Why Sick Kids Need Rest

In 2023, Ph. D. Registered Psychologist Angela Grace was walking her boxer-pitbull rescue near her home in Calgary, AB, when she turned her head towards a sharp voice emanating from the elementary school yard adjacent to the sidewalk. An irate teacher was addressing a few students who’d pulled away from the group, their stooped shoulders and drawn faces indicating they’d rather be in bed than in Phys.Ed.

“Keep running! It’s not going to kill you,” the teacher yelled over the sounds of ragged coughing.

Grace winces as she remembers that day. She’d been a teacher herself, trying to motivate her own students to keep going, but since 2022, when her health declined due to long COVID, she pulled a 180, now advocating for schools to help kids slow down and get the rest they need when suffering from COVID-19 complications. “If kids are sick, they need to rest and recover, not keep going,” says Grace.

Everyone—kids included—needs to rest when they're sick

Instead, we should teach them to listen to their bodies, says Joanna MacLean, a clinician scientist in the Department of Pediatrics at the University of Alberta. After all, without adequate rest when ill, a person can struggle, no matter their age. And the struggles can be devastating—ranging from cognitive damage with Long COVID, heart problems with flu, lingering chronic fatigue or autoimmune issues from Epstein-Barr virus, along with an increased chance of certain cancers.

 “If body tissues are in a prolonged state of stress—whether it’s part of the heart, or part of the lungs or brain—they won’t repair or recover,” says MacLean. It’s like if your child breaks a leg; walking on it adds stress on the fracture, and it wouldn’t heal properly.

Of course, not all illnesses carry the same risk—there are over 200 different cold infections that rarely result in more than a runny nose. But the risks of long-term complications are still greater than in the past, with COVID-19 continuing to circulate widely. COVID-19 can breach the blood-brain barrier, with the potential to invade brain cells, causing serious neurological damage. Studies estimate between five and 30 percent of infections wreak havoc on the body, with effects ranging from brain fog to kidney injury, heart problems, multi-organ inflammation, autoimmune diseases and chronic fatigue, to name a few.

How testing and vaccines help

Vaccines have helped. Reported incidences of Long COVID have gone down since the beginning of the pandemic, but it’s still surpassed asthma as the most common chronic health condition in American children, according to peer-reviewed medical journal, JAMA Pediatrics.

Testing for flu, COVID-19 and RSV can help inform treatment and activities while protecting vulnerable community members, though free tests are no longer accessible in many provinces. Your best shot at fighting illnesses without harm to kids: staying up-to-date on vaccines, paired with rest, according to MacLean.

How much rest is enough?

MacLean says children rarely stay in bed if they aren’t tired, so if they’re insisting on sleeping, we should honour their need for rest whenever possible. Rest is about more than just sleep; it’s about pacing. It’s best to keep them out of group activities, both to prevent spread and to ensure they don’t over-exert themselves. A gradual reintroduction to extreme exercise is always recommended for those who recently had a COVID-19 infection. And always check with a medical professional when concerned about symptoms.

Why rest doesn't always happen

Sadly, what’s best and what’s manageable are often at odds—while parents often have their kids’ health in mind, they also need to pay the bills, with 43 percent of Canadians struggling to feed their families according to a 2024 IPSOS survey. Financial strain, alongside woefully inadequate sick time and few family supports, can make even a half-day off work for a doctor’s visit daunting, never mind booking several days off to tend to a sick child.

But society must adapt, says Grace, who’s seen previously high-achieving, energetic kids struggle to get out of bed even months after an acute infection. “We have to shift our thinking to what we can do right now in the present that’s most important and meaningful,” she says. And that means putting in place accommodations and modifications that put kids’ health first. Her recent documentary explores the struggles of families of chronically ill kids—namely, accessing support—and the difference rest can make in their daily lives.

