS, may have more co-morbidities and have more exposure to ACE-2 receptors in the respiratory tract but also in the urinary and bowel systems that have exposure through catheterization and bowel programs.

CDC graphicVariants of the COVID virus can react differently in children than in adults. The CDC noted in December of 2021 that five times the number of all children (regardless of neurological disease) were hospitalized with the omicron variant than with the earlier delta variant.

The most severe cases of COVID-19 result in Acute Flaccid Myelitis (AFM). This is a serious condition of the gray matter in the spinal cord leading to flaccid muscles and reflexes. It has been associated with appearing after enterovirus infection. Noticeable peeks of the AFM occur every other year. However, with the advent of COVID-19, a major increase in AFM was noted in children who had COVID infections. AFM is typically noted with a sudden decrease in the arm and/or leg function. These symptoms may not be noticed in a child with neurological issues, so monitoring any change is important. AFM leads to respiratory failure, body temperature changes and blood pressure instability. It is life-threatening. Prompt treatment of COVID infection is necessary for an attempt to avoid this complication.

Recognizing the differences between a cold, flu, allergies, and COVID can be difficult as the symptoms are much the same. If you or your child has symptoms, it is best to get a COVID test and contact you or your child’s healthcare provider for specific instructions for treatment that is unique to you, or your child’s healthcare needs. There should be no second-guessing. Contact your child’s healthcare provider.

This chart developed by the CDC, will help you differentiate between symptoms of cold, flu, COVID or allergies. To be safe, have your child tested for COVID if you suspect it. Test yourself, and request tests for caregivers, teachers, or others in contact with your child. This chart is helpful but do not guess. Test for COVID to protect your child with neurological issues.

covid chartTake action to prevent COVID during this time of transition. There will be many exposures to individuals who have elected not to be vaccinated or choose not to wear masks. This can place your child at an increased risk. Some preventions to take include:


Get a COVID vaccination for your child if they are eligible. This includes their age as well as their unique medical condition. Discuss the benefits and risks of the vaccination for your child’s unique health situation with their healthcare provider.

Get a vaccination for everyone who is eligible in your family.

Discuss with your healthcare provider if others who care for your child should be vaccinated. This includes caregivers, teachers, healthcare providers, friends, relatives, and anyone in close contact with your child.

Vaccines are shown to slow the spread of COVID.


Insist on mask-wearing and that the mask must be worn correctly over the nose and mouth. If your child is over the age of two and has hand function, they should wear a mask. If your child is unable to wear a mask, those caring for your child or those exposed to your child should wear a mask for your child’s protection. Otherwise, both the child and those interacting with your child should wear a mask for protection. The pandemic has demonstrated that wearing a mask is an effective deterrent in spreading COVID as well as other infections.

The most protective masks are N95, KN95, and hospital-type masks. Pick a mask that is the correct size for your child. Wearing a mask that is too large or too small will not provide effective protection.

Many individuals will insist that mask-wearing is no longer necessary, but this is not true for those who are immunocompromised. COVID is still active in the community. Your child is vulnerable. Wear your mask proudly so your child will as well.

Hand Washing:

Wash your hands thoroughly with warm water and soap for 20 seconds or the time it takes to sing Happy Birthday twice. This includes the palms, back of the hand, fingers and thumbs, and fingernails. Rinse completely and dry with a clean towel. Use hand sanitizer if hand washing is not available. Clean your hands after touching surfaces, especially after toileting or diaper changes, before and after suctioning, catheterization, and bowel programs, touching your face or your child’s face, before touching food, and after being in a public place. Clean and disinfect surfaces.

Hand washing affects the spread of COVID as well as other bacteria and viruses. Recently a liver infection has been spreading in children. Handwashing has been demonstrated as a deterrent to this as well.

Check the Viral Load in your Community:

Know the amount of COVID in your community and areas that you frequent, such as schools, religious organizations, clubs, restaurants, and public spaces. This should include the general community viral load as well as specific areas such as classrooms. If you feel secure that individuals in your playgroup or school classroom do not have COVID, you may make the decision to participate with masks. However, no one knows where COVID is still lurking or what people do in their off time. Being safe is never an error. Exposure to COVID can take place at any time, with best friends, while eating, or in any public space. Notices about community exposures are found here. Schools should provide notice of COVID outbreaks.


If you are uncertain if you have COVID, testing kits are available. Test if you think you have symptoms or have been exposed to COVID. The sooner you know if you or your child is carrying the COVID virus, with or without symptoms, the sooner you can protect your child.

More information about protection from COVID can be found on the CDC website. It is up to you to help protect your child regardless of all the noise about COVID being resolved. It is still there. Your child is vulnerable. Protect your child and yourself. Nurse Linda

Linda Schultz is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.

In our community, Nurse Linda is a blogger where she focuses on contributing functional advice, providing the "how-to" on integrating various healthcare improvements into daily life, and answering your specific questions. Read her blogs here.

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The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.