Kids health

An infectious disease doctor answers all our questions about the COVID vaccine for kids

As parents start to vaccinate Canadian kids age 5 to 11, we spoke to Dr. Janine McCready about potential side effects, whether it affects fertility, how to handle the holidays, spacing with flu shots and more.

Today’s Parent recently spoke with infectious disease physician Janine McCready about the COVID vaccine for kids under 12. We tackled side effects, fertility fears, and whether your 4-year-old can get the vaccine before their fifth birthday. Here’s a condensed version of that interview.  

Before we get into discussing the vaccine, can you tell me a bit about what you do and how you’ve been involved in the pandemic response?

I’m an infectious disease physician at Michael Garron Hospital in East Toronto. Since the pandemic began in March of 2020 I’ve been really immersed in everything COVID. It started with our work in the hospitals, but we very quickly saw that this was a disease that was spreading in our communities so it was super important to do outreach to the communities and get testing done

When schools went back in last year, I had the opportunity to be involved with supporting our schools and have been working very closely with all our schools in East Toronto to make testing easier and making sure that they have what they need to ideally keep the kids in school.

The last two years have been so difficult for kids. On a medical level, we’ve seen parents come in and are very sick, and some of them are single parents. There’s no one at home to take care of their kids, and their kids have all had COVID as well. So those have been very challenging situations, and in some situations, we’ve seen parents and certainly grandparents pass away from this disease. 

Hopefully some of this improves now that kids aged 5 to 11 can get the COVID vaccine. How was Health Canada able to confidently tell the public this vaccine is safe for kids?

All of the evaluation was built on everything we’ve learned about the previous vaccines. That’s not just what was in the trials, but it’s all the emerging evidence that’s come out from around the world, on the safety and the efficacy of these medications in the 12 and up age groups. 

Pfizer had also done a study in the 5 to 11 age group and they presented all the evidence to Health Canada. Health Canada went through everything, and then they had the opportunity to ask questions to Pfizer, ask for more specific data, and review that to make sure that when they were endorsing this they really could have confidence that the benefits of this vaccine outweigh the risks in this younger age group. 

What should parents be expecting for side effects from this vaccine? Should they plan to keep their kids home from school the next day?

In the Pfizer study, they compared the side effects of the 3000 kids that got the Pfizer vaccine, to the side effects of the people in the 16 to 24 age group. In almost every category, children had lower side effects. That’s likely due to the way their immune system responds and that they are using 1/3 of the adult dose in children, so they are expected to have lower side effects. 

The common things that kids experience were a sore arm…about 30 percent of them had a headache, 40 percent of them had fatigue, and then around 10 percent had chills and muscle aches. That was all short lived within a day or two. If your child is more likely to kind of feel lousy, you might want to plan to do the vaccine heading into a weekend or when they don’t have something big planned.

What’s the risk of cardiac side effects from the vaccine, like myocarditis or pericarditis?

We expect that the rates of myocarditis and pericarditis will be lower in this age group than we’ve seen with the older age groups. 

One reason is that the risk decreases with age. The peak for the cases of myocarditis and pericarditis so far seems to be in 16 to 19 year-old males. Their rate was less than 1 in 10,000 people and almost always after the second dose and self resolving. Then the 12 to 15 year olds had a lower risk. 

The second reason is because generally with myocarditis and pericarditis, five to 11 year olds are at lower risk. So, they have less risk at baseline from other viruses and from basically other things they have a lower risk. 

The third reason is they’re getting a lower dose of the vaccine, one-third of the adult dose. 

What I find reassuring is that even in those other age groups the children improved very quickly. 

This is very different from the myocarditis you can get from actually getting COVID because you can get quite sick and have long term health effects from that.

As a mom and as a physician, I have really no qualms with advising my close friends and family and for my own kids to get vaccinated as soon as possible with this dose in this age group.

If, by chance, your child did experience myocarditis, how would you know?

The things to watch for would be chest pain, difficulty breathing, if they got a fever that wasn’t self-resolving within a day or two, and if they were seeming very lethargic or tired and unwell. In those cases, it would definitely be a good idea to take them to get checked out.

Is there any concern about side effects that could come up down the road?

We would not expect any long-term effects from this vaccine, and there are a few reasons for that. 

It helps to understand how the vaccine works. In the first few days after the vaccine, that’s when there’s an immediate impact and there are local effects from the actual vaccine that would cause side effects. You’d expect those within the first few days. 

Then the second phase of the side effects would be from your immune response to them. Your immune response peaks over the weeks following the vaccine then can’t increase anymore after about four to six weeks. So any serious side effects should be seen within that time frame. With the billions of doses that have been received, there hasn’t been anything unusual or rare that’s popped up besides myocarditis, which we’ve spoken about. 

It would be exceedingly unlikely for something to pop up two years down the road, because it’s just not how the vaccines work. 

Also, mRNA technology is actually not that new. We’ve been studying mRNA technology since the 1960s. So we actually do have long term data on the safety of mRNA vaccines, it’s just not in the setting of COVID. That was part of the reason that they could build the vaccine so fast, because they built on all that research that we’ve been doing for the last decades, and there’s been no long-term signal for anything with the mRNA technology in those people that have been studied.

Can the vaccine affect fertility? That’s a pretty common fear.

There is absolutely no evidence that the vaccine would, in any way, impact fertility. It can’t. There are no hormones in the mRNA and the vaccine doesn’t integrate within your cells in any way. 

On the other hand, in adults with COVID, we are seeing a five times higher risk of erectile dysfunction. 

You mentioned the benefits of the vaccine outweigh the risks. What are the benefits?

We have heard a lot about how kids don’t get severe disease from COVID, and most of them have mild disease, which is true. But there are certainly some kids that get sicker, and it’s very hard to predict which ones those are going to be. In the United States, they’ve actually had 66 children who have died from COVID in the last year and to me, that’s unacceptable. If we have a vaccine that’s safe and effective and can prevent death entirely, then I would jump at the chance to prevent that possibility from happening. 

The second part is really thinking about your individual family. Ideally adults are vaccinated, but there’s some people where the vaccine might not work as well. So if your child is vaccinated, then they can still feel comfortable being around those people. The vaccine is not a bulletproof vest, but it really does provide significant protection and risk reduction of both getting COVID and of passing it on. On a community and societal level, every extra person that gets vaccinated moves us one step closer to getting back to being more normal, whatever that looks like now, and not having to worry about school disruptions and all those other things that have been always on our mind the last 20 months or so.

So practically speaking, if you can get your kid one vaccine in the coming weeks, will they have protection over the holidays if they want to visit with other family members?

Once you’re two weeks post your first dose, you will have a lower risk of acquiring COVID, but it’s still not zero. I think you have to look at your local situation—how much COVID is spreading in your community? What are the risks for your family members? Ideally, if everyone you’re visiting is vaccinated and they don’t have any significant immuno-compromising conditions, and you’re not visiting people when you have symptoms, or you’re getting tested if you have any symptoms—all those things are going to work together to significantly reduce your risk. 

Do you need to wait two weeks between your flu shot and your COVID vaccine?

When Health Canada and the National Advisory Committee on Immunization (NACI) made that recommendation, they put it out there as a precaution so that we can see if there are any other side effects and you can know for sure whether they’re due to another shot or if they’re due to the COVID-19 vaccine. 

