(NEW YORK) — When Dr. Keila Rodriguez comes home, her 3-year-old daughter knows she has to wait to hug her mom.
"After the pandemic started, I would tell her, 'You can't hug mom right now, I have to shower and I have to change because I was around sick people all day and I don't want to get you sick," the Texas pediatrician told ABC News. "She knows now -- I come home and she says, 'Mom, how are you? I'm so happy to see you.' But she'll stay far away and she'll say, 'Go shower and change because I want hugs.”
Rodriguez's hometown of McAllen, in the Rio Grande Valley, was especially hard-hit by COVID-19. Multiple people in her father's family died from the virus, she said.
"It quickly became personal for everybody in the community," she said. "Almost everybody knew somebody who had been very, very sick or died."
Just as the family started to regain a sense of normalcy, the delta variant surged.
In recent weeks, record numbers of COVID-19 cases in children have been reported and pediatric intensive care units in parts of the country are reaching levels not seen before during the pandemic -- just as children are heading back to the classroom.
Rodriguez, like many pediatricians across the country, is worried and overwhelmed, and trying not to get angry.
The pediatricians with children ABC News spoke to said they have fears about the current surge not only for patients but their families, especially as other communicable diseases spread. And they are using their platforms to try to get out the word about vaccination and mitigation.
"It's such a difficult time emotionally, mentally, physically," Rodriguez said.
Record cases in children
COVID-19 cases in children are at record levels. There were over 243,000 pediatric cases reported between Sept. 2 and Sept. 9, the second-highest figure reported during the pandemic, according to the most recent report from the American Academy of Pediatrics and the Children's Hospital Association. The highest number of weekly cases was reported the prior week, topping 251,000, according to the organizations. Hospitalizations have also soared.
"When you tell a parent their child is positive for COVID, you see the fear in their eyes," Dr. David Reeves, a pediatrician for Memorial Hospital at Gulfport in Gulfport, Mississippi, told ABC News. "Luckily, most children are not that ill with it, but we're certainly seeing more severe illness with the delta wave."
Still, children continue to be at lower risk for getting seriously ill or dying from COVID-19, a recent U.S. Centers for Disease Control and Prevention study found, noting that an increase in pediatric hospitalizations this summer has coincided with the rampant spread of the virus. The CDC said it could not determine with the available data whether the rise in hospitalizations was due to an increase in COVID-19 transmission or any greater illness caused by delta.
The American Academy of Pediatrics and the Children's Hospital Associations have warned there is an urgent need to collect more data on the long-term consequences of the pandemic on children, "including ways the virus may harm the long-term physical health of infected children, as well as its emotional and mental health effects."
'Worse place than we were last year'
Dr. Rebekah Diamond has cared for children hospitalized with COVID-19, and then multisystem inflammatory syndrome in children, or MIS-C, since the start of the pandemic as a hospital pediatrician at Columbia University / NewYork-Presbyterian Morgan Stanley Children's Hospital in New York City. She's also seen the impacts on children's mental health and loss of social supports tied to the pandemic.
"There's a lot of talk about if COVID is bad for kids, which I just think is kind of an unhelpful and kind of really frustrating question because we know COVID is bad for kids. We know the pandemic is bad for kids," she told ABC News.
Diamond, who has a 3-year-old daughter, said she felt a "huge amount of anxiety" caring for COVID-19 patients at the beginning of the pandemic, worried she might bring the virus home or spread it to her family.
"Navigating this pandemic, as a doctor, as a parent, I haven't met a single doctor who has said, Yeah, it's been a breeze," Diamond said. "I certainly haven't met a single parent, who, especially at this point, isn't feeling some level of just extreme fatigue or stress or burnout, or just a variety of emotions -- anger, grief, anxiety, it's all there. And I would say, I'm right there with everyone."
As COVID-19 cases have risen across the country due to the highly transmissible delta variant, the past few weeks "have been so destablizing," Diamond said.
"It feels like we're in almost a worse place than we were last year with our kids," she said.
Navigating childcare continues to be especially fraught. Diamond said it is "really breaking my heart as a parent and the pediatrician" as parents continue to navigate difficult choices during the pandemic around childcare and school.
"It feels like we can't control everything, but the degree to which we are having this crisis right now is largely preventable," she said. "And I just know that parents feel totally let down. I can't blame them."
