Table 1.

COVID-19 Risk Mitigation Strategies For Visitors of Hospitalized Pediatric Patients

Scenario	Mitigation
Too many individuals in a clinical area make physical distancing more difficult	Based on current state of community transmission, limit visitation to a single or limited number of adult caregiver(s) that remain(s) in a private patient room if available at all times. Provide meals for visitor(s). Leverage technology to supplement communication (see family-centered rounds below).
Family-centered rounds	Videoconferencing platforms to allow additional family members and healthcare team members to participate in conversations.
Need for caregiver to leave the hospital	Allow adult parents or guardians in the same family unit to switch places with one other designated parent or guardian minimizing time spent in public spaces of hospital. Parents should undergo symptom screening each time they re-enter the hospital.
End of life	Exceptions to allow sibling visitation may be appropriate. Siblings should be screened for COVID-19 symptoms before entry, should wear masks, and should perform hand hygiene. Exceptions for additional adults (eg, grandparents) may also be appropriate, but the risk of severe complications with COVID-19 in visiting adult(s) should be taken into consideration.
COVID-19–positive patient, COVID-19–unknown parent or guardian who may be at risk of developing infection	Members of a family unit have likely already had significant COVID-19 exposure. Risk of additional exposure to a contagious child is generally outweighed by the benefit of parental presence. Parents should be informed of risk of infection and counselled to wear PPE and to maintain physical distance. The healthcare team will be using appropriate PPE for the COVID-19–positive patient (and parent). Parents and guardians who develop symptoms concerning for COVID-19 should seek an alternate asymptomatic adult caretaker and should seek COVID-19 testing.
COVID-19–positive patient, COVID-19–positive parent or guardian	If the parent or guardian is well enough to stay at the bedside and contribute to the child’s care, and no alternative caregiver is available, allow the parent to isolate in the patient’s room, encourage masking when an HCW is in the room.
COVID-19–negative patient, parent or guardian with symptoms concerning for COVID-19	If available, asymptomatic adult caregiver preferred. Parents and guardians with symptoms concerning for COVID-19 should seek COVID-19 test. If symptomatic, the parent or guardian needs to stay in the room, and they should wear a mask and maintain physical distancing as much as possible while awaiting test result.
COVID-19–negative patient, parent or guardian positive for COVID-19	If no alternative adult caregiver, consider shared decision-making with family and healthcare team on a case-by-case basis. If benefit of parental presence is believed to outweigh risk, allow parent to isolate in patient’s room (eg, place patient on COVID-19 isolation). Encourage masking and physical distancing by parent.