The United States and the CDC have said it’s fine for kids to get the dose anytime or at the same time as the flu vaccine, so I think it’s really a precaution. If you happened to give your child the flu vaccine 10 days ago and then you booked an appointment for tomorrow, I would not cancel my appointment. 

People are also asking me—which should I do first? I would get the COVID vaccine first, and then I would wait the two weeks and then get the flu vaccine because there’s more COVID around.

What about kids who are on the edges of the age groups? Which vaccine should they get?

The dose for 5 to 11 year olds is 10 micrograms versus 30 micrograms for people 12 and up. 

They looked at a 10, 20 and 30 microgram doses in this age group, and they determined that the 10 microgram dose was adequate to produce basically the same level of immune response and protection as the 12 and up dose, and minimized the risk of side effects. It’s not based on weight or the size of your child, it’s based on the maturity of your immune system. 

So far, anyone who is four, turning five—so anyone born in 2016—is eligible now to get the vaccine. 

What we don’t know yet is what they’re going to do with the children that are turning five in 2022. That will depend on the provinces and what they roll out. I think it’s reasonable to say you have to wait till you’re five because they are studying the under fives with different doses and we expect that information to come out a little bit later this year, or early 2022. 

But if you’re 11 turning 12—definitely don’t wait. Get the vaccine that is available for your child as soon as possible, assuming that you’re ready to get it. 

For example, if my child was turning 12 in January, I would get them the 10 microgram dose, now. Then, after the eight weeks, once they were due for their second dose, they could actually get the adult dose, or the 30 microgram dose, for their second dose. 

What about kids with allergies? Are there any special concerns?

There is no increased risk of reaction if you have food or environmental allergies. The only thing we’ve seen in terms of allergies in the older age groups is to something called Polyethylene Glycol, or PEG, which is not an allergy you would normally know about because it’s not in most products. You would only know if your children have undergone medical procedures and you would have been told specifically by a physician about that.

What can we expect in terms of the pandemic once this age group has been vaccinated?

On a personal level, if you’ve gotten your child vaccinated, you can definitely breathe a little easier, because even if you did get COVID, if everyone in your household is vaccinated, the risk of anyone having severe or serious outcomes is exceedingly low. It turns what could be something deadly into a cold, basically. 

In terms of how the world is going to look in a few months—I do think that having vaccines available for this younger group is going to further decrease the cases. So you won’t see those explosive outbreaks that we’re seeing now, if kids are attending hockey tournaments or school, and it’ll make things and activities far safer, with lower risk. Whether things will ‘end’ and it’ll be totally back to normal, I think that’s a more challenging question, but I do really think this brings us one step further. 

What do you suggest if people have more questions? Where can they go and who can they reach out to?

One place that’s great is the website ScienceUpFirst. They really break down myths about things and they provide good data and they help interpret the evidence. 

And I think the most important thing is to talk to your healthcare providers and make sure that you have the information you need to feel comfortable making this decision. There are hotlines, for example at SickKids, set up so that parents can have conversations one-on-one with trusted health professionals that have all of the data and all of the knowledge to help you. I encourage people to reach out and make sure you have the answers you need to feel comfortable. 

Then if you do have good information, share that with the people around you, because we do know that if people are a bit hesitant or a bit worried, then they’re more likely to listen to their loved ones and people that they trust.

As we’ve said throughout this—and it’s a cliché—but we are in this together.

Kids health

The truth about the COVID vaccine, myocarditis and kids

Experts say the risk of myocarditis post-vaccine is incredibly low for kids. But if you're still worried, here are five reassuring facts.

Myocarditis—it sounds super scary and not like something you want your kid to have. And now that COVID vaccines for kids 5-11 are approved in both the U.S. and Canada, you’ve probably heard somebody mention it. But what, exactly, is myocarditis? And how much should you worry about it?

Myocarditis is a form of heart inflammation. In the vaccine rollout last spring and summer, some teens and young adults, particularly males, experienced myocarditis after receiving their doses. This occurred more often after the second dose and typically within four to five days of getting the vaccine. (Heart inflammation was also more common in those who had received the Moderna vaccine than the Pfizer vaccine.) Of course, this gave parents pause. Is the vaccine still a good idea? Parents of school-age kids—who don’t, for the most part, seem to get hit as hard by COVID—may be wondering if the vaccine is worth the myocarditis risk for them.

It turns out the answer is a resounding yes. Here’s what we know so far about the risk of myocarditis in school-age kids from the COVID vaccine.

No kids in the Pfizer-BioNTech trial got myocarditis

So far, there is trial data on about 3,100 kids who have gotten the Pfizer-BioNTech vaccine in the U.S., Finland, Spain and Poland and none of them got myocarditis after the vaccine. That’s not to say that once you start vaccinating more kids you won’t see some cases. For example, in Ontario, the rate of myocarditis and pericarditis—inflammation of the lining of the heart—reported after an mRNA vaccine is 22 in a million doses. (Or, another way to think about it: 0.0022 per cent of all the vaccinated people in Ontario experienced this side effect.) As more and more kids get vaccinated, some cases of myocarditis and pericarditis might be identified, but Christos Karatzios, a paediatric infectious diseases specialist at the Montreal Children’s Hospital, says the lack of cases in the initial trial is still a good sign. 

“You don’t need to vaccinate 10,000 kids to see one case of myocarditis. You could still by chance see one, and they didn’t,” he says. 

Myocarditis from the vaccine is easily treatable

Even though myocarditis and pericarditis sound quite serious, doctors are trying to reassure parents that it’s actually not as scary as you might think. 

It sounds bad, but most kids just have chest pain. They take some anti-inflammatories and they recover,” says Jeff Kwong, an epidemiologist with an interest in vaccines and a family physician in the Toronto Western Family Health Team. Generally, there is no lasting damage. 

In Montreal, Karatzios saw four teenagers over the summer with myocarditis post-vaccine. “They got their vaccine and then within a few days they felt chest tightness, chest pain, and every time they would take a deep breath, it would hurt. Or they were playing soccer, they couldn’t keep up and they were tired,” he explains. 

Testing at the hospital showed they were experiencing myocarditis (their blood work had high heart inflammatory markers). “This isn’t a heart attack,” assures Karatzios, who says these patients all recovered quickly with intravenous fluids and ibuprofen.

Kids have a generally low “background risk” of myocarditis

According to Kwong, kids, in general, get myocarditis at lower rates than other age groups.  “We’ve looked at hospitalizations and emergency department visits for myocarditis pre-pandemic, and it’s a lot lower in the 5-11 and the 12-16 age group compared to 16-19 and 20-24,” he says. 

This bodes well for what we might see in terms of rates of heart inflammation post-vaccine in a younger age group, he explains. “The background risk is a lot lower in these younger kids. So even if the COVID vaccine was to increase the risk by a certain factor, it will have less of an effect. We’ll see fewer cases, just because they have a lower baseline risk.”

Spacing the doses eight weeks apart may decrease any myocarditis risk

According to Canada’s National Advisory Committee on Immunization (NACI), some data from the U.K. and Canada has suggested that in adolescents, extending the interval between vaccine doses to eight weeks apart (instead of three weeks apart) may reduce the risk of heart inflammation even further (in addition to increasing vaccine efficacy). That’s why Canadian immunization officials decided to recommend a longer interval here, in most circumstances. Additionally, because the majority of myocarditis and pericarditis incidents happen after the second dose, and because the U.S. is doing a three-weeks-apart vaccine schedule, we may have more data on myocarditis safety by the time Canadian kids actually get their second shots.

