Kids health

What you need to know about ear tube surgery in kids

There's a 1 in 15 chance your kid will need ear tube surgery at some point. Here's why, and what to expect before and after the procedure.

By the time he was two and a half, Malikai Morrell had already suffered through a whopping 11 ear infections. His family doctor examined him regularly and wasn’t concerned, but when Malikai started junior kindergarten, Amy Morrell realized her son was really struggling. “I noticed him staring at my lips when I was talking,” she says. “And when I was reading him books at night, he would put his ear right up to my mouth.” She decided to take him for a hearing test and, sure enough, he failed.

The family got a referral to an ear, nose and throat doctor (ENT), who recommended ear tube surgery. It’s been nearly a year since the procedure, and Malikai, now five, can hear perfectly, even when others are whispering. He also no longer gets ear infections.

Myringotomy—the medical name for ear tube surgery—is the most commonly performed childhood surgery done under general anesthesia. By the age of three, one out of every 15 children will have received ear tubes, says Trina Uwiera, a paediatric otolaryngologist in Edmonton.

Why do kids need ear tubes?

Kids who undergo the procedure are usually those who experience chronic ear infections or related hearing problems. Joan Robinson, editor of the Paediatrics & Child Health journal at the Canadian Paediatric Society (CPS), and a co-author of the CPS’s statement on ear infections, says the general definition of “chronic” is three ear infections over a six-month period or four episodes in one year.

How do the tubes help? They’re a temporary solution that works to ventilate the middle ear, which diminishes the frequency and severity of ear infections and allows any fluid to drain on its own. “We’re just bypassing these kids’ immature Eustachian tubes and trying to buy them more time so they can get past the point when it’s most problematic,” says Uwiera.

The surgery is usually performed between the ages of seven months and six years; after age eight, kids’ own Eustachian tubes, which drain the middle ear to the back of the nasal cavity (and also control ear pressure), have fully developed and can do their job properly, rendering synthetic tubes obsolete.

Before surgery, Malikai weathered the infections all right, but he ended up with hearing loss (albeit most likely temporary) from fluid buildup behind the eardrum. “When you get an ear infection, the fluid that’s in there can last up to three months. The problem is that if it doesn’t go away, you’re more likely to get another infection, because there’s already fluid in your ears,” says Uwiera. She compares it to a fully furnished apartment, waiting for bacteria to move in. “Ear infections and fluid go hand in hand, but they don’t always happen at the same time.”

Ava Percy, 8, never had ear infections, but as a toddler she had a speech delay that prompted her parents to have her hearing checked. The test was inconclusive, but because hearing problems are common in individuals with Ava’s genetic condition—she has what’s known as a distal deletion on one of her copies of chromosome 18—her parents followed the ENT’s recommendation and opted for ear tube surgery when she was three. “Over the next year, her speech did improve. It most definitely was the right choice,” says her mom, Lori Percy.

The surgery is also beneficial for children with cranial-facial differences, such as those with a cleft palate or Down syndrome, that impact the Eustachian tubes’ function. And ear tube surgery can also help kids with ear difficulties caused by a chronically plugged nose, often due to allergies, says Uwiera.

What to expect on surgery day

The procedure involves making a small incision in each eardrum. The surgeon will remove any fluid or infection, if present, and then place the tubes in the incisions, with one end of each tube opening to the middle ear and the other draining into the ear canal. Depending on hospital procedure, the day surgery takes less than 20 minutes in the operating room. General anaesthetic is used because the child needs to hold perfectly still and also because the initial incision in the eardrum is painful, says Uwiera, who has performed thousands of myringotomies.

Children must fast before the surgery because of the anaesthetic, and they’re watched after they awaken to make sure they can take fluids without throwing up (grogginess and nausea are possible side effects from the anaesthetic). Most children are up and on their way after a couple of hours.

“It’s so simple,” says Percy, whose daughter is now on her fifth set of ear tubes because of congenital hearing problems. “It’s pretty much an in-and-out, 10-minute procedure. It’s so quick and so easy.”

It’s rare for children to even have pain afterward, and if they do, over-the-counter medications work just fine, says Uwiera. Older kids will sometimes find there are popping or crackling noises as the fluid shifts and drains. “They find it more disconcerting than painful. It’s just kind of weird,” Uwiera says.

The surgery has few complications. In one percent of cases the eardrum perforation doesn’t close up on its own, says Uwiera, and it might need to be patched in a day surgery.

How ear tubes help

After the procedure, most families notice far fewer ear infections. And if the child does get one, it’s easy to identify—parents can actually see the infection draining out and crusting over, kind of like snot—and it can be easily treated with antibiotic eardrops.

For kids with hearing loss due to fluid trapped behind the eardrum, there’s an almost immediate improvement. “We’ll see these children waking up in the recovery room with their hands over their ears because it’s too loud,” says Uwiera. “If they’ve had the speech delays that often come along with not being able to hear things properly, their speech usually picks up within days to weeks, depending on how delayed it was and their age and hearing.”

Most tubes stay in place for about a year; as the eardrum grows, it lifts the tube out into the ear canal, where it makes its way into the world and usually gets lost in bedding or a carpet. The tubes are tiny, about the size of a grain of rice—it’s much easier to locate a baby tooth that’s fallen out, for example. Parents likely won’t even know the tubes have fallen out, but regular follow-up visits with the ENT would reveal that it’s happened.

Does ear tube surgery ever have to be repeated?

About eight percent of kids who have ear tube surgery need a second procedure, says Uwiera, because the ear infections or any associated hearing loss returns. In some cases, the tubes fall out too early, before they have a chance to do their job. Certain risk factors make a second procedure more likely, including attending daycare (where children come into contact with more cold viruses) and exposure to cigarette smoke, which increases inflammation in the respiratory tract and ears, and decreases the ability to clear the throat, nose, and ears of bacteria , making it more likely for a child to develop an ear infection from a cold.

There’s also a strong familial component. If a parent or sibling has ever had ear tubes, it increases the likelihood of a repeat surgery for the child.

Ashley MacBeath’s son Jack, 6, is on his second pair of ear tubes. His first set was put in at 18 months to treat chronic ear infections. They worked perfectly, but when they fell out around his third birthday, he started getting ear infections again. His parents also noticed he was having trouble hearing, so another myringotomy was scheduled when Jack was four years old.

Incidentally, Jack’s dad had ear tubes twice as a child and knew first-hand what an impact they had. “We didn’t even hesitate,” says MacBeath. “If these come out and they tell us to do it a third time, we absolutely would—they’ve made a huge difference for him.”

The adenoid connection

In Jack’s case, the doctor recommended he have his adenoids taken out when his first set of ear tubes was inserted. Adenoids are small glands located in the roof of the mouth where the nose connects to the throat. “He was getting a lot of fluid trapped behind his eardrums, and they thought removing the adenoids would give him some more room,” says MacBeath. In some cases, the adenoids can act like a physical dam that impedes the drainage from the ear into the throat, so taking them out to remove the blockage is not an uncommon procedure, especially if it’s a repeat myringotomy. “If the child is over the age of four and on their second set of tubes, often we’ll take adenoids out as part of the treatment of the ears,” says Uwiera.

Surgery alternatives

Some parents swear by methods they believe can help kids get over a cold before it develops into an ear infection, such as flushing the nose with salt water or teaching them how to pop their ears by moving their jaw a certain way. There are even devices that claim to help kids clear their ears. But experts say there aren’t enough studies to prove these techniques and products are helpful.

“The most important thing is to try to prevent your child from getting an ear infection in the first place,” says Robinson, who recommends the good old-fashioned cold-prevention techniques of handwashing and staying away from sick people.

Some families choose to skip the surgery and suffer through the infections, knowing that children eventually develop better immunity to colds (and therefore will get fewer ear infections). And as they grow, kids’ Eustachian tubes mature and begin to work properly. What’s more, long-term studies show that by kindergarten, most children with hearing loss from chronic ear infections (who didn’t get ear tubes) have caught up with their peers.

However, many parents are not willing to take a wait-and-see approach. “Families are potentially getting very frustrated because children can’t hear things, and they can’t speak and be understood,” says Uwiera. “You’re not hoping to get better in three years—you’re looking for something that’s going to let you function more readily, earlier.”

The truth about swimming with ear tubes

There’s a myth that kids with ear tubes can’t go swimming. But in fact, they can, say Uwiera. That dated recommendation resulted in a generation of people who were scared of the water and never learned this life-saving skill. Children who have ear tube surgery should only avoid the water for seven days post-op, says Uwiera, unless otherwise specified by their healthcare provider. After that, they can jump right in, just like any other kid.

Kids health

Cannabis candies are landing kids in the ER

The Canadian Paediatric Society says kids have been hospitalized after accidentally ingesting cannabis edibles. Here's how to stash your stash.

Two years after Canada legalized cannabis, most parents who use it still don’t publicly admit it, even though it’s safer than alcohol.

But the issue of cannabis’s safety became a bit hazy (pun intended) last fall, when the federal government also legalized candy, chocolate and cookies infused with THC, the psychoactive component of pot. Experts worried that these products, called “edibles,” might end up in the hands of children. “Edible cannabis is a concern because it’s manufactured to taste good and can look like treats,” says non-profit organization Parachute, which recently launched #HighandLocked, a campaign aimed at parents who keep edibles in the home. A relatively innocuous substance in adults, cannabis is more dangerous to kids because of their small body size and lower weight, and since edibles taste so sweet, a child might consume them in great quantities.

The Canadian Paediatric Society is keeping its eye on this issue through its Canadian Paediatric Surveillance Program, which has gathered data from an average of 2,800 paediatricians monthly for the past 23 years. It found 36 “serious and life-threatening events” related to non-medical cannabis exposure in Canadian kids in 2019; a third of those cases were kids 12 and younger who had accidentally eaten edibles, and more than half were hospitalized.

Keeping kids away from edibles isn’t rocket science. Simply store them completely out of their reach, in a locked container, ideally still in their original childproof packaging. If your child accidentally consumes cannabis of any type, call your local poison centre for advice.

Preschool

Your kids NEED to play—here's why

When you think of what kids need for healthy development—nutritious food, education, a loving home—play might not make the list. But it should.

Melissa Stenhouse knows how play can positively impact a kid. She’s seen it time and again in her role as program coordinator at Hamilton-based Today’s Family Early Learning and Child Care, a non-profit that offers child care and parental-support classes. But her favourite success story is about a girl named Zoey* and her love of pies.

Zoey was a grade four student in Stenhouse’s after-school program who had zero interest in reading. “We started to notice she was creating elaborate apparatuses out of blocks,” says Stenhouse, “and we figured out that she was building a set for a cooking show about pies.” So Stenhouse and her colleagues took it up a notch by adding baking—pies, specifically—to the program offerings. After they talked about what she would need to make a pie, Zoey learned to write out a recipe and began to show an interest in cookbooks; this led to an increase in her desire to read. “It was incredible,” says Stenhouse. “Expressing herself through play expanded her reading, and she won’t put her books down now.”

But improved literacy is just the tip of the jungle gym when it comes to the benefits of play. It’s no secret that play is integral to a child’s overall development—researchers have been reporting this fact for decades. A 20-year study published in November 2015 out of Pennsylvania State University and Duke University found a correlation between social competence (one of the benefits derived from play) in kindergartners and their success as adults. Play is used in innovative ways for kids with cognitive, emotional and physical challenges and in treatment for trauma and grief. The United Nations High Commissioner for Human Rights declared play a basic human right of every child at the United Nations Convention on the Rights of The Child in November 1989.

When you think of what kids need—healthy food, education, a stable home—play might not make the list (but it should). Play is a kid’s most important job, yet it’s increasingly being threatened—by things like increased emphasis on academics, the proliferation of character toys over creative ones, and the trend toward overscheduling. But what is play exactly, and what can it do for your kid?

