Parents' heads are surely spinning.
Schools are reopening virtually or with part-time "hybrid" models, parents are returning to work and general "coronavirus fatigue" has set in months since the start of the pandemic.
For many families, day care is the only option to support themselves and their children, but that opens up many other questions: How safe is child care in COVID-19 times? What protocols should day care centers have in place? Does it matter if kids are separated into pods?
To help with parents' decisions on when and where to send their children back to day care, USA TODAY spoke with three pediatric health experts to get some practical tips and questions to ask themselves and their child care providers.
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No one approach is correct. Have a back up plan.
"I wish there was a simple answer," said Dr. Andrew Hashikawa, a University of Michigan pediatric emergency medicine physician. "Families are quite different."
Some families may have an adult living with them with an underlying condition that puts them at a higher risk, Dr. Charlene Wong, a Duke University pediatrician, said. In those cases, they'll need to consider if sending a child to a day center is the right choice.
But for many families, Wong notes, sending a child to day care is a necessity, given the high costs of private care and parents' work. Additionally, with competitive programs and limited capacities, the number of day care centers a family can consider may also be limited, Wong said.
In cases where there is only one option, Wong said families should be as communicative as possible about their specific needs with the staff. Hashikawa said, for example, if a child has asthma, do they have the necessary medication available to them while at the center or does the center know the child's asthma action plan?
Wong notes that centers also may be facing financial constraints amid the pandemic. "If there are families that can help out ... just ask the school if there are ways that they can help," she said. "Offer support for the staff who are all working so hard."
If a family has the financial resources, some have turned sharing a private tutor or babysitter with other families nearby – often dubbed a "pandemic pod." Hashikawa said asking a family member who is not at higher risk for complications to help may be an option, too.
In any scenario, Hashikawa said having a back up plan in place is important in case a center closes or a babysitter gets sick.
Know your local COVID-19 numbers.
Data should be driving families' and local officials' decisions about whether to send a child to a day care center and also in what capacity the centers are open, experts said.
"The number one thing to consider is what the rates of COVID-19 are in your community," Wong said.
If there is an active surge in cases in your town or county, it may be time to limit the number of people your children are exposed to, Wong said.
Sending a child to a day care center in parts of a state like Massachusetts poses a lower risk right now than states like Texas or Florida, Hashikawa noted. And it's unknown where and when future spikes could occur, making it all the more important to have the most recent and most local data available to parents, Wong said.
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While pulling a child from a daycare is not an easy decision and won't be feasible for every family, Wong said it's still important to know the local numbers and stay informed.
Make sure there is podding of classrooms and outside time.
Wong said within day care settings, separating children into different pods with their own teachers that don't interact with the other students or teachers is one of the most important things a facility can do.
Asking for young preschool students to physically distance can be extremely challenging, but limiting the number of people they come in contact with once at school limits exposure risk, she said.
"If there is a case of COVID-19 in a teacher or student then the number of people exposed is the smallest possible," she said.
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"If you are able to have truly separate pods, if you have teachers and students that can stay with those pods, it does make a difference," Hashikawa added. "If you're putting 15 to 20 people in a room, that's a lot different than having 8 or 9 in a room."
While the U.S. Centers for Disease Control and Prevention says there's no optimal minimum or maximum number of students that should be in one pod, the smaller the cohort, the better. Small cohorts also may not be truly separated from each other as students in one group may have a sibling in another, the CDC notes.
Additionally, a day care center that allots time to be outside can also help reduce risk, Dr. Camille Sabella, a pediatric infectious diseases specialist at the Cleveland Clinic, said. While there is a fear that children won't stay apart during recess, "being outside really is one of the best things we can do to prevent the spread of this virus from person to person," he said.
The CDC agrees. On its website, the agency says activities held outside in general are safer than inside, where there may be less ventilation.
Hashikawa said he's seen centers that are "recreating their play time" and trying to include being outdoors into the curriculum when feasible.
Ask what the day care did to clean before COVID-19.