Kids who get COVID are at risk of other heart issues

It’s important to remember that your kids are more likely to experience heart issues caused by a COVID infection than as a side effect from the COVID vaccine. According to data from the Centers for Disease Control (CDC), kids with COVID have a 30 times higher risk of myocarditis compared to kids without COVID. Looking at data from 900 hospitals, they found that from March 2020 to January 2021, out of 65,000 kids under 16 diagnosed with COVID-19, 86 were diagnosed with myocarditis. Only 132 out of 3.7 million kids without COVID developed myocarditis. 

This is because viruses, including COVID, can lead to inflammation of the heart muscle. “COVID targets our ACE receptors,” explains Karatzios. “ACE receptors are what controls our blood pressure and they are found throughout all our blood vessels, throughout our heart muscle, through the smooth muscle all throughout our veins and arteries, and our hearts.” 

To Karatzios, what’s even more concerning is the risk of multi-system inflammatory syndrome in children (MIS-C), which can affect the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs and usually comes on two to six weeks after an initial COVID infection (even if the COVID infection was mild). “During the second wave, I was seeing about one to two cases a week on average. Forty percent of children with MIS-C, at least in our cohort here, needed to be in the ICU because of cardiac dysfunction.”

Both Karatzios and Kwong think it’s a mistake to downplay the risks of COVID in kids and that the vaccine will offer benefits that outweigh the risks. With myocarditis, Kwong says, “We’re kind of fixated on one semi-bad thing. Versus a bunch of potential semi-bad things, or even really bad things, that could result from a COVID infection.” 

Kids health

Health Canada has approved the COVID vaccine for kids 5 to 11

Here's what parents need to know about side effects, how well it works and more.

It’s your turn, kids.

Health Canada authorized the Pfizer-BioNTech COVID-19 vaccine for kids 5 to 11 years of age. “After a thorough and independent scientific review of the evidence, the department has determined that the benefits of this vaccine for children between 5 and 11 years of age outweigh the risks,” Health Canada said in a release.

This is incredibly encouraging news for parents who have been waiting anxiously to give their kids protection from the virus.

The news is also welcomed by paediatricians like Anne Wormsbecker, who have seen their patients (and their parents) suffer over the last 20 months. “School-aged children have been tremendously impacted by the public health measures to control the pandemic, with school closures, loss of formal extra-curriculars and restrictions on face-to-face socialization. Through immunization, kids and their parents will be another step closer to their pre-pandemic lives,” she says.

Jeff Kwong, a family physician in the Toronto Western Family Health Team as well as interim director of the Centre for Vaccine Preventable Diseases, adds that vaccinating kids is an important step toward ending the pandemic.

Kids under 12 now have the highest number of new cases across Canada, according to the Public Health Agency of Canada.

“By vaccinating them, it will decrease those cases and will decrease their transmission to other age groups, too,” says Kwong.

Although the vaccine has been authorized at an interval of three weeks, the National Advisory Committee on Immunization (NACI) is recommended kids wait eight weeks between shots, which is the current recommendation for people 12 years and up. According to the committee, this recommendation is based on emerging evidence in adults that suggests longer intervals between the first and second doses result in a stronger immune response and longer immunity.

Delaying the time between shots may also be associated with a lower risk of myocarditis and/or pericarditis in adolescents and young adults, according to NACI.

As a precaution, NACI says kids should get the COVID vaccine 14 days before or after another vaccine, including the flu shot. This is to help determine, if there is a side effect, whether it’s from the COVID shot or another vaccine.

On November 2, kids 5 to 11 in the United States became eligible for the Pfizer-BioNTech shot. Since then, more than 2.6 million kids, or about 10 percent, have gotten the vaccine.

How effective is the COVID vaccine for kids

The kid-specific dose is less than the one approved for people 12 and up—10 micrograms per shot, instead of 30. That’s because, in the study, this dose gave the best protection for the least amount of side effects.

To assess protection, researchers looked at a couple of things. One, they looked at antibody levels in kids who got the vaccine compared to people aged 16 to 25 who got the vaccine, and found a similar antibody response.

They also looked at the number of actual COVID-19 cases acquired during the study period and concluded the vaccine was 90.7 percent effective in preventing cases of COVID, including the Delta variant. In the observation period, there were three cases of COVID, compared to 16 cases in the placebo group.  

Is the COVID vaccine for kids safe?

So far, the Pfizer-BioNTech study has included just over 4,600 kids aged 5 to 11. In the first part of the study, about 1,500 kids were given two, 10 microgram doses of the vaccine, three weeks apart. The other 750 were given a placebo. The study was then expanded to include another almost 2,400 kids—with approximately 1,600 getting the vaccine and 800 getting the placebo—to further assess the safety of the vaccine.

No serious safety concerns were noted in the kids who got the vaccine. The researchers were specifically on the lookout for myocarditis, or inflammation of the heart muscle, as this condition has previously been seen in some vaccinated people, particularly adolescent males and young adults. Of the 3,000 kids who have received the vaccine, there has been no incidence of myocarditis or pericarditis (inflammation of the membrane that surrounds the heart) so far.

What are the side effects of the COVID vaccine for kids?

Of course, even though no serious reactions were observed, kids did have some effects from the vaccine, just like teens and adults do. The side effects observed in the study were similar to those seen in teens and adults, although in many cases to a lesser degree.

Common side effects were redness and swelling at the injection site (with no difference between the first and second dose) as well as fatigue, headache and muscle pain. These reactions, referred to as “systemic reactions,” happened more after the second dose. In general, side effects occurred between one to four days after the vaccination and went away one to two days after they started.

Thirteen of the kids who received the vaccine experienced lymphadenopathy, or swollen lymph nodes, and all cases were mild.

Who was in the study?

Most of the study participants were white (about 80 percent) while 6.5 percent were Black or African American, 6 percent were asian and 7 percent were multi-racial. Just over half, 52.1 percent, were male.

About 20 percent had a co-morbidity known to increase the risk of severe COVID disease, such as asthma, neurologic disorders and congenital heart disease. The median age was 8 years old.

What happens next?

As kids in Canada, the US and elsewhere get the vaccine, researchers and officials will continue to monitor for vaccine safety and efficacy.

And there may soon be another vaccine available as well—on November 16, Moderna submitted data on its vaccine in 5 to 11-year olds for approval.

For parents worried about the relative newness of the vaccine, Kwong, who plans on getting his school-aged child vaccinated as soon as possible, provides this reassurance. “These are very safe vaccines. Billions of people have gotten this vaccine in the world. The sooner we get as many people vaccinated as possible, the sooner we can get out of this.”

Kids health

8 science-backed ways to make needles less painful for your kid

Is your kid afraid of needles—and it's time for a vaccination? There are specific things parents can do to reduce kids’ distress from an impending needle.

It’s a tough thing when your child hates getting needles. You know it needs to happen, but you also know that a major freak-out is highly likely. But did you know that parents play a huge role in how kids cope with pain from shots? Studies show that there are things parents can do to noticeably reduce their kid’s pain and distress.