Play takes many forms, but at its core, it’s an activity that engages and challenges the mind. It can be completely child-directed, or it can be more ordered, with a set of instructions. It can be a solitary activity or a rousing game of make-believe with other kids. It can be producing and filming a YouTube video. If it gets your child to push the limits of the world they know, it’s play. And when given appropriate opportunities for it, it will help your kid grow in ways you would never have attributed to a set of LEGO® blocks or a sandbox. Read on for some of the key developmental benefits play can offer.

Illustration: Kinomi

Kids learn life skills

The Center on the Developing Child at Harvard University says children must be provided with chances for “scaffolding,” or activities that practise life skills. This includes engaging in creative play and having chances to direct their own actions with decreasing adult supervision and intervention. Unstructured play, especially, helps with the development of executive function—fostering self-regulation (such as a person’s ability to stay calm and focused in stressful situations) and emotional coping, as well as problem-solving and planning abilities.

“Executive function happens in the frontal cortex: Those are your most important skills for making your way through life,” says Melissa Healy, a child and family psychotherapist with Canoe Therapy in Burlington, Ont. “If we’re not able to offer experiences that help foster those skills, research has shown that children will fall behind developmentally.”

In her therapy practice, Healy uses child-directed play, a method that’s also popular in academic circles. Many educators specifically reference the Reggio Emilia Approach when integrating open-ended play into their curricula. The Reggio Emilia philosophy says that this type of child-directed exploration is essential for development. The school of thought was developed after the Second World War in the Reggio Emilia region of Italy. A teacher named Loris Malaguzzi worked with parents to build schools that provided kids with a new way of learning that would encourage democratic thinking. He believed children are endowed with “a hundred languages” of expression—or a multitude of ways to relate to the world around them—and that for an education philosophy to be successful, kids had to have a degree of control and be treated as apprentices rather than the subjects of instruction. The philosophy is centred on respecting kids as resourceful individuals who can help guide their own learning; on positive relationships between kids, parents and teachers; and on treating the kids’ surroundings as a “third teacher.”

Stenhouse’s program is based on this educational philosophy. She and her colleagues treat the kids like they’re capable and competent, and try to give them real experiences—like Zoey having the opportunity to bake a pie—whenever they can. “It really is amazing,” she says. “We’ve found that, for most kids, when they’re doing something they’re interested in, behaviour issues often disappear.”

Communication comes from play

Learning to communicate effectively—to express thoughts and feelings, to learn how to gracefully insert yourself into a social situation or conversation, to ask for what you need or want—is vital to a successful adult life. “If a child just jumps into a group and takes a toy, the other kids are going to immediately expel him from that group,” says Daniel Chorney, a child psychologist in Halifax. “Learning to approach people and ask, ‘Can I play with you?’ is a huge communication skill that has lifelong importance.” Communication also includes the ability to pick up on social cues and to read facial and body language. All of this begins on the playground.

Chorney says giving kids a taste of all types of social situations —playdates, structured activities, free play—is important, but parents can also do skills training at home. “If a kid is really struggling with a specific thing (like asking to be included), a parent and child can role-play and practise acting out the problem. Then they can approach the dilemma in the real world and regroup after.”

Kids learn to resolve conflict

A long-term study from the University of Maryland found that between 1981 and 2003, children’s free time has dropped from 57 hours a week to 48, with outdoor play declining a whopping 37 percent. This type of unstructured, unmonitored play not only instills independence in kids but also helps them develop other important abilities, including developing appropriate problem-solving behaviours rather than always looking to an adult to manage circumstances for them.

Healy gives an explanation of how play, especially child-directed play, can help a kid learn lifelong skills: “Say you’re at the park, and another child pushes your child. The automatic reaction of the parent is to jump in and tell that other child to stop pushing, but that’s not helpful. It just proves that, ‘When someone pushes me, Mom’s going to swoop in and save me.’ But the reality is, Mom isn’t always going to be there.” You want kids to be able to handle these conflicts on their own. Children who haven’t had the experience to problem-solve in play situations will automatically look to an authority figure to take care of things, but children who have been faced with this type of confrontation during playtime are able to deal with it better.

Kids also learn the power of social censure on the playground. “Most of the time, if there’s a kid who’s consistently mean to others, that child is going to get excluded,” says Chorney. “If someone is too pushy, another child is going to correct that behaviour naturally. An understanding of logical social consequences should develop when we’re kids.”

TP09_Power of play_Secondary_660x660

Illustration: Kinomi

Play helps with bonding

Play is a proven means for parents and educators to connect with kids. Healy finds that play is essential to building rapport with her clients. “Often, sitting down to have a conversation with a child about how they feel just doesn’t work,” she says. In therapy, play helps build connection and trust. “If, through play, we can better understand a child’s thoughts and feelings, that’s successful therapy. It’s also successful parenting.”

Play can be an important part of the relationship between a parent and child, too. Chorney often advises parents with kids struggling with behavioural issues to set aside time daily to just play one-on-one with them. This is part of an evidence-based treatment called Parent Management Training (programs like The Incredible Years, or Parent-Child Interaction Therapy, fall under this approach). These therapies focus on strengthening parents’ bond with their child as a means of improving emotional and behavioural problems.

“I’ll often suggest taking at least 15 minutes a day, with no distractions, to play something together that’s co-operative, that doesn’t have rules attached to it, where you don’t have to ask a lot of questions or give a lot of commands or criticisms.” That means board games are out, but you could build with blocks, make crafts or even just colour together. This shared fun time strengthens the attachment between parent and child, which encourages kids to look for positive attention from parents rather than seeking the spotlight by misbehaving.

This shared time can be as important for parents as it is for kids. “I have parents who will say, ‘I love my kid, but sometimes I hate them,’” says Chorney. “I’ll often tell them to go home and try this method because they’re going to laugh; they’re going to connect; they’re going to feel like they’re five years old again. It will help to remind them why they became a parent in the first place. It’s the kid equivalent of date night.”

Play increases kids’ capacity for learning

A 2007 report in the medical journal Pediatrics focusing on the importance of play in promoting healthy child development says, “play is integral to the academic environment. It has been shown to help children adjust to the school setting and even enhance children’s learning readiness, learning behaviours and problem-solving skills.”

The academic system in Finland—which is touted as one of the best in the world, with consistently high international assessment results—is a case in point. Because the Finns believe play is a valuable educational medium for young kids, children don’t start formal school until age seven (before that, they’re in pre-primary education, which has a focus on play). The school day is also typically structured in 45-minute blocks, with 15 minutes of free time between each period. The idea is that these breaks help kids stay focused during classroom time. But play is a form of education out of the classroom, too.

Deborah McCoy, a lifelong early childhood educator and the assistant vice-president for education at The Strong National Museum of Play in Rochester, NY, believes in kids helping direct their own learning. The Strong, which is a history museum but also an institution with a mission to focus on development through play, also uses the Reggio Emilia philosophy when creating its programs.

“We feel that imaginative play, especially, is really critical to building representational abilities,” says McCoy, “which is just a fancy way of describing using one thing to represent another, which is the foundation of literacy. It’s really important for kids to think in stories and act out stories. To do this spontaneously through play is really the best way, because it’s innate in children. Our job is to set up environments to support that.”

Exhibits in the museum include opportunities for arts and crafts, science experiments, sensory play (one of the areas, called Build, Drive, Go, even has a giant gravel pit kids can muck about in), and dress-up and imaginative play.

The Strong also has a part-time preschool called Woodbury School, where kids engage in fun activities set in the museum’s exhibits and teachers hold storytelling workshops. The instructors use play as the first step in teaching kids how to create plot lines—they provide items like figurines as inspiration and the kids are encouraged to tell the stories they’ve come up with. Teachers then write them down, which opens up even more opportunities for learning.

“Kids can read their stories back; they can read stories to their friends,” says McCoy. “It literally translates into their ability to read and write.”

There are so many benefits to regularly integrating play into a child’s day. As Chorney says, “Play is practice for real life.” It doesn’t have to take long, and often it just means standing back and letting your kid take the wheel. Sounds like a piece of cake, right? Or maybe a piece of pie.

Illustration: Kinomi

Illustration: Kinomi

Take 45 minutes to try

Unstructured play

Collect all of your empty cereal and tissue boxes, as well as paper towel and toilet paper rolls, or try to get your hands on a large appliance box. Set out the boxes, paint, markers, scissors (if the kids are old enough), glue, tape and jars of buttons and beads, and let your kids have at it. If they’re having a hard time getting started, give them a broad theme, like space or jungle.

Group or team play

Sit kids in a circle, and tell them they’re going to create a brand new game using a couple of balls, a skipping rope and a hula hoop (or whatever other active toys you have lying around). Each person is allowed to make up one or two rules. Write down the rules as the kids brainstorm and then try the game out. Decide together what works and what doesn’t.

Art or drawing

Place each child in front of a large mirror with a handful of dry-erase markers. Challenge the kids to draw their self-portraits by tracing their facial shape, features and hair. Add another element by encouraging them to enhance their image with items that reflect what they want to be when they grow up. Chef’s hat? Check! Stethoscope? You got it.

Role-play and make-believe

Find an old laundry hamper and fill it with a variety of old clothing and accessories. Tell kids to act out the characters they might find in a waiting room (or a restaurant, an office, a house, a classroom, etc.). Stand back and take pictures or videos or write down what the kids chose to be or do to remind them about it if they get stuck for ideas the next time they’re playing.

* names have been changed

 

A version of this article appeared in our September 2016 issue, titled “The power of play,” pg. 73-76.

Read more:
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4 classic playground games to play with your kid
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Kids health

Updated: 62 reusable cloth masks for kids

Cute, functional and made to fit little faces.

As the wearing of non-medical grade masks slowly becomes part of the new normal, it’s important to find a mask that’s designed to fit smaller faces. Here, we’ve rounded up some washable options that are currently in stock. (Note: with such high demand, inventory depletes regularly and back orders are common. Please check back frequently for availability.)

While these masks will not stop your child from getting coronavirus, health officials in both Canada and the United States have advised that wearing non-medical cloth masks could help prevent the spread of COVID-19.

For the most effective use, be sure to practice appropriate mask hygiene after each wear.

1. Peace Collective Kids

kid wearing face mask

Photo courtesy of Peace Collective

These masks are made from machine washable 100 percent cotton. For every pack of masks purchased, the company will donate one mask to a frontline worker. $30/pack of two, peace-collective.com

2. Mayana Genevière

kids wearing face mask in lifestyle shots

Photo courtesy of Mayana Genevière

This intimate apparel company has pivoted to making masks for adults and kids made from a tight knit woven quilters cotton fabric. Suitable for children three and up, these masks are made in Toronto. $19, mayanageneviere.ca

3.Together

small girl wearing a white mask

Photo courtesy of Together

Breathable, triple-layered, these masks come in four sizes and have a built-in slot for a filter (not included). $15, togethermask.ca

4. Pizi

two young girls playing together while wearing masks

Photo courtesy of Pizi

This Quebec-based company uses local dressmakers to make three-layer masks featuring an anti-bacterial fabric with emojis printed on them. Each week, they will launch new designs on their website. $15, pizimasques.com

5. Weddingstar

kid wearing shark-print mask

Photo courtesy of Weddingstar

This Alberta-based wedding supplier is now making masks for kids with adjustable nose clip and ear straps. Choose from solid coloured or a wide variety of patterns and prints. From $16, weddingstar.ca

6. Kokoro

colourful printed face masks for kids

Photo courtesy of Kokoro

Each mask from this Montreal-based company is made of double layered cotton with adjustable ear elastics and has an interior pocket to insert a filter. For every mask purchased, Kokoro will donate a mask to frontline and essential workers. From $14, wearekokoro.com

7. Dream Designs

cat print masks for kids

Photo courtesy of Dream Design

Sized to fit kids aged six and up, these Vancouver-made masks are fabricated out of two layers of tightly woven organic cotton sateen. For each mask sold, the company will make a donation to a local charity, including the Downtown Eastside Women’s Centre and The Greater Vancouver Food Bank. $24, dreamdesigns.ca