More concerned 'than ever'
Dr. Katherine King, a pediatric infectious disease physician scientist who works at Baylor College of Medicine and Texas Children's Hospital in Houston, Texas, has seen cases surge in her area, just as she was preparing for the new school year.
"I have to say that I'm more concerned about the situation now than I ever have been because the rates of infection in our community are higher than ever," she told ABC News.
King said she has done "everything we can to try to limit exposures." She pulled her 8-year-old daughter out of summer camp as COVID-19 cases were increasing in the community and masking and social distancing practices were subpar. Instead of a big party for her daughter's birthday this summer, they had something small in their backyard.
But two weeks before the start of school, her daughter was exposed after a fully vaccinated neighbor tested positive, King said.
"I went through the whole concern and worry that she might test positive and would she be able to start school on time," said King, noting that her daughter ultimately tested negative twice.
"I felt like I was really going through it with everyone else in terms of all the anxiety about the many exposures that are happening in the community right now and all the concerns we have about whether our kids can be in school," she said.
The worries have only continued since school started amid a delta surge in Houston. On the second day of school, King got an email from her daughter's school that someone in the class had been exposed to COVID-19, who ultimately tested negative. On a recent Friday, the school sent students home with a go-bag in case they weren't able to return the following Monday.
By two weeks into the school year, King had already heard of two nearby schools needing to shift to remote due to COVID-19 cases.
"Unfortunately I think we're in this place right now where there's so many cases and so many contacts that it's becoming really impractical for the schools to stay open, and particularly in the areas of town where masking has not been made a requirement," she said.
Since the week ending Aug. 8, there have been over 126,000 COVID-19 cases in students reported from Texas public schools -- including over 40,000 during the week ending Sept. 5.
"I am expecting that this school year we're going to have more disruptions than we did last," King said. "So as a parent, this means that we're constantly kind of on edge."
Using their platforms
Rodriguez, King and Diamond have been using their platforms as pediatricians to help educate and inform people during the pandemic and push back against misinformation.
Rodriguez published a children's book last year, "When the World is Sick: A Story About Staying Safe and the Coronavirus," about talking to children about COVID-19 and how to stay safe, and plans to write more books.
"It fills my cup, the way people say about things that fulfill them," she said. "It just really makes me happy and fulfilled to help the community."
Both Rodriguez and Diamond have taken to Instagram to engage with parents and their questions throughout the pandemic.
"It's been really gratifying for me to put myself out there and show parents that as pediatricians, we really do know what you're going through," said Diamond, who has a forthcoming book, "Parent Like A Pediatrician." "Not everyone's struggles are the same, but we've seen you throughout this pandemic, I've seen parents throughout this pandemic, and I think what it does is it just makes me feel all the more protective and even angry on behalf of parents because I've seen that journey, not just for me, since last March.”
King has advocated for vaccination to reduce transmission and prevent prolonged illness related to COVID-19 infection. She plans to have her daughter vaccinated as soon as she is eligible.
"I was one of first to get the vaccine myself, and I hope my daughter will be one of the first children to get it when it becomes available," King said, noting that that could come before the end of the year. "We will be eager to have her vaccinated as soon as we can. We can see the direct effects of vaccination, ZIP code by ZIP code in the United States.”
Masking mandates have become a lightning rod issue this school year. Though mask use is crucial to prevent the spread of the virus, particularly for those still too young to get the vaccine, the doctors said.
"The only thing that will traumatize kids about masks for the next few months is continuing to make it a debate conversation, when the conversation really should be -- what kind of safety and support are we giving children for the next few months so that they feel safe in home, they feel safe in school, they feel that if they get COVID they will do well, that will keep the hospitals open and staffed appropriately," Diamond said. "The things you can control are how you frame your own peace of mind and your own comfort and safety and how you model all of this to your kids."
King urges people to "buckle down again" amid surging COVID-19 cases and hospitalizations, to which she has a front-row seat.
"It's so hard to sometimes really incorporate statistics and numbers into our lives and really feel what that means, but it's really easy for me because I go to work every day and I can see with my own eyes what coronavirus can do to a child and the impact it can have on a family," she said. "So it's very clear to me how valuable it is to try to control this virus and to try to avoid it."
ABC News' Arielle Mitropoulos contributed to this report.