One study, which was conducted by researchers at York University and published in the journal Pain, followed 760 children through their vaccines in their first year of life, and then again at preschool. “We were not only looking at them but looking at their parents,” says Rebecca Pillai Riddell, senior author of the study and York research chair in pain and mental health. “We really found that parents are powerful in shaping their preschoolers’ pain response.”

Want to offer your kiddo some comfort while they’re getting a shot? Try these eight evidence-backed strategies to make the whole process smoother for both of you.

1. Check your own stress.

Pillai Riddell recommends parents start by assessing their own feelings, because the research shows that when parents are stressed, kids don’t cope as well. If you’re anxious, take some deep belly breaths to calm yourself before you transfer some of that anxiety to your kid.

2. Guide your kid to take deep breaths, too.

In the study, kids whose parents coached them through taking deep breaths in and out experienced less pain. Start doing this beforehand, if you see signs of stress, and encourage these coping skills both before and during the needle—the less distressed kids are in advance of getting a needle, the less pain they experience after the needle.

3. Tell kids that they’ll get through it.

Kids can control their pain when they have good coping skills, says Pillai Riddell. “One thing kids in the study did was tell themselves, ‘I know this is going to hurt, but I’m going to get through it.’ You know that they’re getting that script from their parents, but when kids say it, it works.”

4. But don’t be overly reassuring.

If you repeat “it’s OK, it’s going to be fine” over and over, you’ll actually make your child feel more anxious, says Pillai Riddell. “When things are good, you don’t remind children that things are going to be good. And if you’re reassuring yourself, kids can pick up on that.” Also avoid saying things like “I’m sorry this is happening to you,” which suggests there’s reason to be distressed.

5. Touch or cuddle your child.

Pillai Riddell suggests “a calm, close cuddle” is a great way to help a child cope. Once your kid is getting a little bigger, you might have them on your lap during a needle or hug them while they’re sitting on the examination table. Either way, the key word is “calm.” When you’re holding your child close, they’ll pick up on your racing heartbeat or other signs of stress. And if your kiddo is not a cuddler, Pillai Riddell suggests offering to hold their hand.

6. Distract them.

Pull out your phone and play their favourite song, or talk to them about plans for later that day. “Saying that something positive is going to happen afterwards reminds them that this, too, will pass,” says Pillai Riddell. “Even if it’s getting them to talk about soccer practice. Ask them, ‘What are we going to pack for soccer practice?’”

7. Use humour.

Preschoolers especially are at an awesome age for corny jokes, says Pillai Riddell. A good joke or funny story is another effective means of distraction that can help take a child out of that stressful moment. “The brain can only process so many things at once, so the more you get them to think of something outside of the pain, the better.”

8. Don’t shame them for getting upset.

Saying things like “strong girls don’t cry” or “you can do better than that” is not only ineffective, it makes kids feel worse. Pillai Riddell acknowledges that most parents say these things to try to remind their child that they can cope well, but the message backfires and it causes more distress.

Kids health

Parents, get Benadryl out of your medicine cabinets

Allergists have been saying for years that newer antihistamines are safer, but old habits die hard.

Many new parents are given advice from other parents, or even doctors, to have a bottle of Benadryl for kids on hand, just in case of an allergic reaction.

But according to allergists, the medication shouldn’t be used at all to treat allergy symptoms such as itchy eyes, sneezing or hives because it—and other ‘first-generation’ antihistamines—pose unnecessary risks to your child’s health.

“These medications have significant side effects,” explains Doug Mack, a Burlington, Ont., paediatric allergist and assistant clinical professor at McMaster University, who is also on the board of the Canadian Society of Allergy and Immunology. That group published a statement on October 1st, 2019 regarding Benadryl (diphenhydramine) and other older antihistamines such as Atarax (hydroxyzine) and chlorpheniramine (found in some over-the-counter children’s cough and cold remedies), reiterating this recommendation (which allergists have actually been making less formally for years) and laying out the scientific evidence behind it.

What’s wrong with Benadryl?

Side effects of Benadryl and other first-generation antihistamines include impaired school performance in kids who use it regularly for seasonal allergies, drowsiness, agitation, hallucinations, and—rarely—seizures and even death. For instance, according to a study using data from 2003, that year, in the US, “there were six reports of fatalities (in children) related to first-generation antihistamine use,” Mack says. When the drug was released back in the 1940s “we didn’t have the same safety standards or requirements before over-the-counter medications were licensed for use,” he adds. And yet, in Canada, the drug is readily available over the counter, and, according to online surveys of physicians and pharmacists, Benadryl was the most recommended antihistamine for kids in each of the past seven years.

Newer, better antihistamines

Mack and other allergists say newer antihistamines, which include cetirizine (Reactine), loratadine (Claritin), fexofenadine (Allegra) and desloratidine (Aerius) are actually much safer. (These brands all offer kid-friendly versions.) In fact, products with the brand name Benadryl sold outside of the US and Canada actually contain cetirizine, not diphenhydramine.

What’s more, studies have also demonstrated that these second- and third-generation medications, “actually do a better job,” Mack explains. “They last longer, they work quicker, and they don’t cause the same degree of sedation we find in first-generation antihistamines.” (The one downside: They cost a bit more, but you can get cheaper generic versions.)

Benadryl for anaphylactic reactions

But surely Benadryl is a good medication to use for potentially life-threatening reactions due to food allergies and insect stings, right?

Actually, no, says Mack. “Antihistamines have never been demonstrated to improve outcomes in anaphylaxis,” Mack stresses. “The only validated treatment for anaphylaxis is epinephrine, or the EpiPen. People get lulled into a false sense of security thinking an antihistamine will prevent the allergic reaction from getting worse—it totally doesn’t,” he says.

Benadryl and other sedating antihistamines can actually make it harder to gauge the severity of the situation. “One of the markers of a worsening allergic reaction is drowsiness,” Mack explains. That means if you give Benadryl and your kid starts nodding off, medical personnel have no choice but to act as if their life is in imminent danger, which can be traumatic for everyone. Also, when Benadryl is given as a “wait and see” medication it delays the administration of epinephrine, which has been linked to more severe reactions.

While antihistamines may still be used in the emergency departments of hospitals to help manage less serious symptoms, such as itching and hives, “a number of hospitals in the area, including McMaster, have removed Benadryl from their anaphylaxis action plan,” says Mack. Similarly, organizations such as the BC Centre for Disease Control no longer recommend Benadryl as part of first-line management of anaphylaxis outside of a hospital.

While some patients and health professionals may insist on sticking with Benadryl because it’s what they’ve always used, that’s not much different than using Aspirin (acetylsalicylic acid) to treat your kid’s fever. (That’s now a no-no because, in children, it’s linked with a rare, but potentially deadly condition called Reye’s syndrome.)

“Why would you use anything that is so old, and isn’t safer, or particularly effective?” Mack asks.

Despite allergists harping this message for years, it has yet to reach many physicians, pharmacists, and parents. Every day, Mack says he sees parents who are surprised to learn Benadryl isn’t recommended. “Old habits die hard, but hopefully this will turn people’s thinking,” he says. “Today, I had a kid say to his mom, I heard on the news that Benadryl wasn’t okay.”

This article was originally published online in November 2019.

Kids health

What a paediatrician mom wants you to know about the COVID vaccine

What are the side effects? What if my kid is scared? And how can I be reassured it's safe?

