(CNN) Dr. Sarah Ash Combs' first step of treatment for children brought into her emergency room with Covid-19 usually begins with a question: "What socks are you wearing today?"
As her school-aged young patients look up at indistinguishable faces covered by PPE, Combs pulls up a pant leg of her scrub to show her own socks. Sometimes they're mismatched, sometimes they're covered in animals. And if she's wearing her favorite, they have sushi.
The surge in Covid-19 cases brought on by the highly transmissible Delta variant has meant an increase in hospitalizations among children -- many of whom are not eligible for a vaccine yet. Nearly 26% of all Covid-19 cases nationwide are reported in children, according to recent data published by the American Academy of Pediatrics. And about 290 children are hospitalized with Covid-19 every day, according to Sunday's data from the US Centers for Disease Control and Prevention.
The unrelenting nature of the pandemic has overwhelmed health care workers across the country. And for those in pediatric care, they've had to overcome many new obstacles. For some, it's making children feel comfortable in an intimidating environment. For others, it's navigating the stress of a child's diagnosis on top of the family's financial insecurity. And many providers are struggling to adapt virtual visits for patients who can't always describe what they are feeling.
"I am here to work with people, work with kids, treat them, make them feel better in the fullest sense of the word," Combs said. "If that means I have to wear mismatched sparkly socks and have a large badge with my face up a little too close and speak really loudly in wacky tones, then sure, I'll do it."
For the pediatrician, the pandemic has been fraught with emotional considerations.
She returned to the emergency room of Children's National Hospital in Washington, DC, from maternity leave with her first child in early May of 2020, she said. At the dawn of the pandemic, she found herself relating to the parents of her pediatric patients in a whole new way.
On her first day, she remembers saying goodbye to her husband and 2-month-old and feeling scared for the first time, she said.
That same day, a mother brought in a 2-month-old patient who tested positive for Covid. Combs sat with her amid the fear and uncertainty. Typically, when a child comes in with an ear infection, she could rely on years of experience and reassure the parents by telling them exactly what to expect, but this virus was something the medical community knew little about.
Fortunately, she said, the baby recovered and is doing well.
But while some interactions with families left her feeling more connected, others were filled with tension, she said. For much of the pandemic, only one parent could stay with their admitted child, which sometimes resulted in fear, sadness and anger.
"This was one of the most blurred lines I've ever felt," Combs said, as she detailed the agony of not being able to embrace grieving parents with a hug.
Combs said she knew she had to respond with the logical reason, detailing the regulations and importance of infection control.
"But inside I was emotionally dying a little because I so viscerally felt exactly what they were going through," she said. "I couldn't imagine, God forbid, if my 2-month-old was going to need something, being there by myself for days on end."
Dr. Sanchita Sharma is the one who gets called in when things get difficult.
As a clinical psychologist at Children's National, doctors treating children with Covid-19 will often bring her in when a child's infection also raises mental health concerns.
When the pandemic erupted, it became quickly apparent that it was especially hurting families who were struggling economically, she said.
Those in lower socio-economic groups are particularly vulnerable to infection, Sharma noted. So, on top of behavioral issues and diagnoses of their own, she is helping many children cope with the trauma of seeing a loved one die in the pandemic, she said.
"Pretty much every patient that I'm seeing now has had someone pass away in their home from Covid," Sharma said.
And the pandemic has made financial concerns that come with illness even more stressful on families -- many of whom rely on their children having time at school or daycare to allow them work.
"When a child is diagnosed, they're getting quarantine from daycare right ... that means a parent has to stay home with them and what does that mean -- economically, financially -- for the family?" Sharma said.
For Black families, there's also a mistrust of the medical community, born from a history of neglect and mistreatment.
"It's the fear is my child going to die?" that Sharma says parents express to her. "I have that and is my Black child going to get the care that they need."
It has become more important than ever to approach conversations with parents not as an authority, but as someone who can help explain what the pandemic means for their children and what they can do next, she said. Part of that could even mean helping parents address their own mental health.
"Their mental health is directly related to their child's mental health will be like," Sharma said. "Check in with yourself see if you've been feeling anxious see if you've been feeling stressed about everything, and then you might notice your child might be picking up on one of those things themselves."
Over the course of the pandemic, Dr. Alicia Johnston's work has involved a lot more baby dolls and games of Simon Says.
Johnston is a pediatric infectious disease doctor at Boston Children's Hospital, where she works in a multidisciplinary clinic for children with Long Covid.
With many families wary of traveling or going into offices, Johnston holds more virtual visits with the families.
It has helped children feel more comfortable, opened access to more families and allowed caregivers to focus on their conversation with the health care provider while their child plays or naps at home, she said.
But there are real obstacles.
"Clearly, there are many, many limitations to trying to do a physical exam in a two-dimensional format without being able to put a stethoscope on a child's chest and actually palpate a limb and abdomen," Johnston said.
So, she has gotten creative, playing Simon Says over the camera to go through a neurological exam, asking parents to hold a phone flashlight to their child's open mouth and using baby dolls to show parents what she wants them to do for their infant's exam.
The greatest innovation of her work, however, is the collaboration of specialists that come together to treat children still facing symptoms after they have cleared the infection.
At her clinic, Johnston can offer many doctors working together to treat the symptoms. And despite the dearth of information on Long Covid in kids, she can provide acknowledgment that what their children are going through is real.
"That's a fair amount of solace to the patients and parents, to know they're being heard," she said.