Jennifer's story

Jennifer Thompson’s family is among them. In Grade one, her daughter was diagnosed with Long COVID after she came home from school, and hid pieces of garbage throughout the house, eventually admitting that she thought the refuse was alive and she wanted to help it. The behaviour change was drastic, sudden, and fit the diagnostic criteria of Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), characterized by obsessive-compulsive thoughts and/or eating restrictions due to brain inflammation after an acute infection. PANS can be triggered by many infections, including influenza, hand, foot and mouth disease, pneumonia, chicken pox and now there is a surge associated with COVID-19, as was the case for Thompson’s child.

Her constellation of symptoms—different from the rest of the family who also have long COVID—includes obsessive thoughts such as a fear of choking, headaches, fatigue and a sharp deterioration in her ability to handwrite, draw, and colour. The symptoms flare up when she’s over-tired and overworked, making rest crucial.

Thompson informed the school about the diagnosis and her daughter’s need for consistent breaks, but initially, no support was put in place. The six-year-old sat quietly at her desk throughout the school day, using every ounce of energy to appear normal, but she’d erupt in strong emotional outbursts once home, resulting in hours of recovery and more missed school.

Finding support

Finally, a legally binding ISP (Individual Support Plan) detailed her needs. Now, she can take a rest in the Student Support room as needed, and she can go home when she has headaches. She can learn at her own pace rather than pushing past her limits and spending the whole evening recuperating.

But getting those supports in place was a struggle. No one seemed to believe the diagnosis or the need for support, and many concerns were dismissed as simply anxiety on the part of Thompson. And that’s the crux—not everyone believes the severity of the issue or that Long COVID even exists, especially for children.

 “When you have a relapsing and remitting illness, it’s hard for others to understand that you might be able to do something one day and not the next,” says Thompson. “It’s also hard to get others to believe you when the narrative from public health has been that kids don’t get COVID and even if they do, they don’t get Long COVID.”

What needs to change

We need a complete overhaul in how we look at illness, says Thompson. After all, there’s no shortcut to recovery. Schools need to stop worrying about perfect attendance awards and start focusing on supporting families with ways that will enhance their child’s health and ability to learn. We need to encourage hybrid workplaces—which worked well at the start of the pandemic—and help caregivers provide support to their children, she says. And we need more education around the real harm happening to children and the ways we can prevent it.

Thompson’s daughter wears an N95 mask to school to prevent another COVID-19 infection, which could exacerbate her health conditions. But, Thompson says, even something as simple as the mask causes misunderstandings and social isolation. Her daughter has to constantly field the same question over and over from her peers: Why do you still wear a mask? That attitude is a reflection of the broader community, and Thompson says that from the moment children enter a school, they should be educated that masks are a health tool that can help both the person wearing it and the community at large.

Since many illnesses are airborne, one of the best ways to prevent them, says Dr. Thomas Piggott, medical officer of health and CEO at Lakelands Public Health, is by improving air quality in public spaces. Air quality is an equity issue—everyone deserves access to clean air, much like clean water. Sadly, many schools, where many children spend a majority of their time, have aging infrastructures with HVAC systems that fail to meet modern standards, says Piggott.

But there are success stories, including a group of parents in Edmonton, AB, who successfully advocated for the addition of $6 million worth of HEPA air purifiers in all public-school classrooms within the city.

 It’s nearly a full-time job for parents to navigate the advocacy process while passing those skills to their children so that they can express what they need from a young age. But that work matters—it deserves acknowledgement and support.

How to support kids when they're sick

Dr. Ric Arseneau of the B.C. Centre for Long COVID, ME/CFS, & Fibromyalgia gave these tips for providing children with rest when sick:

• Prioritize sleep with an earlier bedtime and the option of extra sleep in the morning as needed.
• Build in quiet time during the day through quiet activities, including reading, audiobooks and calm play.
• Avoid pushing through fatigue, dizziness, chest pain/tightness or shortness of breath.
• Keep activities light when there is a fever present or symptoms beyond what's expected with a minor cold. Stop activities if symptoms worsen.
• Return to strenuous activities, including sports, at a gradual pace once a child is at their usual baseline, free of concerning symptoms, including chest pain, shortness of breath, heart palpitations, fainting or unusual fatigue.