COVID vaccines for kids in the 5 to 11 age group are on the horizon, with Health Canada currently reviewing study data from Pfizer and provinces getting ready to start getting shots into younger arms. Officials in Ontario have said plans are underway for rolling out the vaccine once it’s approved and in British Columbia, you can even register your kid for the vaccine through the GetVaccinated website.

But of course, as parents, we have questions, so we spoke to vaccine advocate and paediatrician at Unity Health Toronto Anne Wormsbecker, who also happens to have a five- and seven-year old who can’t wait to get their shots. 

We’re getting much closer to getting our 5- to 11-year-olds vaccinated in Canada, which is super exciting, but of course parents want to make sure they’re going to be safe. What are you looking for before you’re comfortable having your own kids get the vaccine? 

I really trust our immunization system in Canada. I’m fortunate to know a little about the vaccine approval process and about the recommendations that come from the National Advisory Committee on Immunization (NACI). For me, knowing that something has been vetted and that it’s effective and safe, and recommended for the child population, gives me reassurance.

We know that Pfizer has submitted trial data to Health Canada and that they have officially requested approval for their mRNA vaccine in the 5 to 11 age group. What are they looking at? 

Health Canada will review all of the data that’s been supplied by the manufacturer, showing things like antibody levels, disease case counts in vaccinated versus unvaccinated individuals, and showing common side effects that we expect from all vaccines like a sore arm, and feeling tired. They will also review the data for more rare side effects as well. 

They’re also looking to see if these studies have been done in a robust, scientifically rigorous manner. After Health Canada does that, then the vaccines go to the National Advisory Committee for Immunizations (NACI), that’s made up of scientists, physicians and epidemiologists, all of whom volunteer their time to review the data as well and come up with program recommendations—that is, how the vaccine is delivered to the population. 

Side effects are a major concern for parents. What do we know so far? 

As with any vaccine, parents can expect their child to have discomfort, redness or swelling where the vaccine was given. That’s the immune system doing its job. For example, I had my flu vaccine last week and my arm was sore for a couple of days.

Like adults, children can also have generalized, whole body discomfort after vaccine with fever, chills, muscle and joint aches, low energy, headaches, and even vomiting and diarrhea. Low energy, muscle aches and headaches are expected to be common whereas the others are not expected as frequently. In the manufacturer’s studies, where kids were given one-third of the adult dose, approximately 90 percent of kids did not develop fever and chills.

Other side effects are extremely rare. Reassuringly, there were no cases of heart muscle inflammation [myocarditis] or severe allergic reaction in the studies used to approve the vaccine. There will be ongoing monitoring for these.

Where can we expect our kids to get the vaccine? I think a lot of parents would prefer it was at their doctor’s office rather than a big convention centre. 

I wish I had some insider information, but I don’t. I do think it’s important to have child- and family-friendly immunization experiences. I would be delighted if there were programs that made the experience a positive one for kids and their parents. But we don’t know yet. 

A recent Angus Reid poll showed 50 percent of parents are ready to vaccinate their kids as soon as it’s available, while almost a quarter don’t plan to do so. How do you reassure parents and encourage those who are on the fence?

When it comes to vaccines, and medications in general, we spend a lot of time talking about potential side effects, but that’s only because we know they work. So I like to focus on the benefits. I ask the family what they understand about the benefits of being vaccinated and the drawbacks of not being vaccinated. 

Then I ask if they have any questions. Some people want to hear about the science and others want to hear about how a vaccine works. Others want to know more about the basics, like, ‘How is this going to get in me?’

How does it work?

Using the metaphor of a recipe or instruction manual is a great way to describe how mRNA works. The vaccine sends an instruction manual to your cells to make a specific protein that’s on the outside of the COVID-19 virus, the spike protein, and then that, in turn, has your body make the antibodies against the spike protein. Once that recipe is used, it’s no longer in your body. It’s kind of like when you searched online for that perfect recipe to bake cookies, and then you can’t find that online recipe anymore.

The other thing I explain is that the vaccine doesn’t go into the very centre of the cell, what we call the nucleus. It doesn’t join your DNA, your own recipe for your body and yourself. 

How can you prepare your kid for getting the vaccine? 

For kids who are really anxious, you don’t want to be talking about something for a month, two weeks, or multiple days in advance because it gives them an opportunity to worry. Instead, spend time in advance taking a lot about the benefits. Then maybe the morning of the appointment,  talk to them about what they can expect in the room when they go for their vaccine. So it’s not a total surprise to them, but at the same time, you haven’t given the opportunity for their anxiety to build it up and imagine it to be more than it’s going to be.

For kids who have fear of injection and fear of pain, you can buy a numbing patch over-the-counter that you put on prior to the immunizations, that can make it less painful. Also, pulling out a video of their favourite song or favourite show can easily distract them. 

There’s also guidance that encourages people to get vaccinated in their dominant arm because you use that arm more, and there’s good blood flow to the area. You’ll actually experience less discomfort in that side versus if you got it in your non-dominant arm.

Some parents are wondering why we even need to bother with vaccinating kids, since they don’t get that sick from COVID. Do the risks of the vaccine outweigh the benefits?

We know with the Delta variant of COVID-19, younger patients are experiencing it more than they had with other variants. So there is, in fact, risk to kids. Likewise, when we are immunized, we have the ability to protect others. 

The other thing is, we’ve often said we’re suffering through a parallel pandemic, with missed school time, increased sedentary activity in kids, and worsening mental health for children and youth. By getting vaccinated kids can get out and about and get on with their regular kid lives, which is really important right now.

Yes! Kids are missing out on so many things. What are your kids looking forward to after they get their vaccinations? 

My son’s birthday is in March and the pandemic was declared the day before his birthday. We cancelled his birthday party at an indoor playground and we still have a credit note. Having a birthday party at an indoor playground and running around with friends, sitting to share cake, ice cream and snacks—for my kids, that would really be a sign that we’re back to how things were before the pandemic.

Kids health

The COVID vaccine for kids 5 to 11 years: What parents need to know

If you have a school-aged child, it's almost their turn for a COVID-19 vaccination, and you may have questions. Here are the answers.

When the COVID-19 vaccine became available to teenagers in Canada back in May of 2021, many parents rejoiced. After all, being vaccinated is highly protective against the nasty virus, which has now taken the lives of more than 28,000 people in Canada, and infected more than 1.5 million of us. Widespread use of the vaccine is also a key element of the larger plan to end the pandemic.

But now that it’s almost time for younger kids the get the COVID-19 vaccine, parents have questions. Here are some answers.

What do we know about the safety and effectiveness of the vaccine in kids aged 5 to 11?

At the moment, only one vaccine manufacturer, Pfizer-BioNTech, has discussed the results of its studies on how the vaccine works in school-aged kids.

In a press release published in September 2021, the company said that its trials showed the vaccine had a “favorable safety profile” and “robust neutralizing antibody responses” in children aged five to 11. Put simply, it was found to be highly safe and effective in that it created the necessary antibodies, just as it does in adolescents and adults. It was also well-tolerated as far as side effects—no new side effects were identified.

Will kids need one vaccination or two? 

Parents of needle-phobic little ones will inevitably be wondering if their child will need one shot or two. Kids are small and light, so do they really need two doses?