8. Unbelts

colour kids face masks

Photo courtesy of Unbelts

Shifting from holding your pants up to keeping your face protected, this belt-making company is now making colourful kids masks with adjustable straps that secure behind the head instead of the ears. $49/pack of 3, unbelts.ca

9. Whistle & Flute

kid wearing printed face mask

Photo courtesy of Tiny Trendsetter

This adorable kids clothing brand has extended their collection to include masks that compliment their clothes. Made to best fit kids aged three to 10, partial proceeds from the sale will be donated to COVID-19 relief funds. $40/pack of 3, tinytrendsetter.com

10. Protect Styles

 

kids masks

Photo courtesy of Protect Styles

These Canadian-made masks are machine-washable polyester and come in adorable prints, like racoon, pizza, Toronto Blue Jays and more. The proceeds from your purchase will go to the Centre for Addiction and Mental Heath (CAMH) in Toronto, Ont. $19, protectstyles.com

11. Smitn Bebe

embroidered kids face masks

Photo courtesy of Smitn Bebe

These beautifully embroidered face masks comes in two sizes: small (for kids ages three to five) and medium (for kids ages five to seven). While you’re shopping, check out the adorable mommy and me clothing collection. $26, smitnbebe.com

12. Narces

leopard print kids face mask

Photo courtesy of Narces

Turn mask-wearing into a glam game of dress up with these adorable kids masks made from repurposed materials from the company’s red carpet gowns. Adjustable straps ensure that masks fit kids ages two to 10. Bonus: most patterns also come in matching adult sizes. $30, narces.com

13. Levelwear

young girl in child mask

Photo courtesy of Levelwear

These three dimensional masks are designed to mould and fit around faces of kids ages six to 12. Made in Canada, these two layers masks are fabricated from cotton twill. $16/pack of two, levelwear.com

14. Community

kids mask

Photo courtesy of commUNITY

Made from Quilter’s Choice cotton, the kids’ version of these masks is best suited for 3- to 11-year-olds. Add a disposable filter (sold separately) for extra protection or wear as is. A dollar from each purchase will go towards Food Banks Canada. $14, communitymasks.ca

15. McCarthy Uniforms

printed kids face masks

Photo courtesy of McCarthy Uniforms

The popular school uniform provider is now dipping their toes in PPE. Working with kids and teens, they co-created a line of masks out of 100 percent Egyptian cotton. $15/pack of six, navyandwhite.ca

16. Mabel’s Labels

kids mask

Photo courtesy of Mabel’s Labels

These masks from the popular label company are designed for kids ages three to 14. Made from a lightweight, moisture-wicking fabric, they have a pleated design, soft ear loops and adjustable nose piece. Available in four designs. $19, mabelslabels.ca

17. Old Navy

pack of kids masks

Photo courtesy of Old Navy

This multi-pack comes with five triple-layer cotton poplin face masks designed to fit children four and up. Masks have been made using excess fabrics from Old Navy clothing, which means the prints you receive will be a surprise based on availability. Old Navy is donating 50,000 of these masks to the Boys & Girls Clubs of America. $15 for pack of five, oldnavy.ca

18. Hancock masks

colourful pleated masks

Photo courtesy of Hancock Masks

Made from three layers, these classic pleated masks have a plastic coated wire to help shape the mask to contour around tiny faces. Choose from an ear or head elastic. $20, hancockmasks.com

19. Ever Mine Boutique

kids face mask

Photo courtesy of Ever Mine Boutique

These handmade masks are double-layered and reversible. Handmade from 100 percent cotton, they are machine-washable. $15, evermineboutique.com

20. Irish Design House

kids mask

Photo courtesy of Irish Design House

This Toronto-based sewing school is selling masks for the whole family (including kits, so you can make your own!). Made from cotton, the simple pleated design has a filter pouch (filter not included) and a long elastic that stretches across the back of the head—they have included instructions of how to alter the elastic ties if your child wishes to wear it as an ear loop mask instead. $15, theirishdesignhouse.com

21. Puffin Gear

colourful kids face masks

Photo courtesy of The Orange Room

These reusable two-layer woven cotton masks have a gently contoured compression fit under the chin and across the nose, which they claim makes them comfortable to wear for extended periods of time. Two soft elastic bands go around the head and hold the mask securely in place. Masks come in adult and kid sizing. $63 for pack of four, theorangeroom.ca

22. The Cutting Edge

young girl wearing face mask in winter

Photo courtesy of The Cutting Edge

These cloth masks are made by the Winnipeg social enterprise, The Cutting Edge. The two-layer 100 percent cotton mask is pleated with soft polyester jersey knit ear loops. $14, shop.lite.mb.ca

23. Mask Buddy Mini

kid in protective face mask

Photo courtesy of Mask Buddy

These cute masks are made from upcycled polyester. For each mask sold, a mask is donated to a front line worker. $6, themaskbuddy.com

24. Olive and Smash

kids bamboo mask

Photo courtesy of Olive and Smash

Made from lightweight bamboo, these masks come in adult and mini-me versions. $20, oliveandsplash.com

25. Gap Kids

kids face masks

Photo courtesy of Gap Canada

These cute kids masks are made from 100 percent printed poplin offcuts from the production of kids clothing. $20/pack of three, gapcanada.ca

26. Kejeo Designs

African-print kids mask

Photo courtesy of Kejeo Designs

Made from 100 percent cotton, these adorable masks feature a unique Cobi African print. Hand or machine-wash mask with cold water and hang to dry between uses. $18, kejeodesigns.com

27. Etsy

cotton and linen toddler face mask

Photo courtesy of Mira and Belle

Etsy is full of local sewers making masks for adults and kids. This toddler-sized mask is designed to fit kids ages two to six. Made from organic cotton and linen, masks are adjustable, so you can get the right fit and don’t pull on tiny ears. Prices vary, etsy.com

28. Handsome and Lace

kids mask

Photo courtesy of Handsome + Lace

These double-layered face masks are handmade by a Toronto designer and can be customized with embroidery (Darth Vader, Storm Troopers and Hello Kitty, to name a few.) They come in kid and parent sizes. $35, handsomeandlace.ca

29. Bien Aller

kids mask

Photo courtesy of Bien Aller

Made in both adult and kid sizes, this cotton mask comes with a washable filter, nose wire and adjustable ear elastics to ensure a snug fit. $17, bienaller.com

30. Fresh Rejects

logo-printed kids mask

Photo courtesy of Fresh Rejects

These kids fashion masks are washable and feature either the brand’s signature logo or signature cartoon characters: the skunk and raccoon. Twenty percent of each sale will be donated to Food Banks Canada. $15, freshrejects.com

31. Covid Cuties Mask

kids in masks

Photo courtesy of Instagram/covid.cuties.masks

Made to order by a Toronto designer, these cotton masks are sold through her Instagram account and come in four sizes (baby, small kid, big kid, and adult). An optional filter pocket can be added to masks for $5. from $15, instagram.com

32. Jonny Mask

father and daughter wearing matching masks

Photo courtesy of Jonny Mask

These reversible masks are made of two layers of cotton and come in a variety of prints. Pick up one for yourself and a matching one for your little. From $15, jonnymask.com

33. Kanuk

young boy wearing face mask

Photo courtesy of Kanuk

Made with silver thread, which is known for its antibacterial, antifungal and thermoregulation properties as well as its ability to cut down on odours and moisture, these adjustable masks are designed to mould around young faces. $24, kanuk.com

34. Q Design

young boy in pleated face mask

Photo courtesy of Q Designs

This Canadian drapery maker has pivoted in response to COVID-19 and is now producing PPE for both adults and kids. The pleated kids mask fits most kids aged 5 to 10 years old and is made with an 100 percent cotton lining and a poly-cotton blend outer layer. $12, qdesigncentre.com

35. Minikane

young girl and her doll wearing matching masks

Photo courtesy of Hey Kiddo

These mask sets come in three sizes: parent, kid and doll. The hope is kids will be more likely to wear the mask if they can share the experience with those closest to them. $25, heykiddostore.com

36. Nonie

reusable cloth face masks for kids

Photo courtesy of Nonie

These 100 percent cotton masks are lightweight with an internal sleeve for a filter (sold separately). For added protection, masks have been lined with a high-density SMS fabric that claims to protect against airborne and waterborne ingressions. $33, houseofnonie.com

37. Moji

patterned kids masks

Photo courtesy of Moji

Kids can stand out in these limited edition masks featuring zoo animals, flowers, abstract designs and more. Each mask is handmade in Canada by a local seamstress who has been directly impacted by the COVID-19 outbreak. Each mask is made of two layers of cotton with a pocket that you can add a filter to—they recommend a coffee filter or baby wipe. $20, mojimask.ca

38. Project Safety Box

anti-viral cloth mask

Photo courtesy of Projectsafetybox.ca

These masks claim to be made of patented, antimicrobial layers that provide extra protection and blocks external bacteria and pollution: the outer layer prevents the passage of bacteria from the outside, the second layer is a silver-based anti-viral coating with a filter film and the last sheet is a soft comfort layer that is smooth and safe for your skin. Masks have adjustable ear loops. from $13, projectsafetybox.ca

39. Giftgowns

kids reusable cloth face masks

Photo courtesy of Giftgowns

Made from two layers of cotton, these come in three different sizes to ensure the perfect fit. $21, giftgowns.com

40. Fujifilm Printlife

kids wearing custom masks

Photo courtesy of Fujifilm Printlife

Kids can customize their own designs on these stylish masks from the popular photo-printing company. Masks are made from a double layer of soft fabric and over-the-ear elastic straps. $12, fujifilmprintlife.ca

41. Comfey

kid-sized reusable cloth face masks

Photo courtesy of Comfey

The whole family—including your pup!—can match with these hand-made masks (and bandanas for the furry set). Made from two layers of soft, premium cotton, masks have adjustable ear loops and can be machine-washed. $12, comfey.ca

42. Mistyelle

kids reusable face masks

Photo courtesy of Mistyelle

These cute masks are washable. Made from a cotton polyester blend and engineered for breathability, they’re ergonomically designed and water resistant. Masks also come in adult sizes. $15, mistyelle.com

43. Freed and Freed

siblings wearing matching reusable cloth face masks

Photo courtesy of Freed and Freed

This Canadian mom of three has been using her supply chain to procure N95 masks for essential workers since the beginning of the pandemic. Now, she’s making reusable masks for kids, which feature cute emojis. With each purchase, 5 percent of all proceeds will go towards The Black Youth Helpline. $14, freedandfreed.com

44. Mouse Loves Pig

two young girls with stuffies wearing matching face masks

Photo courtesy of Lindsay Cox, Mouse Loves Pig

These contoured kids masks are reversible and come with a coordinating mask for a stuffy or doll. Made to best fit 2 to 10 year olds, they’re fabricated with soft cotton and stretchy ear loops. $15 US, mouselovespig.com

45. Bond Street

reusable cloth masks for kids

Photo courtesy of Staples Canada

These printed poly-blend masks are airline-approved and have adjustable ear straps and metal nose wires. They have a pocket for a filter (one included) and can be machine-washed. $13/pack of two with one filter, staples.ca

46. Vista Print

reusable cloth masks for kids

Photo courtesy of Vista Print

These kids and adult-sized masks come in a variety of prints (or you can create your own!) Made from a durable, breathable stretchy fabric, they’re designed to wick away moisture and have adjustable ear loops for comfort. From $18, vistaprint.ca

47. My Pop Mask

reusable cloth masks for kids

Photo courtesy of My Pop Mask

Claiming to be “extremely breathable”, these water-repellant masks comes in fun prints or solid colours. $19, mypopmask.ca

48. Little Blue House

reusable cloth masks for kids

Photo courtesy of Little Blue House

Made from a soft blend of cotton and spandex jersey fabric, these adorable masks are best suited for kids ages two to five. $9, littlebluehouse.com

49. Kidcare

reusable cloth masks for kids with fanny pack kit

Photo courtesy of Toys “R” Us

These kid-friendly kits come with two masks and a hip pack you can personalize with the included patch and cut-outs. $25, toysrus.ca