Some of the cleanliness practices day cares are including in their COVID-19 protocols are things most parents would hope they were doing anyways, Sabella noted.
Certain viruses and bacteria that were around before the new coronavirus can spread even more easily on surfaces like toys, he said.
While there may not be documentation about the cleaning of every toy in a center, day care staff may keep track of how often the center as a whole is cleaned, he said.
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How detailed is their safety plan?
"The devil is in the details," Hashikawa said. A COVID-19 safety plan should be thorough and transparent. "If that's not there, I worry quite a bit about the child care center," he said.
For example, does the child care center screen for symptoms or a fever on site or is it up to the parents to self-report that information from an at home screening, Sabella asked. The actual ratio of students to teachers or day care attendees matters, too, he said. Though even before COVID-19, that number may be dictated by state law.
If the center is able to, consulting with a pediatric public health expert is one of the best ways to ensure that staff has every area covered, and it also gives them someone to check back in with if needed, Hashikawa said.
Should I send my child to part-time daycare in a hybrid school model?
A hybrid model of schooling — going in person part time and staying home the other time — could work well to reduce children's risk of spreading the virus, Sabella said.
What could make the hybrid model more of a challenge is if children spend their days when not physically in school at daycares instead, he said.
The hybrid model works well for children who can be unsupervised for some periods of time, such as middle and high schoolers. But for younger children, the time not physically in school may "get diverted to child care centers," Hashikawa said. Sending children to two separate locations and with different groups could increase potential exposure to the virus, he added.
Trust your child will wear a mask.
Children under 2 years old should not be wearing face coverings. It's dangerous, Wong said. But children above 2 years old should be given more credit for their ability to mask.
Sabella said while it may not be true in every case, it's possible for children to wear masks for the length of a day care day, it just needs to be done correctly.
"Kids can certainly be rule followers with good teaching techniques and talking about it the right way and getting kids involved," Sabella said. "I think kids are much more willing to be compliant with (wearing a mask) ... people will be surprised."
Hashikawa said it's also helpful when centers openly talk about wearing masks with the children and actively include it into the curriculum. "Make it fun. Make something that is kind of cool to do," he said.
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Ask your nanny, baby sitter where and with whom they're socializing with.
For parents who can afford it, splitting the cost of a babysitter with other families nearby has become a popular way to get child care and reduce the risk of spreading the virus.
But what's important is asking about the people you're letting into the "pandemic pod."
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"What we are trying to do is to reduce the number of people who are sort of in your circle who you have regular and frequent close contact with," Wong said. "So it's important to ask: What is that babysitter's circle looking like during the COVID-19 pandemic?"
Before the pandemic, questions like, "How many people do you live with?" or "How often do you go out to bars and restaurants?" may seem intrusive. But those are the kinds of things parents should be asking now, Wong said.
Like with a child care center, parents need a back-up and communication plan with their babysitter, especially in case someone inside the "pandemic pod" gets sick, Hashikawa said.
Talk with your children about what they're seeing in day care.
It's important to discuss with children the importance of wearing masks and washing their hands, Wong said, and having those discussions in a way that emphasizes "play" and "fun" can be most effective.
Whether it's singing "Happy Birthday" twice when washing hands or making masks with their favorite TV characters, Wong said more positive communication around the pandemic will have a better effect than fear-based learning.
Wong also said showing your children your own safety practices can reinforce good behaviors for when you're not around. If a child sees you wearing a mask, it'll make more sense to them when they see their teacher in a mask, she said.
Sabella added that at this point in the pandemic, children are probably very attuned to these safety practices, too.
"If this was in March or April and we were trying to do this, I think it would be somewhat different, but now that it's several months later and a lot the kids have been isolating, I think they get it," he said.
"Even the youngest ones, they're wearing their masks, they're washing their hands. They're even asking me if i'm washing my hands," Sabella said.
Follow USA TODAY's Ryan Miller on Twitter @RyanW_Miller
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