Pfizer said that in its study, which was conducted on 2,250 kids aged five to 11 years, kids received two needles administered three weeks apart. It’s worth noting that the dose being approved is a third of what teens and adults received—10 micrograms per shot as opposed to 30 micrograms.

It remains to be seen if other vaccine manufacturers are developing shots that can be administered in just one dose.

Why is the dosing based on age, not weight? What if my child is heavy for their age?

With most medications, weight plays a big role in dosage. But that’s not the case for vaccine doses. “This is because your immune response is not weight dependent,” explains Sabina Vohra-Miller, the Toronto-based founder of Unambiguous Science, a platform that aims to make science accessible to Canadians. Instead, researchers look for a dose that creates a strong immune response in that age group while minimizing side effects.

When can we expect the vaccine roll-out for kids in Canada to begin?

Pfizer-BioNTech has formally requested Health Canada to approve it’s COVID-19 vaccines for 5 to 11-year olds and the agency is currently reviewing the data. We don’t know when that review will be completed, however, we do know that some provinces are already getting plans together to start the roll-out once the vaccine has been authorized for use.

In the United States, on Oct 26, a key FDA advisory committee endorsed the vaccine for kids, by voting to recommend an emergency-use authorization for the shot.

What are the vaccine’s side effects in children?

Pfizer reports that in the study, the vaccine’s side effects in kids were similar to the side effects seen in teens and adults.

In a briefing document submitted to the FDA committee, Pfizer reports the most common local reaction was pain at the injection site, and the most common systemic reactions included fatigue, headache, muscle pain, and chills.

You may have read about myocarditis (inflammation of the heart muscle), and pericarditis (inflammation of the outer lining of the heart) occurring after an mRNA COVID19 vaccination. In Canada, there have been “a small number” of these reports, according to a report from SickKids hospital in Toronto. As of October 17, 2021, there have been 455 reports of myocarditis or pericarditis after the COVID-19 mRNA vaccines in Ontario, out of the more than 22 million doses received. The symptoms of these conditions include chest pain, shortness of breath and feelings of having a fast-beating, fluttering, or pounding heart, and are more likely to occur after the second dose. Adolescents who developed myocarditis or pericarditis after their vaccine generally experienced mild illness, responded well to conservative treatment and rest, and their symptoms improved quickly, says SickKids.

According to the study data, no cases of myocarditis/pericarditis were observed during the vaccination period and three months after the second dose.

Do kids truly need the vaccine?

Since early in the pandemic, parents have been assured that when kids contract COVID-19, it’s almost always a mild illness, and that serious illness and death are extraordinarily rare. This led many parents to believe that vaccinating kids against the virus was unnecessary.

But according to Health Canada, although kids are less likely than older adults to get very sick from COVID, they can still get sick, and some will become very sick and could require hospitalization. Hospitals in the United States have seen paediatric admissions surge with the Delta variant and now that schools are open in Canada many experts worry about a similar situation occurring in Canada. There’s also a very real concern about infected kids experiencing longer-term effects, known as “long COVID.

It’s also worth remembering that kids with COVID, even if the case is mild or asymptomatic, can spread the virus to others. Many experts believe that, because of the Delta variant, to achieve herd immunity, we need almost everyone in the country vaccinated, including children.

Should any kids avoid the vaccine?

Anyone who has had a severe allergic reaction to any ingredient of the Pfizer vaccine should not get the vaccine, according to Pfizer, but speak to your healthcare provider if this is the case for your child.

What about kids younger than 5?

Pfizer says that data on the other two age cohorts from its trial—children 2 to 5 years of age and children 6 months to 2 years of age—is expected to be released before the end of the year.

Kids health

Halloween candy: How three dietitian moms deal with it

They may be healthy-eating experts, but they aren't buzzkills. Three dietitian moms weigh in on the best ways to dole out Halloween candy.

Halloween is fast approaching, and I’m already cringing at the thought of the candy that’s going to rain down from my kids’ trick-or-treat bags and onto my living room floor.

It’s hard to find that balance between letting our kids indulge on special occasions, while coaching them to practice a modicum of self-control. Do we let them go nuts, or put a limit on their consumption?

We reached out to three dietitians—who are also moms—to find out how they handle the sugary loot after a night of trick-or-treating.

1. Cara Rosenbloom

Registered dietitian at Words to Eat By in Toronto, and mom of two kids, ages six and 10.

“My kids love good food, and understand the idea of the 80/20 rule,” says Rosenbloom. “They eat well 80 percent of the time, and leave room for 20 percent indulgence. Halloween is much the same.”

Rosenbloom says her kids have a few pieces of candy on Halloween night, then separate the rest of their stash into two piles: Keep and Don’t Keep. Her husband brings the Don’t Keep pile to his office.

“From the Keep pile, a chocolate bar or chips is added to their lunch or recess snack each day for the week following Halloween, and then the fun fizzles out,” says Rosenbloom. “They tend to forget about the candy once the excitement of Halloween is over. It also helps to keep the candy out of their sight line—makes it easier to forget about it.”

Rosenbloom says it’s important to remember that Halloween is only one day, so it’s okay to let your kids indulge more than usual. “It’s more important to fix what kids eat the other 364 days,” she says. “Providing your children with education about a balanced approach to food will help them learn not to overdo it at Halloween, or on any other day. With a healthy, real, whole food-based diet, a little chocolate won’t hurt.”

2. Tristaca Curley

Registered dietitian at Fueling with Food in Kelowna, BC, and mom of kids ages three and five.

“I let my kids fully embrace Halloween—every sugar-coated, chocolate-filled aspect of it,” she says. “Halloween was one of my favourite holidays when I was young and I don’t want to take that experience away from my kids.”

On Halloween night and the following day, Curley lets her kids eat as much as they want of their candy—no limits. On the third and fourth days, her kids only eat candy along with their otherwise healthy snacks. And by then, she says, they’ve usually lost interest in the candy. We make the holiday about more than the candy,” she says. “We make a point of sharing a filling meal with friends before heading out trick-or-treating, and often meet up with friends afterwards for a victory celebration. The night becomes less about the candy, and more about the fun times spent with friends.”

“While I certainly don’t recommend routinely feeding candy, I do believe that one of our many jobs as parents is to promote eating competence—that is, teaching children to fuel their bodies with nutrient-dense foods most often, while enjoying pleasurable foods in moderation, without guilt.”

3. Sarah Remmer

Registered dietitian and child and feeding expert in Calgary. Her children are 22 months, four and six.

Remmer strongly advises parents to resist the urge to act as the “treat police,” because it doesn’t help kids learn to moderate their intake of treats.

Instead, Remmer suggests letting kids older than four years old have as much as they want on Halloween night, even if it means they might go overboard. That’s what she does with her six year old. “Kids learn by making mistakes, and however upsetting it is for us parents to see our kids gorge on treats, ultimately, this will teach our kids to moderate their intake of them.” If your kids feel ill after overindulging, Remmer suggests asking them why they think they feel like, what they might do next time to avoid feeling that way again.

For little trick-or-treaters—those between two and four years old—Remmer suggest that parents come up with a fair, daily amount of candy, since young children aren’t yet old enough to manage their stash on their own. This is what Remmer does with her four year old.

But when it comes to when her kids eat the treats, she sets designated eating times. “Grazing all day on snacks is a recipe for mindless eating and mealtime battles,” she says.