50. Katrin Lablond

reusable cloth masks for kids

Photo courtesy of Katrin Lablond

This five-pack of masks is made to get kids ready for back-to-school. Best suited for 5- to 12-year-olds, the two-layer cotton masks are made in Montreal. $79/pack of five, katrinleblond.com

51. Kids on the Lake

reusable face mask for kids

Photo: courtesy of Kids on the Lake

These kids masks are made from cotton with antibacterial thread (Hanilon ab+ fiber) in Niagara Falls, Ont. Masks are designed to fit kids ages three to 10. $10, kidsonthelake.com

52. Province of Canada

reusable cloth masks for kids

Photo courtesy of Province of Canada

These ultra-soft cotton masks come in sizes to fit the whole family (opt for XS for kids ages four to nine). $14, provinceofcanada.com

 

53. Deux par Deux

reusable cloth masks for kids

Photo courtesy of Deux par Deux

Wearing a mask doesn’t mean you can’t show off your personality. Let your little one’s inner tiger out with this adorable kids cloth mask. From $12, deuxpardeux.com

54. School Mask Pack

reusable cloth masks for kids

Photo courtesy of School Mask Pack

Kids will be back-to-school ready with this five-pack of colourful masks made in partnership with Crayola. $40/pack of five, safemasks4u.ca

55. Drake General Store

reusable cloth masks for kids

Photo courtesy of Drake General Store

These fashion-forward masks have a trendy terrazzo print and come in adult sizes, too. For every mask sold, Drake General Store will donate another mask to help families in need, both kids and adults. The masks are made from double layered upcycled locally knit jersey with a pocket for a filter (not included).  $22/pack of two, drakegeneralstore.ca

56. PK Beans

reusable face mask for kids

Photo: courtesy of PK Beans

These extra soft masks are made with a jersey fabric and have a pocket for a filter (not included). $11, pkbeans.com

57. Kombi

reusable face mask for kids

Photo: Courtesy of Kombi

This range of antimicrobial junior masks are double layered with a removable filter and a bendable nose bar to help keep the masks in place. The masks also feature unique ear guards and a breathable lightweight fabric that is soft on skin. from $15, kombicanada.com

58. Uniqlo Airism

reusable face mask for kids

Photo: courtesy of Uniqlo

Made from three layers (the middle filter layer is built-in and washable), these masks comes in both kids and adult sizes. $15, uniqlo.com

59. Under Armour

reusable face mask for kids

Photo courtesy of Under Armour

Designed for the kid that likes to be active, these high performance masks use UA Iso-Chill fabric on interior lining and ear loops, which feels cool to the touch. An antimicrobial treatment on the inside layer will help keep mask fresh while the polyurethane open-cell foam lets air through but makes it hard for moisture and sweat to pass. $35, underarmour.ca

60. Pehr

reusable face mask for kids

Photo: courtesy of Pehr

This popular baby brand has masks that match their minimalist aesthetic. Coming in five packs, masks are made from the same organic cotton as their baby clothing and for every mask set purchased, they will donate a set to a person in need in India, which is where Pehr products are made. $25/pack of 5, ca.shoppehr.com

61. Proteq Canada

reusable face mask for kids

Photo: courtesy of Proteq Canada

Made with silver ions, this antimicrobial mask claims to provide the same protection of a three-layer mask with only a single-layer construction. It has a nose wire to ensure a snug fit and has been OEKO-TEX tested to be free of any harmful chemicals. $25, proteq.ca

62. Masksandscrubcaps.ca

reusable face mask for kids

Photo: courtesy of Masksandscrubcaps.ca

This Toronto-based company was formed in July using local sewers to sew masks and scrub caps for frontline workers. They now sell curved and pleated masks for kids in a variety of fun fabrics and prints. From $12, masksandscrubcaps.ca

Kids health

A parent's guide to virtual doctor appointments (they're here to stay!)

Video appointments have largely replaced in-person visits—and that might not change, even when the pandemic is over. Here's everything you need to know.

Late on a Friday afternoon in June, Rebecca Liu’s son’s face was flushed and he felt hot. Liu took Oliver’s temperature and saw that it was 102F. Liu, a first-time mom who lives in Newmarket, Ont., had a fleeting thought that it might be COVID-19, but she wasn’t too worried because she and her husband hadn’t seen anyone outside their family since the lockdown, and neither felt sick or showed any symptoms. She gave the 16-month-old Tylenol to help him get some rest, and the fever dropped. But when he woke up with a fever of 103F the next morning, Liu started to grow more concerned. She called their family doctor only to be told the clinic would not allow patients with a fever to be seen in person, but they were offering virtual doctor appointments for kids.

“When the doctor called back, she asked if Oliver had other symptoms, which he didn’t. And by this point, his temperature had dropped again. She advised me that if his temperature went up a third time, to 103F, I should take him to the hospital’s emergency department,” says Liu.

Oliver’s temperature spiked again by early Saturday evening, but she was reluctant to go to the ER unless it was truly necessary. “I didn’t want my son to be exposed to COVID,” she explains. Her sister, a nurse, suggested she call the virtual ER clinic at the Children’s Hospital at London Health Sciences Centre (LHSC), in London, Ont. (LHSC will take virtual patients from all over the province.) After phoning at 7 p.m. and giving some basic information, Liu received an email with instructions to download the Cisco Webex Meetings app and was on a video call with a paediatric emergency physician within 10 minutes.

The doctor reviewed Oliver’s symptoms, answered all Liu’s questions, reassured her that she could wait overnight, and advised her on what to do if his fever continued or worsened in the morning. To everyone’s relief, Oliver woke up totally fine.

Interacting with an emergency room doctor over a video call is just one example of the explosion in virtual healthcare that has resulted from the COVID-19 pandemic. Across the country, patients are using smartphones, regular phones, tablets and computers to connect with doctors and other healthcare professionals, such as nurses, psychologists and dentists, for everything from emergencies to routine physicals. A fringe service before the pandemic, virtual doctor appointments for kids has practically replaced regular in-person visits in many instances—and it’s likely here to stay.

What types of virtual healthcare is available for families?

When the world shut down due to coronavirus, doctors’ offices in Canada had to quickly adapt to seeing patients virtually, as it would be too risky to bring potentially infected patients into a clinic. Virtual doctor visits are now being offered in some form by many family physicians, paediatricians and children’s hospital emergency departments, and by more than 20 privately owned virtual healthcare apps and services, such as Maple, Babylon by Telus Health, Tia Health, and Lumeca in various provinces.

The virtual emergency clinic at the Children’s Hospital in London was launched in early May. “Our ER visits were down dramatically. We were very worried that parents were delaying seeking medical attention and risked hurting their children. In New York and Italy, there was delayed presentation of cancer and undiagnosed type 1 diabetes because parents were afraid to visit the hospital,” says Rodrick Lim, medical director in the paediatric emergency department at Children’s Hospital.

Private virtual healthcare services, which typically charge a fee per visit or offer a monthly or annual subscription fee, were around before the pandemic, but the use of them has increased. Some of these are now temporarily covered by provincial health plans for residents with valid health cards in certain provinces, but they charge users fees in other provinces. Private virtual healthcare services are an option for parents to consider at times when their primary care doctor or a paediatric emergency hospital virtual service isn’t available. It’s also a potential alternative for parents who don’t have a family doctor, if they’re able to pay the fees.

These companies typically hire licensed Canadian physicians to work for them part-time to supplement their practice, or in some cases to work full-time for the company. The service is like a virtual walk-in clinic. You are connected to an available doctor and will get some basic information about their name and credentials just before or during the visit. You can also ask for the virtual consultation report to be sent to your regular family doctor.

A key difference between private virtual care apps and seeing your regular family doctor virtually is that your regular doctor knows your child and their medical history and you know the doctor has expertise and experience caring for kids.

What are the pros and cons of virtual doctor appointments for kids?

In some ways, the benefits of virtual healthcare are obvious—fast, easy and convenient access to medical advice is a big advantage. This is especially true for families who would have to travel long distances to see their family doctor or get to a hospital ER or for those who don’t have a family doctor. Private healthcare apps are often available 24/7, a bonus for parents when a kid spikes a fever in the evening. Of course, during the pandemic, virtual healthcare also means no risk of exposure to the COVID-19 virus for you or your children. Using virtual healthcare services appropriately can also free up time and physical space for in-person visits to doctors and ERs that are truly needed.

But not all conditions can be successfully diagnosed without an in-person examination. Some conditions, like a rash or minor skin infection, can be safely assessed and treatment can be prescribed over a video call, while other health problems, such as a possible bone fracture, ear pain (the doctor needs to look inside the child’s ear) or a serious cough (the doctor needs to listen to the chest with a stethoscope) require one.

Kathryn Pasma, a mother of four young children in Edmonton, connected virtually with her kids’ doctor when her three-and-a-half-year-old daughter had a severe rash on her chest and collarbone. She sent him a picture of the rash before their appointment. “I tried a natural moisturizer for dry skin, but the rash kept getting worse and she was scratching it all the time. Our doctor looked at the picture, asked some questions and prescribed a steroid cream for eczema that cleared up the rash,” says Pasma. She appreciated not having to take her daughter to the clinic and arrange care for the other three during the visit, something that has gotten more complicated during the pandemic.

But when you see a doctor over a screen rather than in person, there’s a possibility that your child’s health problem may not be properly diagnosed or treated, causing their condition to worsen, or that an important health problem the doctor would have detected in person will be missed. The extent of that depends in part on who is providing the healthcare. Is it a family doctor or paediatrician who sees your child regularly, a paediatric emergency physician from a children’s hospital you trust or a private virtual healthcare service? It matters how much experience and expertise the doctor has in treating children, how well they know your child and whether they have good judgment in recognizing the limitations of virtual care.

However, a lot can be accomplished by a physician with specialized assessment skills and experience. “We can do a modified neurological exam through video and talking to the parent,” says Sarah Reid, a paediatric emergency physician at CHEO, a paediatric hospital and research centre in Ottawa. “So much of paediatric assessment is around how the child is acting, looking and behaving. We can also coach a parent if a baby falls, for example, to touch and feel and move the body in certain ways to do an assessment. But any doctor doing virtual care needs to recognize its limits.”

In some cases, a virtual doctor’s appointment for kids can lead to an in-person one—and that’s OK. Lim says that at the London virtual ER, 30 to 40 percent of families using the service ultimately go to the ER for tests and treatment of conditions such as sepsis infections, wounds that need stitches, bone fractures, or head injuries with concerning symptoms like vomiting or confusion. “Virtual visits ease parents’ anxiety about whether they need to see a doctor in person or not. For me, it also harks back to the days of house calls. There is something very personal about seeing a parent in their own home just after their kid falls,” he says.

Will virtual doctor appointments for kids be the new normal?

Like many doctors, Raphael Sharon, a paediatrician and associate clinical professor of paediatrics at the University of Alberta, only started providing virtual care during the pandemic, using apps such as Zoom and Doxy. His nurse sits in on the appointment and takes notes so he can give the parent and child his full attention. He also gets parents to help facilitate certain aspects of a physical examination by using their smartphone to observe the colour of the child’s skin, whether it’s jaundiced or pale, or look inside the throat to see if the tonsils are enlarged.

Sharon has done about 80 percent of visits virtually and 20 percent in the office since the pandemic started. He sees every newborn and baby up to three months of age in person, and babies older than three months if there is a concern about failure to thrive, as it’s important to weigh the baby and keep a close eye on growth and development. Regular immunizations for children are also important to maintain as usual to prevent common and serious childhood infections, he says.

“I think virtual care is a wonderful addition for advice, care and as an initial screening tool. But I don’t want it to replace my in-person practice, and there are many situations where you need to see the patient in the clinic. If you have a five-year-old kid who is often tired, peeing more than normal and drinking excessively, you want to bring them in to check their glucose on the spot for possible diabetes. It’s also important to see kids with developmental delays. You need to examine them to make sure there isn’t a neurological problem, such as autism,” says Sharon.

