Christi Arnerich, MD, a pediatric ear, nose and throat specialist at Stanford Children’s Health Specialty Services in Emeryville, Fremont and Walnut Creek, answers one parent’s question.
Q: My child has PFAPA, a condition that can be managed by steroids, but I’m reluctant to have him continue using steroids as a treatment method. Is surgery safe during the COVID-19 pandemic?
A: During the last year, parents in your position have been asking themselves the same question, especially when their child is faced with the possibility of an elective surgery. For children with periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) syndrome, the condition can be managed through steroids. When short bursts of the medication are effective through continued use, potentially for a few years, the disease may fizzle out by itself.
An alternative to continued steroid use is a tonsillectomy, one of the most common pediatric surgeries performed in the United States. While there is no proven scientific reason why the removal of tonsils is beneficial, one theory is that by removing the tonsils, you are removing the microbes causing the inflammation that accompanies PFAPA.
The good news is surgery is safe during COVID-19. For both inpatient and outpatient surgery, we have always complied with strict levels of infection control. We wear masks, and we disinfect all surfaces before and after a procedure. We don’t take shortcuts. These are all the standards we are used to complying with to control the transmission of any communicable disease.
The two big safety protocols that acknowledge the presence of COVID-19 involve the patients.
1. Testing. First, a COVID-19 test is required 3 to 5 days before any surgical procedure. For kids under the age of six this can be a challenge, but Stanford Children’s Health testing personnel have extra training on how to manage testing for young children. And if a test is positive, the surgery is cancelled, and the patient is advised on what care is needed.
2. Limits on visitors. There are limits on the number of people who can accompany the child in the hospital or outpatient facility. Usually that is one person. Often, parents decide in advance which segment they will each cover, from pre-operative preparations to post-operative recovery. Exceptions to this policy can be made for special needs or extremely anxious children.