Many weeks ago, I wrote a very long piece on a decision process for many things in COVID-19, notably grandparents and child care. It included a 5 point “decision framework”:
- Frame the Question
- Mitigate Risk
- Evaluate Risk
- Evaluate Benefits
- Decide
I thought it might be useful to revisit this, briefly, today in the context of the question I get by far the most. It is a version of: “I am pregnant, due in October, and I’m trying to decide whether my two year old should go back to day care.”
Frame The Question
Should I sent my toddler back to day care or…what? In many cases, especially with a newborn at home, the alternative is to keep the toddler at home in whatever child care solution the newborn has. But your choice may be slightly different. If the newborn is planning to be in out of home child care, this probably changes the calculation.
Mitigate Risk
Just two notes on risk mitigation. First, make sure the child care solution you choose has some simple symptom monitoring and case reporting. This will go a long way to lowering the risk of in-care transmission.
Second, totally independent of COVID-19, you should be careful about having your toddler interact with your infant before the have their first shots. Infants are more susceptible to (non-COVID) illnesses and they will need more intensive treatment if they, say, get a fever. So it’s always worth being careful of these interactions in the first month or two. (I talk about this some in Cribsheet, in the non-COVID world).
Evaluate Risk
The key question I think people are grappling with here is how risky is this? This combines a few pieces: how likely is my toddler to get COVID-19 in child care, how likely are they to transmit to the family (either pregnant person or infant), and how likely is it that serious illness will result in anyone in this chain?
One piece of this relates to the prevalence around you, so I’d probably start everything by going to Johns Hopkins and checking out the situation in your area. There is no hard and fast rule about what is a “low” prevalence, but at least you can get some sense of the chance of exposure.
Of course, what you really want to know is the risk of your child getting infected at child care, and our data on that is poor. What we do have generally suggests pretty low risk — you can see some data from crowd-sourcing here, and all the data that we could find on state-level outbreaks here. There have been some cases in child care centers but the fact is that this risk is low.
You can refer above to the information on the chance of your child getting very sick. In terms of in-household transmission, the best evidence we have is probably from this South Korea study which showed very limited transmission from younger children within the household. So that is also reassuring.
What if you do get COVID-19? COVID-Explained has some resources here on COVID in pregnancy, most of which is very reassuring. A few weeks ago everyone panicked when the CDC said pregnant women were more likely to be hospitalized with COVID-19 than non-pregnant, but what most coverage failed to note is that this included hospitalizations to give birth. Sigh. Infants do seem to be at slightly higher risk than older children but, still, very low.
How do we aggregate all of this? There is a low probability of infection, and then a low chance of transmission and then a very low chance of serious infection. Small times small times small equals small.
It may actually be more helpful to refer to the flu information above. If you send your toddler to child care they are more likely to get seriously ill from the flu than from COVID-19. This flu would also be much more dangerous for you and your infant. The fact that you probably wouldn’t be having this conversation in flu season suggests something about your risk tolerance (not something bad! These risks are also small!). But I think it puts this all in some context.
Evaluate Benefits
You do not need me for this. What is the value to your family? How much do you think your toddler needs socialization? Are there other (less risky) social opportunities? How difficult would it be to have the toddler home during parental leave (if you have it)? Do you have other help?
Don’t ignore the mental health benefits here. I think we too frequently forget that parental happiness and sanity should be valued in these choices.
Decide…
…and then move on. You’ll never really know if the decision was right ex ante. This is part of what makes this especially hard here. There is so much uncertainty, so much fear, that it is difficult to ever really feel “happy” with your choice. What you can feel happy about is the choice process. So make that the goal.
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