Pasma, whose children are patients of Sharon’s, values the convenience of virtual care and is comfortable knowing she can rely on her doctor’s judgment to determine whether and when her children need to see him in person. “He was also able to do a nine-month and one-year checkup virtually on my twins and was just as thorough as he would be in person. I don’t think I need to go into the clinic as often now that I know how easy and efficient this is,” she says.

The popularity of virtual healthcare among patients and doctors ensures that it is here to stay as a complement to in-person care, especially if governments continue to fund doctors to provide the service. And it will be a necessity as long as we’re still dealing with COVID-19. “I’ve become a big believer in the future of virtual care based on our experience. Parents are ecstatic about the virtual emergency service and our patient satisfaction rate is over 95 percent,” says Lim.

Rebecca Liu echoes that view: “There is a gap where you might have urgent concerns in the evening or on the weekend, but you don’t have access to your family doctor,” she says. “Injuries and illness don’t stop just because your family doctor isn’t in the office.”

Buyer beware

Not all private healthcare apps are created equal. When using a private virtual healthcare provider, it’s important to do your research to find one you can trust. Here are some questions you should consider:

  • How long has the service been in business?
  • What is its reputation, who are the doctors, and what is their training and experience in caring for children?
  • Is the provider Canadian or foreign-owned, and will your child’s health information be private and secure?
  • How long will it be between when you call and when you can see a doctor?
  • Do you have to pay a fee and if so, how much and for what type of service?

Tip: If possible, talk to other families that have used these services, and ask your family doctor for their opinion or recommendation about  using any specific apps.

Kids health

7 things to do before your kid's virtual doctor appointment

Even when the pandemic ends, virtual doctor appointments might not. Video doctor visits can be effective—especially if you follow these best practices.

Before the pandemic, having an online doctor visit was something you might do if you lived in a remote area. But now, things are different, and many if not most doctor appointments are being done by video call, both for adults and for kids. And guess what? That might not immediately change even when the pandemic is over—in fact, it could become the new normal. While an online doctor visit for kids does have their limitations—your kid’s cavity can’t be filled over Zoom, unfortunately—they can often be highly effective, especially if you follow these seven best practices.

1. Provide information beforehand

In advance of the appointment, send a high-resolution picture of visible symptoms like rashes, cuts, wounds or bruises. If there’s a symptom questionnaire to fill out, don’t neglect to do so—it will make the appointment more efficient.

2. Select a good spot for the call

Choose a quiet, private place for your appointment, so you and your child can speak and hear well. For a video call, choose a well-lit spot so the doctor can clearly see your child.

3. Collect the required accessories

Gather any health devices suggested by your doctor such as an oral thermometer or a bathroom scale and have them ready for your online doctor visit.

4. Test your tech

If you’re using a video call app that’s new to you, try it out with a friend or family member in advance (if it’s a publicly available app). Decide and test whether a smartphone, tablet or laptop would work best for you and your child.

5. Write down your main concerns

Write down key points and questions you want to discuss. Blanking in the middle of the appointment is common.

6. Don’t expect your kid to stay still for too long

Online doctor visits for kids can be a little frustrating, especially if you know your little one isn’t the best at sitting quietly. Try to have the doctor examine your child early in the appointment, so they don’t have to stay at the computer too long. Once they run off you can ask more questions without being flustered or distracted. It can also be helpful for both parents to be there for an appointment with a baby or toddler. One parent can hold the baby or entertain the toddler so the other can focus on the doctor.

7. Make sure you know what happens next

Make notes about the doctor’s opinion and recommendations and ask questions if the doctor’s advice or next steps aren’t clear.

Kids health

EQ vs IQ: Why emotional intelligence will take your kid further in life

Long gone are the days of taking IQ tests. Here's why emotional intelligence is a better predictor of your child’s success.

Little boy with many stacked smiley blocks looking at little girl with three blocks with math symbols on them

Illustration: Sarah Rafter

One day on the school bus, six-year-old student Martin Moran gave a toy car he’d brought from home to a boy with special needs. He had noticed that no one ever wanted to sit next to the boy, who was often disruptive during the ride. Martin’s plan worked—the distraction helped the other child focus and stay calm, says Martin’s mom, Jessica Moran.

“It was his idea. Martin’s pretty in tune with other kids’ emotions and came up with that solution on his own,” says Moran.

The story illustrates her son’s high EQ, or emotional intelligence quotient. It’s a skill set that’s been getting a lot of buzz, with some experts and educators saying it matters more than IQ—your child’s intelligence quotient.

Psychologist Daniel Goleman estimates that, at best, IQ makes up only 20 percent of the factors that determine life success, while other forces, such as EQ, wealth, temperament, family education levels and pure luck make up the balance. That means cognitive skills—verbal comprehension, memory, reasoning and processing speed—will help academically, but they will only get a person so far in life. To really go the distance, those IQ traits should be rounded out with social-emotional skills like motivation, perseverance, impulse control, coping mechanisms and the ability to delay gratification.

Goleman, one of the first people to raise awareness of EQ, is the author of Emotional Intelligence, a groundbreaking book that came out in 1995. Since its release, study after study has proven EQ’s importance: that emotional intelligence predicts future success in relationships, health and quality of life. It’s been shown that children with high EQs earn better grades, stay in school longer and make healthier choices overall (for example, they are less likely to smoke); teachers also report that high-EQ students are more co-operative and make better leaders in the classroom. There’s also a relationship between emotional intelligence and bullying, with EQ education initiatives seen as a way to help prevent it. What’s more, having a high emotional intelligence is a greater predictor of career success than having a high IQ, which means it’s valued by employers looking for candidates who can complete work and get along with people in progressively collaborative workplaces.

How do you measure EQ?

A traditional IQ test assesses cognitive abilities through vocabulary, reading comprehension and retention, reasoning and math skills. Meanwhile, EQ assessments test different aspects of emotional intelligence: emotional literacy, empathy, intrinsic motivation and how we navigate emotions. Schools with more progressive approaches to social-emotional learning are starting to assess EQ in students to get a baseline, much like they test math or reading in September to get a sense of where kids are at. Some school counsellors may suggest an EQ test for a child who is struggling socially, to determine which skills to work on.

Just like with IQ scores, an EQ score of 100 is considered average; 115 is awesome, but 85 indicates there are some challenges.

Emotional intelligence quotient scores are in decline all over the world, according to the State of the Heart 2016 report, an annual scorecard by Six Seconds, the Emotional Intelligence Network, a non-profit whose mission is to foster and raise awareness of EQ through research and education. It tracks emotional intelligence levels among 100,000 people in 126 countries using online tests. Some experts blame this decline on increased stress and anxiety levels, which make it harder to cope with life’s curveballs. Another culprit is our growing reliance on technology and social media for communication. We aren’t using the basic face-to-face social and emotional skills that are so crucial to interpersonal relationships and future academic and career success.

In my family, our daughter, Avery, 12, has come to the defence of a boy who has a learning disability by standing up to a group of kids who were taunting him in the schoolyard. “How would you feel if someone called you that?” she challenged them.

Like Martin Moran, Avery is able to understand another’s perspective and then take steps to help that person feel better. Her little brother, my nine-year-old son, Bennett, has autism, so I wonder if perhaps his EQ deficit has boosted Avery’s emotional intelligence. It has forced her, on many occasions, to decipher his feelings based on behavioural rather than verbal cues.

But there’s more to EQ than empathy. The emotionally intelligent child is also one who can label her own emotions accurately, regulate them and control reactions to them; for example, she can verbalize her anger or frustration and think of ways to defuse her feelings rather than throw a book against the wall. A child with a high EQ can also handle more complex social situations and build meaningful friendships, in part because of that ability to relate to or empathize with peers.

As a kid grows into a teen and then an adult, EQ becomes tied to internal motivation and self-regulation. It governs how she makes decisions or harnesses her thoughts and feelings to cope with stress, solve problems and pursue goals. For example, well-developed EQ is personified in the student who can manage her time to complete homework assignments, study for tests, hold down a part-time job and apply to university, all while successfully juggling multiple family and peer relationships.    

As my daughter nears adolescence, I’m starting to see how EQ will help her navigate all the social and emotional pitfalls of junior high and prepare her for life as a young adult. At the same time, I worry about my son, whose emotional intelligence is still in its infancy.

The good news? Unlike IQ, which is static, EQ can increase. But to really develop and master those skills, a child may need explicit teaching and practice.

Can you teach EQ?

“There is a component that children are born with, but there’s a large component that’s learned. There’s an intersection between nature and nurture,” says Joshua Freedman, CEO of Six Seconds. Much of that social-emotional piece is being taught in Canadian schools, where the focus for early childhood and primary school education is on social skills and emotional literacy, the term for naming and managing feelings and learning to respond to others’ emotions appropriately.

“What we try to do with young children really focuses on those areas as much as on traditional curriculum goals,” says Marilyn Chapman, a professor emeritus at the University of British Columbia in the faculty of education. Over the years, Chapman has updated the province’s primary education program, which teaches empathy through play, especially in the early grades.

Storytime is also key, in almost any form, including picture books, oral storytelling, dramatic play, role-playing with dolls and letting kids read on their own.

“Kids learn to understand the social world through storytelling—it helps them relate to a situation and learn how to handle events and emotions,” Chapman says. “It’s a powerful way for them to learn to contextualize situations. In kindergarten, it’s learning to be aware of their own feelings, to express those feelings, to be able to get along with other kids, to share, to be responsible—we do a lot of that.”

This may sound like basic stuff, but for kids to focus and to behave in class and to make friends, it’s imperative to master these concepts. (No one wants to play with the kid who doesn’t share or take turns.)

As children progress through the grades, the learning moves from social skills and emotional literacy to social responsibility, or what many elementary schools call “citizenship,” which is learning to be a good community member in the classroom. Kids are encouraged to put away their books and belongings, to be respectful of others’ work and ideas and to tackle projects that make the school or community better for everyone. (For example, the grade six students at Avery’s Calgary school spearheaded a campaign to collect winter clothing donations for a local charity.)

Social initiatives like this are important because they teach kids that they are part of something larger than themselves, says Chapman.“We are interdependent and we have to be socially responsible—whether in a classroom or a community,” she says.

Participating in Roots of Empathy is another way schools are teaching emotional intelligence in the classroom. This widespread program—it ran in almost 2,400 Canadian schools in 10 provinces in 2016—teaches empathy through regular visits from a parent and baby. During each session, a trained facilitator guides the students’ observations about the baby’s feelings by helping them recognize and name what different facial expressions or vocalizations might mean. Then the kids are coached to think about a time when they felt scared or frustrated or sad, for example.

When children realize all humans—even babies—have these emotions, it’s the beginning of empathy, says Carolyn Parkes, the North American director of Roots of Empathy. Not only that, but when students learn to empathize, it becomes harder to be mean to peers.

“The research on Roots of Empathy shows that there’s a reduction in aggression and an increase in pro-social behaviours,” says Parkes. “When you understand another person’s feelings and who they are, it’s really hard to be hurtful to them. So the bullying decreases as a result.”

Joshua Freedman wants schools to approach social-emotional learning in a more systemic, developmental way. “I would like to see schools treat it much like math or any other area where there’s a scope and sequence. And we assess it, we focus on it, with time dedicated to it, and we don’t just do it for a couple days here and there,” says Freedman, although he concedes that any time spent developing EQ pays off.

In one Six Seconds study, the organization found that when a high school math teacher spent time on social emotional learning, the rest of the more traditional math lessons were easier to get through (compared with classes that didn’t have the EQ component). The teacher dedicated one class a week to emotional intelligence. She started by checking in with the students about how they were feeling and then moved on to an EQ exercise: for example, watching a video clip that dealt with a difficult decision and talking afterward about what made it hard. Finally, the teacher asked the students to write about a similar challenge or problem they were facing and then brainstorm solutions. The teacher attributed the results—improved math learning following EQ exercises over a three-month period—to better relationships, better communication and better context for problem solving in the classroom.