If you want to limit the amount of candy your kids come home with, Remmer suggests sending them out with smaller buckets, or setting a time limit for trick-or-treating. Parents might also ask their children if they’d like to trade any of their candy for a homemade dessert, a small toy or a trip to a movie or indoor play space.

“Don’t dread Halloween because of the candy overload,” says Remmer. “Think of it as a great opportunity to teach your kids about moderation, balance, and healthful indulging.”

This article was originally published online in October 2017.

Kids health

Why aren't all the provinces keeping kids safe with rapid testing and masking?

As we wait for vaccines to be approved, some provinces are falling short in protecting kids from COVID.

“How are the kids doing?” is a question whose answer depends on where one lives. In British Columbia, before classrooms reopened, the rate of infection for those under 10 years of age stayed below that of older residents, though all rates were rising, according to the BC COVID-19 Modelling Group. The panel warned that children under 12 not yet eligible for inoculation make up nearly half of the unvaccinated population in the province, making them a large risk group, especially as they have high numbers of contacts.

On Sept. 8, the day after school began, the under-10 rate of new cases per 100,000 population exploded in a sharp upward trajectory while the rate for those 10-and-older stayed pretty much flat. By the end of the month, the rate of COVID-19 among unvaccinated children was more than double that of older residents.

In neighbouring Alberta, data was harder to obtain as the province restarted reporting data on COVID in the classroom just before Thanksgiving. By then, 54 schools reported outbreaks (10 or more cases) and a total of 756 of the 2,400 schools in the province had at least two cases. The situation also isn’t good in New Brunswick, which reintroduced masks in schools by mid-September and where rising case counts forced more than a dozen schools to shift to online learning a week ago.

The number of students contracting COVID-19 in Alberta, B.C. and other hotspots highlights a pressing worry for both parents and decision-makers: children are now the largest unvaccinated group, vulnerable to a variant that has proved highly efficient at finding pockets of unprotected victims—especially those who are in congregate settings like schools for hours each day.

Are governments doing enough to mitigate the risks during the third school year affected by this pandemic? And how close are we to vaccinating our children? 

Ontario, whose education system was pummelled by COVID-19 earlier in the pandemic that students spent much of their school year online, has largely avoided the problems plaguing the West. Its number of daily new cases in schools has been essentially flat since the school year started, with 16 per cent of schools reporting at least one case. One key difference may be mask mandates, especially for unvaccinated children. Well before school began, Ontario announced that face coverings would be worn by everyone from Grades 1 to 12. In contrast, it took until Oct. 1 for B.C.’s provincial health officer, Dr. Bonnie Henry, to extend the province’s mask mandate to students in kindergarten to Grade 4.

“There are a list of options on the table for how to mitigate transmission in schools and some of those options haven’t been pursued to the extent that they could be,” says Dr. Devon McDonald, an ICU physician in Lindsay, Ont. He singles out the Toronto public school system, which enacted stricter public-health protocols than those mandated by the province, including requiring students to remain within their cohorts, even during lunch, and masks for even kindergarteners.

McDonald also wonders if another reason could be Toronto’s investment in HEPA filters, which are operating in many of its classrooms. As of Tuesday, the vast public school system had reported only two schools out of 583 with more than 10 cases, with one closure.

Another tool being rolled out in more and more provinces: rapid testing for students. In September, Quebec began having schools in hot spots administer rapid tests to kids who display symptoms; the system went provincewide this week. In an effort to keep schools open, New Brunswick began distributing rapid tests on Tuesday to students who are deemed close contacts to someone who has COVID-19. As of now, one quarter of the province’s schools have COVID-19 cases, CBC News reports.

Ontario has gone a different route. On Oct. 5, it announced that it would provide rapid tests only to public health units experiencing a high risk of transmission so they could test asymptomatic children.

McDonald is a proponent of rapid testing on a much larger scale, pointing out it is almost ubiquitous in the United Kingdom, where households are given free tests, as well as in Europe and Asia. He did rough math on what could happen if Ontario tested all students, using a popular rapid test’s own error rates. He determined that the province could expect to find and remove 4,156 infectious students from the classroom while the tests would miss 144 infectious students, though the vast majority, 988,730, would be correctly identified as negative.

At the same time, his basic calculations found that 6,970 students would receive false positive results, though he believes that rough analysis could be high. Those students would be away from classrooms for a day or two until more precise PCR tests came back negative. “I think we would find we would be better off accepting some school absences due to false positives,” he says, “rather than the current situation, where we have entire schools closed because of COVID-19 outbreaks and classrooms transitioned to online learning.”

And for students, teachers and parents, hope is building that those ages 5 to 11 will soon be eligible for COVID-19 vaccines. This week, Pfizer is expected to seek approval from Health Canada, while Procurement Minister Anita Anand tweeted that the federal purchase agreement with Pfizer “allows for access to pediatric doses upon the receipt of regulatory approval” and that they intend to make doses available as soon as possible. B.C. is already prepping for that day. Over the holiday weekend, it openedits COVID-19 vaccine registration system to kids 5-11, so they can be notified as soon as appointments are available.

Vaccinating children could dramatically help Canada reach its goal of getting more than 90 per cent of the population protected against COVID-19. Trevor Tombe, an economics professor at the University of Calgary who has been crunching vaccine data, told Maclean’s that there are 2,885,026 individuals aged 5-11, as of 2020. Assuming children got vaccinated at the same rate as the 12-17 age group (85 per cent have at least one dose and 76 per cent with both doses, according to his estimates), that would add more than six percentage points to our national tally, which currently sits at 77.1 per cent with one dose, and 71.3 per cent fully vaccinated.

As well, anecdotes and social media posts suggest many children and their parents are eager to get them vaccinated as soon as possible. One nine-year-old girl informed this reporter of exactly what she’s going to wear when she gets her first dose (for the record, there will be lots of pink). She’s still thinking about style options for her second shot.

Kids health

If you're freaked about long COVID in kids, here are the facts

Long COVID in children isn’t common—but can be debilitating for those it affects.

When now 13 year-old Manuel Firkus first got sick with COVID-19 in March of 2020, his only symptoms were constant burping and about three days of diarrhea. In fact, his family, who lived in B.C. at the time, would have thought nothing of his brief illness if it weren’t for his sister’s high fever and cough, his mom’s horrible wet cough and the fact that the World Health Organization had just called COVID-19 a global pandemic. 

His mom, Jaymie’s, symptoms persisted—she was unable to return to work due to fatigue, a racing heart, low blood pressure, brain fog, loss of taste and smell and a host of other symptoms that terrified her. But Manuel’s symptoms went away completely—until a sunny day in May, when he suddenly collapsed while mowing the lawn. “His legs were too weak and we had to carry him into the house,” recalls his mother, who now lives in Alberta. That night he experienced chest pain and strange heat sensations throughout his chest and torso, which he described as his insides “sparking up” with the heat. His mom says that over the next week he started vomiting, got severe headaches and dizziness and his toes turned purple and sore. They took him to the hospital but didn’t get any answers. “There was a lot of confusion and different opinions about what was occurring,” recalls Jaymie. No one in the family had been tested for COVID-19—at the time of their first symptoms, testing was sparse and Manuel wouldn’t have qualified anyway—but they were working under the assumption it had gone through their family. Doctors agreed COVID could have been at the root of Manuel’s symptoms but said there was nothing they could do. He was sent home to recover on his own.