“It’s really a beautiful situation,” says Freedman. “By focusing a little time on social-emotional learning, we actually can go further in academics.”

Modelling EQ begins at home

Parents begin teaching emotional literacy to their kids from infancy. “One of the things that’s really important in the early years is for children to be able to understand how they’re feeling and to be able to put words to those feelings rather than acting out,” says Chapman.

She says the peak time for physical aggression in children is between ages two and five—before they start school. It’s a time when kids grab, hit or bite because they don’t have the language to express themselves adequately. But their aggressive communication presents an opportunity for parents to help them name those feelings and to coach them—through play or by moderating their play with other children—on how to get along.

Parents should also take a close look at their own emotional intelligence, says May Duong, director of parent education for Six Seconds. “It starts with our own self-awareness,” says Duong. Her organization has found that parents who participated in EQ workshops had better family interactions as well.

Have you ever told your kids to “suck it up” when they were sad or disappointed? Or responded to a crying child with, “You’re fine,” or “Don’t be sad”? That’s not very empathetic. Slowing down and trying to be less dismissive of how our kids are feeling is the goal.

Freedman, a dad to two teenagers, thinks parents have a tendency to dismiss children’s feelings because we don’t know what to do with them—their emotions are so very big and raw that we want to flip the happy switch as quickly as possible.

“When my kids are expressing strong feelings, I feel overwhelmed,” says Freedman. “But one of the things I’ve learned is that most of the time, I don’t have to do anything. Kids cry and you want to fix it. Instead, just sit. Bite your tongue.” You can validate or mirror their feelings, but ultimately, he says, “It’s their job to learn how to fix it. You can help them by coaching them in the moment.”

High EQ as a job requirement

Companies know that employees who score well on emotional intelligence will not only be able to do the job but will also be better equipped to read workplace situations, get along with co-workers, collaborate and solve problems.

“Employers of today are looking for individuals with high EQ. We’re working with companies like Google, American Express, and FedEx—and it’s high on their list when they select people,” says Steven Stein, CEO of Multi-Health Systems, a test-publishing company that came up with the EQi, one of the first tests of emotional intelligence. Testing prospective employees—usually as part of the final interview process—is legal, as long as it relates to the job they’re applying for, he says.

“We’re going on some pretty hard data when we select people,” says Stein, who has also authored The EQ Edge: Emotional Intelligence and Your Success and Emotional Intelligence for Dummies.

Employers testing the EQ of applicants illustrates a major shift in thinking, and it’s all the more reason I’ll continue to nurture my kids’ emotional intelligence. Their EQ—together with their IQ—will help pave a path to future success in all aspects of life.

Read more:
Mindfulness for kids: Learning emotional regulation in school
How to raise a self-sufficient kid
4 social skills school-age kids should know

Family health

I dealt with my kid's anxiety by letting her be anxious

All I wanted to do was fix my kid's problems. But my mom instincts were telling me that by doing so, I might be feeding the anxiety monster.

The first time my daughter suffered a panic attack, she was 11. It was terrifying. She was hyperventilating, gasping for air and shaking uncontrollably, as tears streamed down her face and her stomach heaved.

All because she had worn the wrong soccer jersey to her weekly practice.

I’d never witnessed a panic attack before. I had no experience with anxiety. But just as I had kissed her booboos better in the past, I wanted to make this all better for her too. Driving home to retrieve the proper jersey would fix everything, right? She said it would. But as for fixing the root of the problem, I wasn’t so sure. Deep down, very quietly, my mom instinct was telling me not to do it—that I’d be feeding a monster, and while that may quiet it, it wouldn’t destroy it.

So I listened to my inner voice. I told her I wasn’t going to get the jersey. Can’t lie—she cried, and begged, and then cried more. But I stood strong and stayed calm, rubbing her back and repeating, “I’m right here. You’re okay,” until the panic had run its course. Then, together we walked onto the field and I explained to the coach that my daughter had worn the wrong jersey. He smiled, assured her it was no big deal, and encouraged her to join the rest of her teammates dribbling soccer balls around pylons.

Panic attack number two occurred a few months later, the night before her school’s annual cross-country race. My kid loves running. In previous school years, she had eagerly signed up for the cross-country team and looked forward to the daily practices and the annual multi-school meet. Well-buffered by hundreds of pint-sized runners, she’s always placed within the top quarter.

But this time was a bit different. Her school was holding its own mini cross-country meet on their grounds, meaning the buffering of runners would be quite diminished. Her every move would be on full display without an ample padding of runners surrounding her. The entire school would be witness if she were to fall down, come in last or fail to finish.

As the event approached, my poor girl was at war with herself, panicked with worry. I was clueless to it all until bedtime the night prior. As I was tucking her in, the symptoms started, just as they had that day on the soccer field: tears running down her face, completely out of breath, stomach heaving.

I sat by her side and together we waited for the panic to dissipate. I calmly assured her that it would pass, and that I wasn’t going to leave her until she felt better. It took 20 minutes, but slowly, the tears stopped, her breathing returned to normal and her stomach calmed. And then she told me everything: With only four other girls in her grade competing, there was no way she could be inconspicuous. She didn’t want to go through with it.

A child holding an apple for school lunch. When your child’s food allergy leads to anxietyOnce again, my baby was hurting and scared and of course I wanted to fix it. Why shouldn’t I just let her drop out? It’s a silly, insignificant school race, for God’s sake. A tiny blip in the life of a child soon to spread her wings and experience bigger and better things.

But, again, my instinct whispered loudly: This seemingly tiny blip is actually a crossroads. And the choice she made here could pave the way of many choices in her future.

I won’t lie: I wanted her to run the race. As her mother, I knew how much was riding on whether she faced her anxiety head-on and pushed past it to learn that it’s always better to take chances in life, no matter whether you succeed or fail. I’m no psychologist, but I felt strongly that if she allowed her anxiety to hold her back in this one, seemingly insignificant event, it would continuously hold her back in life—when she had to face unpleasantness, discomfort or dread, when dealing with a tough exam or an intimidating interview, when challenged by anything that could jangle her nerves.

So I improvised my way through a conversation. We talked about what she was most afraid of (coming in last) and the worst-case scenario of this (being made fun of). We discussed the pros and cons of participating and not participating. I reminded her of the soccer jersey incident. By the end of our talk, I could see she was feeling better, stronger—but still not sure what she should do. This is when I donned my mother-as-advisor hat and told her I was going to give her my two cents, which in a nutshell was this: “I know deep down you want to run. I think if you don’t, if you give in to this anxiety, you will be making a mistake. I believe that if you run, no matter the outcome, you will show the anxiety that you are the boss—that it has no control over you.”

I told her to think about what I said, and to sleep on it.

The next morning, she said she would run. Whether she was buoyed by my advice or pressured by it, I’ll never be sure. What I do know is, sitting in the stands at the cross-country meet, watching her wait for her turn to run, my heart was in my throat. Had I done the right thing? Should I have convinced her to run or left the decision entirely up to her? What if she just couldn’t do it? What if she had another panic attack—right here and now—in front of the whole school?

I could see she was holding back tears right up until the moment the teacher yelled “Go!” And then, like a shot, she was off.

It doesn’t matter how she placed. All that matters is that she ran the race— into the unknown, straight toward the source of all her anxiety.

When it was over, I ran to where she lay on the grass, trying to catch her breath. I told her how proud I was of her—and the smile radiating from her breathless face was answer enough as to how she herself felt.

I don’t want my children to be anxious. Perhaps counter-intuitively, I believe that means that I have to allow them to be anxious. That school race was three years ago, and although she still sometimes gets a case of nerves, she hasn’t had an anxiety attack since.

Note: Childhood anxiety isn’t always treatable at home, and doesn’t always go away on its own. Contact your child’s doctor if you are concerned.

This article was originally published online in August 2018.

 

Kids health

Does your kid still wake up in the night? This could be why

Biology, psychology and environment can all influence a child’s sleep patterns.

For some parents, getting their child into bed is a struggle that can take hours. Others get up at midnight to help their child fall back to sleep. Sleep problems like these affect one in four kids—and their parents, too.

As a pediatric sleep researcher, I’ve grappled with the question of why these sleep problems in children happen. My team’s research delivers the largest synthesis of why kids develop these sleep problems, capturing over 30 years of research. We have identified the 10 biggest reasons these sleep problems occur for kids ages one through 10 years.

Why kids develop sleep problems

This is a complex question. We identified nearly 60 factors that could play a role, from a pool of 98 studies. Ten of these factors were supported in several rigorous studies.

These factors fall under three “lenses” we can use to understand where children’s sleep problems come from: biology, psychology and the environment.

Biology

We identified two reasons kids develop sleep problems stemming from their biology—their temperament and their age. Biology involves the child’s internal functions, their make-up.

Temperament, or disposition, is the personality you see in your baby. Babies who seem more fussy or irritable can have a hard time responding to change and may not settle easily. Babies with this type of temperament may be more likely to have sleep problems later in childhood.

As children get older, they are less likely to have sleep problems. This may be because their brains can better manage the processes needed to settle at night, or that they are more independent in their bedtime routines.

Psychology

The psychology of sleep problems in children involves two parts: how children act and feel, and how children and parents interact with each other.

We found six psychological reasons kids develop sleep problems: three relating to how kids act and feel, and three relating to family interaction.

Firstly, we know that children who have had sleep problems earlier in life are likely to continue to have sleep problems later in childhood—unless change happens.

Children with mental health problems tend to have more sleep problems, even if there’s no diagnosis. There are two groups of problems linked with sleep problems: internalizing problems (like anxiety and depression) and externalizing problems (trouble with following rules and focusing). Internalizing problems can make it harder for kids to settle down and fall asleep, due to higher stress levels. Externalizing problems may make rules and routines more difficult for children to follow, which then makes it harder to settle to sleep.

How children and their parents interact also matters.

At night, parents who stay with their child until they fall asleep tend to have children with sleep problems. Parents become a cue for children to fall asleep. So, when a child wakes in the middle of the night and mom or dad isn’t there, it’s tricky to fall back asleep.

During the day, parents who have inconsistent rules at home, who do not enforce limits on their children or who react very strongly to little hitches tend to have children with more sleep problems. Parents who act in these ways may have trouble keeping their child on the same bedtime routine from night-to-night and have children who have more stress at bedtime, making it harder to fall asleep.

Consistency is also important at night. Children with consistent bedtime routines tend to have fewer sleep problems than children with inconsistent routines. Consistent bedtime routines help kids to feel safe, settled and ready to fall asleep.

The environment

The environment involves how children and parents interact with the world around them.

Firstly, more electronic use is associated with more sleep problems in children. This is especially true when children use screens in their bedroom or close to bedtime. This is because screens prevent melatonin (the sleep hormone) from doing its job, which is to make us sleepy. But this isn’t the whole story. Electronics may also keep kids’ minds alert, especially if they are playing a game or watching an interesting show.

Secondly, families with lower incomes and lower education are more likely to have children with sleep problems. This likely isn’t a direct result of income or education, but the fallout from these circumstances, like living in noisy neighbourhoods or having parents with changing schedules.

Chart displaying why sleep problems in children develop

Copyright Adam Newton. (Adam Newton), Author provided

These factors give a principal account of why sleep problems occur, but not the whole story. We don’t yet know how these factors might influence each other to make sleep problems better or worse. There are also other factors I’ve not mentioned—like bedroom light and noise or conflicts between parents—that may help our understanding.

How can parents help?

Of the 10 factors I’ve listed, parents can directly improve four:

  • Help kids to fall asleep on their own;
  • Develop a clear and consistent bedtime routine;
  • Limit electronics in the bedroom and at bedtime;
  • Calmly, set clear and age-appropriate limits for your child during the day.

These changes can be easy to make and can have a great impact on your kid’s sleep.

Adam T. Newton is a PhD candidate in clinical psychology at Western University.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The Conversation

Kids health

The COVID-19 pandemic is remapping childhood—and the effects may linger

Not only do we not understand what the virus does to kids, we're also in the dark about what this crisis might mean for them psychologically and emotionally. Some researchers are trying to look ahead.

Children adapt quickly. The group headed to school in Beijing one recent May morning seemed to know their new routine. They approached a building whose entrance resembled an odd blend of movie-theatre foyer and airport-security checkpoint: red ropes, barrier posts, bright directional signs painted on the ground. News clips showed them moving efficiently through the stations in two lines, always keeping a six-foot distance: take a squirt of sanitizer, wait; get temperature check with a thermometer gun, wait. And of course they all wore masks. At a different school, they might use a personal thermometer to take their own temperature twice a day. Or a worker in a hazmat suit might spray disinfectant on their shoes and the ground as they entered. Or they might have to show a green code on a smartphone app signalling a low enough risk of infection.

If they were at a school in Hangzhou, in eastern China, they could be wearing special hats, made with three-foot-long poles and designed to encourage social distancing. (One poke in the eye is surely a good enough lesson.) If they were in Taiwan, they might have individual cardboard barriers on their desks at lunch—a “cone of silence” of sorts with a more sinister undertone. If they were nursery schoolers in France, they’d each be confined within a square drawn in chalk on the ground, six feet or more from the next square. In Denmark, they would wash their hands at least once an hour at specially installed hand-washing stations. And of course, none of them could touch a classmate or friend.

Children in Saint-Jean-sur-Richelieu, Quebec, use green dots painted on the tarmac to help maintain proper social distancing.

Children in Saint-Jean-sur-Richelieu, Que., use green dots painted on the tarmac to help maintain proper social distancing. Photo: Christinne Muschi / Reuters

This is what it is to be a child on planet Earth in the spring of 2020. In faraway Canada, where back-to-school is still months away for most—Quebec and now B.C. being the exceptions—the signs of change are less forbidding: ubiquitous hand-coloured rainbows in windows; posters in bubble letters thanking front-line heroes (they are heroes, yet it’s strange to hear war metaphors and public-health jargon trip lightly off the youngest of tongues); and, on one Toronto sidewalk, cheery sidewalk-chalk drawings of coronaviruses, their telltale haloes of tiny crowns rendered in mauves and apple green. Each is a signal of how much the world has changed for children.

Not long after news of a deadly outbreak emerged from China, we learned a surprising, hopeful fact: this novel coronavirus didn’t seem to target kids. In fact, it rarely seemed to sicken them. Of the more than 376,000 global fatalities from COVID-19, few have been minors. So we’ve read obsessively about testing protocols and how to protect seniors, and flattening the curve; most of us haven’t had to worry as much about kids.

Well, sort of. Kids started the pandemic as part of a group accusingly dubbed “superspreaders.” They were kept home from school mostly to help flatten the curve. Then, in late April, came reports from New York hospitals of a rare but severe new ailment in kids that caused organ failure and heart complications, sometimes fatal. The mystery illness seemed tied to COVID-19; children with the symptoms either tested positive or had antibodies, meaning they’d had COVID-19 in the past. And it seemed to strike kids who had no underlying health conditions at all. Doctors in Canada are now looking into 47 possible cases of multisystem inflammatory syndrome in children.

As it turns out, we actually don’t understand what the coronavirus does to kids. There isn’t consensus on the most fundamental question: Do children get sick from the coronavirus? The thousands of confirmed children’s cases worldwide would suggest yes; yet it remains true that most children don’t. In late April, Switzerland’s infectious diseases chief announced young kids could now visit and hug their grandparents because, as he put it, they can’t transmit the coronavirus. “They just don’t have the receptors to catch the disease,” Daniel Koch said in a news conference. That’s not science denialism at work; at least one recent study reached this conclusion, although it is in a pre-print stage and has not passed peer review—the benchmark for issuing clinical guidance. Other studies have concluded kids spread the virus less than adults, and still other studies say kids transmit at the same rate as adults. So how much should we worry? In the absence of data and scientific consensus, children remain a kind of black box.

We are, likewise, in the dark about what this crisis might mean for them psychologically and emotionally. How could we not be? We don’t know how long the pandemic will last. We don’t know if normal life—or some form of it—will resume by fall. We don’t know if or when the virus will return with twice the force, as many epidemiologists warn. It’s hard to predict the long-term effect of this period on children, hard to engineer a solution that is stress-proof for them. Keeping kids home indefinitely is hardly an option. The prospect of economic recovery—parents returning to jobs, businesses staying open, supply chains reactivating, money flowing, food on the table—rests on those small shoulders.

Yet resumption of normal life, and a return to school and socializing, brings strange new realities to which they must adapt. The pandemic may have mostly spared kids, but there are few groups whose experience of the world is changing so dramatically as a result.

***

Most years, around this time, children across the country are counting down the hours to overnight camp, that Canadian ritual of days spent in the wilderness canoeing, swimming, and bunking with a pack of strangers-cum-best friends-in-waiting. A week at Camp Tamakwa, near Algonquin Park in Ontario, is one of these cherished experiences. Its website suggests business as usual: a countdown clock flips on top of a picture of South Tea Lake’s still, blue waters. There’s a quote from an alum (1986): “This is the place I see when I close my eyes and dream.”

Victoria Flowerday went to Tamakwa last summer. She met her boyfriend there, and was going to be a counsellor this summer, a last stint before heading to university on the East Coast. An athletic 18-year-old, she runs triathlons, swims competitively and plays water polo. Her bedroom (we talked on Zoom) is decorated with camp pennants and her racing tags. But overnight camps are closed in Ontario, and Victoria looked wistful as she counted off the other cancelled events in a milestone year: graduation, prom, the senior trip, triathlons, her lifeguarding job. “It’s really hard,” she said. She can’t see her boyfriend, who lives in Michigan, or her friends. “But I got a job at Sobeys as a cashier,” she said, “so I’m doing that and saving up some money for university.” In lieu of the last real summer of her childhood, she gets the chance to be a front-line worker.

Flowerday missed most of the milestone experiences of her last year of high school; she now has a job as a front-line worker.

Flowerday missed most of the milestone experiences of her last year of high school; she now has a job as a front-line worker. Photos: Courtesy of the Rockwell Flowerday Family

She worries a little about that. She wears a mask and gloves for fear of bringing the virus home to her large blended family of seven: five siblings, two parents. She worries about school this fall: “I hope they don’t move to online classes.” But there are silver linings. “I’ve become a lot closer with my family,” she said. “I hadn’t spent this much time with them in a really long time. Through all of the negative things that come with this, my parents made sure we make the best of it. I had my 18th birthday in quarantine, and it was my best birthday yet.”

All the kids I spoke with for this story said they miss their friends, school and activities (often in that order). “I miss going to places I haven’t been,” Victoria’s half-brother Evan, age 13, said, capturing succinctly how the pandemic has shrunk the world for all of us. Joshua Miller, an angelic eight-year-old, said, “ ‘Me time’ is the only time I get alone, but I don’t get ‘me time’ till my brothers go to bed”—again encapsulating a reality for many. We are distancing, but never very far from the people with whom we share our homes.

For the oldest of this cohort, though, there is a poignant added layer. Victoria Flowerday’s parents can work from home, and there is financial security, a huge plus. But that doesn’t take away the sense of loss, the interruption to milestones that bring meaning, the broken transition to a next stage of life. “The developmental tasks young people are supposed to be working on at this age are positive, healthy separation from family, autonomy, spreading their wings, establishing more intense social relationships,” said Joanna Henderson, a senior scientist at the Centre for Addiction and Mental Health (CAMH) in Toronto. COVID-19 has slowed all that. The past 10 weeks don’t feel like a blip to Victoria. “I’m definitely not gonna be the same after this,” she said. “I’ll always think about even the most mundane things differently.”

That wouldn’t surprise Jean Twenge, a professor of psychology at San Diego State University, who studies generational patterns and differences. “The coronavirus outbreak,” she said, “is equivalent perhaps to World War II in its impact.” At one point, Twenge lived in a neighbourhood with a lot of elderly residents, people who were young in the 1930s. She recalls getting a catalogue in her mailbox that was bursting with products aimed at that demographic. “For $2 you could buy this plastic device for your toothpaste tube that would push the toothpaste all the way to the top so you could get every last drop out. And as a Gen Xer, I remember looking at that and thinking, ‘Why would you spend $2 on that? Who cares?’ ” Formative events stay with us.

Twenge wrote the best-seller iGen: Why Today’s Super-Connected Kids Are Growing Up Less Rebellious, More Tolerant, Less Happy—and Completely Unprepared for Adulthoodand What That Means for the Rest of Us. She argues that pandemic life reinforces some patterns for a generation already more accustomed to virtual life and dealing with higher levels of anxiety, though behaviours could also go the opposite way post-pandemic.

The implications of pandemic life can be dramatic for some. For refugees who have escaped political violence in Latin America or fled domestic abuse in Nigeria, the sense that the world is unsafe again can revive old traumas, said Mariana Martinez Vieyra, a counsellor and coordinator of refugee mental health services in B.C. at the non-profit Vancouver Association for Survivors of Torture (VAST). Stay-home guidelines are hard on everyone, but they are intensely destabilizing for people who were just beginning to make a home. “It ruptures their sense of control,” she said. “They say, ‘I feel as if I’m in jail again.’ At the same time, some parents have got very comfortable staying cocooned. Hiding has been the strategy to survive in the past, so some parents are not letting the children out of the house.”

The kids’ experiences, as in any family, depend on the parents’. For some, this is cherished time together. The counsellors hear often how grateful their clients are to be experiencing this pandemic in Canada. But it’s not an easy time. A number of clients are essential workers, so some kids have been going to daycare. Other kids are stuck indoors with none of the frills that ease life in quarantine. And while they may find comfort in family, said Martinez Vieyra, “one thing that refugee children present is difficulty in moving beyond the family unit and trusting other adults.” Those connections with the outside community are vital to settling, and may now be set back.

Kids who are resettling are not alone in navigating such disruptions. I heard about kids of various ages who don’t want to go outside. One teen stayed home for the first six weeks of the lockdown. A preschooler I came across who loved dogs pre-COVID is now afraid of them—and of bugs. (“I should’ve called it a ‘virus,’ her mom told me.) Suniya Luthar, an American academic whose research for decades has centred on kids, feels for a generation denied its real-world connections to peers. “It’s just heartbreaking to think of the physical contact, the hugs, time with teammates,” she said. “A lot of their camaraderie and support, not to mention, for older kids, romance, comes from physical contact and proximity.”

Mom sitting on driveway with kid in lap and hockey sticks nearby

Beth Miller hugs her son Matthew. Photo: Marta Iwanek

I live with a member of this tribe, a third-grader. Early in May, on the anniversary of the Hindenburg crash, I showed him a short film on the disaster. The Hindenburg was almost as big as the Titanic, we learned, a mammoth reflective balloon launched into the sky. As news cameras lingered on its luxurious interiors, diners clinking their glasses in the dining lounge, my son began flailing his arms. “Mummy!” he squealed. “Pause it. Pause it. All I can think about is why are they all so close to each other? Why on Earth did they pack themselves into that small place?” He was looking at the Hindenburg, and what he saw was a crowded room.

My son shows no signs of anxiety; a talkative kid who loves to draw and make books, he doesn’t leave too many thoughts unexpressed. But there are glimpses of a new world inside his head. In the dreams he now recounts, the people are always socially distancing. It’s winter, the roads are iced over and we get around on skates; he’s in school in Japan, studying art and math and prayer; he and his dad chat with a knife sharpener in the park every night at 10 o’clock. In the most improbable dreamscapes he describes, nobody touches and there are invisible two-metre barriers between people.

***

What longer-term effects will all this have for children? It really depends on which child. The pandemic has created bubbles of personal experience. Every family, every individual, seems to go through it differently. Experiences like this are not automatically traumatic, child psychologist Stacey Schell noted. “Trauma is really about someone’s response to an event,” she said. “For some kids this might end up being traumatizing and for others it might not.”