When COVID-19 first started circling the globe, parents were reassured by reports that kids mainly get mild cases of the disease—a fact that remains true, although we now know some do have more severe illness. What’s also become clear, however, is that a small subset of kids will go on to suffer debilitating symptoms that can last for months. According to Danilo Buonsenso, a paediatrician at the Gemelli University Hospital in Rome, who has published several papers on long COVID in children, one to four percent of kids who get COVID could have symptoms that last longer than six months. Susie Goulding, the director of the support group Long Covid Kids Canada, says more than 200 families across Canada have reached out to her group for support since the pandemic began, and the number is growing. While the overall risk of a child getting long COVID still appears low, experts say more awareness of the condition is needed so those suffering can get the help they need. 

Symptoms of long COVID in kids

So far, it seems that most children who develop long COVID have initial infections, like Manuel, that are mild. According to two studies published by Buonsenso, over 95 percent of children who have persisting symptoms were not hospitalized. About three quarters of those initially infected had mild to moderate symptoms like fever, sore throat, cough or shortness of breath that could be managed at home and, depending on the study,  twelve to twenty-five percent were asymptomatic. Although we don’t have a lot of data in Canada so far, these trends appear consistent here. According to Thanh Diem Nguyen, a paediatric respirologist at the Post-COVID-19 Clinic at Ste Justine hospital in Montreal, all of the children seen so far at the clinic had mild initial infections. Of the 22 children that attend the clinic, most had flu-like symptoms like a wet cough, headaches, shortness of breath or fever.  

Some long-haul kids continue to have symptoms from the time they first get infected. Other kids seem to get better but within several weeks a wide range of physical or neurological symptoms set in. According to information reported by members of Long Covid Kids Canada, the symptoms among Canadian children run the gamut from fatigue, headache, sore throat, diarrhea, reflux, nausea and vomiting, joint and muscle pain, brain fog or dizziness, rashes, mood changes and chest pain. Other symptoms reported include fevers, shortness of breath, feeling illness or discomfort after exertion, weight loss, abnormal heartbeats, seizures, hair loss, testicular pain, phantom bruising, hallucinations, intracranial hypertension, bladder inflammation, temperature dysregulation, sore or bleeding gums, mouth blisters or canker sores, and changes in vision. “The symptoms can ebb and flow in what seems like a never-ending cycle,” says Goulding, who has spoken with many of the families. “Old symptoms may come back, and you never know what symptoms you may have on any given day.  Some children can even experience 40 to 50 symptoms.”

Kids at the Post-COVID-19 clinic in Montreal have many of these same symptoms, but the most common one there is fatigue. Other symptoms like dizziness and heart palpitations are common enough that one designated cardiologist and one ENT (ear-nose-throat) specialist are available for fast-track consultations. Less common symptoms seen there have been memory retention problems, loss of smell, or not being able to smell properly.

Does long COVID go away?

The good news is, most kids recover from long COVID within three to five months, says Buonsenso. However, some continue to experience symptoms for much longer. Nguyen has treated children with symptoms lasting 18 months but this isn’t common. 

Although it’s unknown whether those with persisting symptoms will eventually get better, both Buonsenso and Nguyen are cautiously optimistic. Buonsenso believes that large public interest in COVID will lead to more research and a better understanding of long COVID, including treatments. He also says that preliminary evidence suggests that inflammation or viral persistence could be causing lingering symptoms in most children. Kids’ progress in the Montreal clinic seems to confirm that permanent lung damage is unlikely. “So far our tests show that all of our patients have normal lung function, even though they have a decreased capacity for exercise.  We’re not sure why just yet,” says Nguyen. “Most of the kids are getting better with time, but it’s much slower than with the flu or other viruses.  However, even though they’re getting better, they’re still not reaching their condition before COVID.  I believe that it will eventually go away, but it’s hard to tell. It may take several months to years.” 

There isn’t enough data yet to know whether vaccination may improve long COVID symptoms in kids, or if it may help prevent them from getting long COVID if they become infected, although Buonsenso says it’s reasonable to believe that vaccinated kids will have a very low risk of long COVID.

Who’s at risk for long COVID?

The biggest risk factor in developing long COVID is probably age. According to Buonsenso, adolescents are at a higher risk than younger children, and the Post-COVID-19 clinic in Montreal has mostly seen kids 12 years old and older. However, any child can be affected. “We have an even mix across all ages,” says Goulding, of the long COVID kids support group.  “The youngest is only 13 months old.”

It’s less clear whether other factors can increase the risk of a child developing long COVID. In the Montreal clinic, 64 percent of the patients are girls, but there are no other clear risk factors. One UK study found that asthma, eczema and allergies were the most common pre-existing conditions. However, most of the kids in published studies, the clinic, and the Long Covid Kids Canada group were healthy, active and had no known risks before getting long Covid.

What’s the impact of long COVID on kids?

While so far, it appears that the statistical chance of your child getting long COVID is low, if your kid does get long COVID, it can have a big impact on their lives. A few of Nguyen’s patients are failing their classes because of memory retention problems. Others can’t do physical education and need to be removed from the class. According to Goulding, members of the Long Covid Kids Canada group are reporting similar problems. Some of the kids are having trouble paying attention or concentrating in class while others need to take virtual classes and take five-hour naps during the day. “Some children are bedridden and can’t attend school at all. Grades definitely slip and so does mental health,” she says. “Kids have to stay in while their friends are out playing outside. They can’t participate and do the things that they could before.” 

Getting support for long COVID can be difficult. “It can be hard to find providers in small communities outside of big cities, and provinces with low caseloads may not have knowledgeable providers,” says Goulding, speaking of several group members’ experiences. “Long Covid is so new and the issues these children are having often don’t show up on any diagnostic imaging. The families are often not believed.”  Also, many symptoms can easily be attributed to something else. “Most (kids) are told that this is psychological and no investigations are offered nor treatment,” says Buonsenso. One 15-year-old girl in the Long Covid Kids Canada group who suffered from phantom bruising experienced this firsthand. She went to three different medical professionals, who all said that she was self-harming. 

For Manuel, the fatigue, chest pains, and dizziness occurred on and off for about six months.  “It was a frightening and lonely time,” recalls his mother, who eventually got antibody testing for her family that indeed showed they had been previously infected with COVID. “There were frequent naps, almost like when the kids were toddlers.” Manuel’s symptoms got worse after running around and he couldn’t attend school for a while. After about six months, his symptoms finally started to subside—although mom’s are ongoing. “He does seem to be better now,” says Jaymie, noting that it took until March 2021 for his purple toes to clear up. “This year will be his first time back at school since getting ill. He hasn’t quite gotten back to team sports, but hopefully will soon.”  Though he has improved physically, his experience with long Covid has left an emotional toll.  “He still doesn’t want to go into stores or visit with a lot of people. He’s scared to get the virus again and bring it into the home.”

What should families do to protect their kids?

Though long Covid is concerning, there’s no need to panic, says Buonsenso. “Parents should not be worried since most kids recover, but should try their best to minimize risk of contracting COVID through vaccinations, hand washing and masks.” Still, it’s important to be aware of. “People only see the accessible data like hospitalizations,” says Nguyen. “They are less aware of the impact of long COVID.” 

With files from Emily Latimer