In an effort to capture the variety of experience, and the seismic changes in family life, Toronto’s Hospital for Sick Children (SickKids) is launching a project surveying 6,000 children and families over the next nine months. The real-time data-gathering exercise relies on new recruits and subjects from four existing research groups, including the Child and Youth Psychiatry Outpatient Program at SickKids and Spit for Science, a study of the interplay of genes and environment in kids’ health. The children will be surveyed monthly on their dietary habits, physical activity, sleep, screen time, and how they feel: Are they sad, irritable, anxious? How is their concentration? (Their parents will be surveyed, too.)

“I’m looking to see how these kids fare over time,” said the project’s head, Daphne Korczak, a psychiatrist, researcher and director of the Children’s Integrated Mood and Body program at SickKids. “How did they fare on the return to school? Are there differences? How can we understand kids who come in with higher risk vs. kids without known higher risk? And how can we use that information to plan for the future and to support them?”

One factor the SickKids study is tracking is pre-existing anxiety, and how kids with these issues fare over time compared with other kids. Among the children I spoke with, experiences of the pandemic can be worlds apart. The coronavirus isn’t a big worry for Joshua, the eight-year-old who craves “me time.” “I just pretend it’s not really there and school was just canceled,” he said. Joshua lives in a small town near London, Ont. He misses knocking on his best friend’s door, but his family has holed up at the cottage, where they get lots of outside time. He likes the reduced schoolwork, and he and his two younger brothers, four and six, now get to watch movies every day.

Family playing ball hockey in their driveway

Neil Miller plays hockey with his son Joshua. Photo: Marta Iwanek

His parents check in with them periodically about how they are feeling, which is hugely beneficial. “We know that trauma is linked to a feeling of being unsafe or at-risk,” Stacey Schell said, “and one of the best protectors from trauma is the space for people to talk about what they’re feeling.” Joshua’s parents have also shielded the kids from the pandemic’s harshest realities, as well as their family’s own. In January, his mother, Beth, a fit, active gym teacher, had a hemorrhagic stroke. “At a time when many Canadians are in isolation,” she said, “this has been my norm since January.” She spent a month in hospital relearning how to walk and write. She has three hours of physical and cognitive therapy a day, plus weekly virtual meetings with her doctors, physiotherapist, occupational therapist, and social worker. Beth shows the calm of someone who has had to recalibrate her goals and expectations, and in the process has stumbled onto a deeper happiness. “My life has already changed so much that I am so happy to be with my family,” she said in May. “I feel among the fortunate in this situation.”

The virus looms larger for 11-year-old Yohan Maramot. His mother, Reyamie, is a nurse at Michael Garron Hospital on Toronto’s east side. She often works double shifts, getting home at 7:30 a.m. Lessons about COVID-19 are part of Yohan’s schoolwork, and he’s alert to misinformation online. “There’s a lot of fake news, like people saying it comes from bat soup, and exaggerations,” he said.

He worries his mother will test positive for COVID-19. His mother worries about him. She monitors the COVID-19 case count in their west-end neighbourhood (it was 100 the day we spoke), and they sanitize high-traffic door knobs and light switches at home. Reyamie works in respirology and acute medicine, and sees two to three patients who have tested positive for COVID-19 a day. “I see how quickly patients can deteriorate,” she said.

Yohan misses normal life. His mother, an immigrant from the Philippines, follows the “takes a village” model, and most pre-COVID weekends were spent with close friends. He misses church, “especially the part when church is starting and all of us get to say a brief announcement about our week, and the part after, where we arrange play dates,” he said. These days, hanging out with friends over Roblox games on his iPad and chatting with family makes him happiest.

Not everyone understands the burden shouldered by families of health-care workers, said Indrani Lakheeram, a pediatric anesthesiologist based in Montreal. “It’s very hard to manage the two things: my role as a parent, trying to safeguard my family; and my role as a professional, trying to do what’s right for my patients.” Lakheeram is the one who’s working now, while her husband, Roger LeMoyne, a globetrotting photojournalist, stays home with their two teenaged kids. Anesthesia is a high-risk profession—intubations and managing the airway mean exposure to COVID-19—and when the pandemic started, she found it nerve-wracking. “Does my loyalty lie with my patients, and is it worth it for me to get sick and potentially die vs. my loyalty to my kids?” she said. The kids find it hard, too. “They don’t like it. I work in pediatrics and they often wonder why somebody else’s child is more important than mine.”

***

There are not many modern precedents for these times. A couple of studies, including a survey from 2004 that examined the effects of the SARS quarantine affecting 15,000 Canadians, have found a spike in symptoms associated with post-traumatic stress. But those were adults, and the scale of this shutdown is different.

The news is not all grim. There are indeed troubling spikes in youth anxiety and depressive symptoms in Canada, on top of rising anxiety rates pre-COVID. In an April CAMH survey of youth aged 14 to 27, 68 per cent of youth who had previously sought mental-health help, and four in 10 youth who hadn’t, said they’ve had problems. But there were also signs of hope in the study. Rates of substance abuse dropped, presumably as more kids stayed home. Social connection matters, and eight in 10 said they connected with friends online. “I was surprised by the proportion of young people who reported positive impacts: more time to spend with family, more time with pets, on their hobbies. Some even said they’re saving money because they go out less,” said Joanna Henderson, the lead researcher and director of the Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health at CAMH.

Anxiety and depression are what Suniya Luthar, the American academic, thought she’d find when she began surveying students about COVID-19. Luthar is an authority on resilience in children. Her ground-breaking research in the 1990s exposed the reality that high-achieving students, often from educated, white-collar families, are among the most vulnerable populations for substance abuse, anxiety and depression, alongside kids who grow up in urban poverty or whose parents have been incarcerated.

Luthar’s organization, Authentic Connections, conducts student surveys at schools to identify vulnerabilities in mental health. When COVID-19 struck, the organization pivoted and began running student resilience surveys instead, focusing on anxiety, depression and kids’ concerns during the pandemic. They’ve administered the surveys to kids at 25 schools so far, and what they found was startling: rates of clinically significant depression and anxiety were consistently lower than in 2019.

“This is why we do research,” Luthar said. “You stop to think about it, and it adds up. The oppressions that these children experienced have by default become less. They’re not running from pillar to post with multiple extracurricular activities.” Absent an early school start, kids are sleeping in—a great boon to adolescent bodies, which want to wake later. And most are carrying a lighter load at school. “Everything is not crammed, and in most cases teachers are being understanding,” she said. “So I imagine that there is some sense of relief: ‘my God, I can breathe now.’ ” Gone, too, are the social dynamics of school. “Nobody is going to feel left out because they’re not at the popular kids’ lunch table,” Luthar offered.

Three kids sitting on the couch

Thomas, Evan and Jamie (top to bottom), of the Rockwell Flowerday family, have found that staying home isn’t the end of the world. Photo: Courtesy of the Rockwell Flowerday Family

Some of these were motifs in conversations I had with kids. Jaime Rockwell, 15, is happy she doesn’t have to go to overnight camp, as is her brother Evan. An introvert by nature, Evan seems to enjoy the reprieve from social gatherings; both have actually made new friends in quarantine through online social apps or games. Their half-sister Julia Flowerday, 13, told me she too likes elements of the new normal, including the fact they now eat all their meals together; before, they were too busy with activities.

Some younger children prefer this time. “I’m doing great,” said Thridev Chandramouliswar, a sweetly impish eight-year-old who lives in a Toronto high-rise with his parents, his two-month-old-sister and, for now, his grandparents, who came to visit from India not long before borders closed in March. An athletic kid, Thridev loves the sorts of activities the pandemic has made difficult. But he has virtual art and music lessons and, somehow, basketball coaching. He does a lot less schoolwork. And he has a grandmother who loves to bake, and time with his parents, who are now both home. A molecular biologist by training, his mother, Jayantasri, is on mat leave, and intrigued by the pandemic rather than worried—a coolness that her son seems to have picked up.

What the pandemic has given Thridev’s family is connection. Until two years ago, when his parents immigrated, all five lived as a joint family in a sprawling Chennai homestead with his cousins, and aunt and uncle. So this is familiar, if at closer quarters. “Actually, the social isolation period was when we first moved here,” Jayantasri said with a laugh.

That ties in with a theme in Luthar’s decades-long research: resilience rests on relationships. Close relationships with parents are a big predictor of resilience in adulthood, and can compensate for dire risk factors. Research from Cornell University found that higher environmental risk—from poverty, overcrowding, even family stress—was mediated by a mother’s responsiveness. “If your mom was particularly sensitive to your emotional state during a game of Jenga . . . ,” Paul Tough wrote in the book How Children Succeed, “all the bad stuff you faced in life had little to no effect on your allostatic load”—meaning blood pressure, stress-hormone levels, and so on.

How, then, are parents doing? In another CAMH survey, nearly a third reported being more anxious vs. only a quarter of people without kids. (How could we not be?) In a joint Italian-Spanish study from April of the effects of COVID-19 on kids, parents who were more stressed turned out to have kids who were more anxious, worried or argumentative. Yet the increase in family time also affords many more of those ordinary opportunities for parents, even stressed-out ones, to be responsive to kids. It’s a tremendously reassuring thought.

Ensuring a child’s well-being also means ensuring the well-being of those caregivers. For parents, as for kids, Luthar believes the answer lies in meaningful relationships. It’s not the easiest time to nurture adult friendships, but busy or not, parents must make time for connection. “Just as we learned to put on our masks and distance and wash our hands,” said Luthar, “we have to learn to do this. It’s not optional.”

***

The other critical component of children’s lives is, of course, school. Reopening schools isn’t just a necessary step in restoring the economy; it’s also something kids themselves desperately need, for structure, for social connection. The question is when and how to do it safely. As Reyamie Maramot, the Toronto nurse, put it, “We want our kids to be happy, and we want them to be safe. How can we choose?”

Since kids generally have mild or no symptoms when they have COVID-19, they don’t get tested. “We don’t have very good information on what proportion of kids may have been infected,” explained Amy Greer, the Canada Research Chair in Population Disease Modelling at the University of Guelph, who’s working on mathematical modelling of COVID-19 transmission at summer camps. Greer said it concerned her that discussions of relaxing guidelines in Quebec in early May were taking place in the absence of this data, while cases were still high. Schools reopened on May 11; by month’s end, 44 students and 34 staff at several schools had tested positive.

kid laying on their bed reading a book

Being the child of an anesthesiologist can be worrying for some, like Chloe Lemoyne. Photo: Courtesy of Roger LeMoyne

Greer believes we will have more data in the coming months with which to make policy decisions about schools. Several studies are under way examining transmission by children within households for clues to how SARS-CoV-2 (the virus that causes COVID-19) spreads. There should also be data out of other countries soon, where schools have been open for a while.

All roads seem to lead to testing and contact tracing. “There is still time for us to get our testing and tracing house in order,” Greer said. “If we can drive cases down over the course of the summer, if we can ramp up testing and tracing such that we’re able to really understand what we’re dealing with, then we can make better decisions.”

Reopening will bring its own challenges. A common mantra in these times is that kids are resilient. “Yes, kids are resilient,” said Stacey Schell, the Toronto child psychologist, “but not all kids are equally resilient. And I worry that we will underestimate the challenges for some.” Daphne Korczak of SickKids pointed out that for high-achieving kids or anxious kids who enjoyed a reprieve during the pandemic, anxiety may return. There will also likely be much variation in kids’ academic levels when they go back. “It’ll be important for schools to have the capacity to address different educational needs effectively,” she said.

Three family members cuddled together with a laptop watching a movie in the dark

Chloe, Sasha and Lakheeram (left to right) take advantage of a rare opportunity for family movie night. Photo: Courtesy of Roger LeMoyne

Then there are the day-to-day realities. “As a parent, sending your kid back to school and wanting to ensure that they’re safe is one thing. But the other thing is, what is the experience like?” mused Greer, who is also a mother. Other parents, such as anesthesiologist Indrani Lak­heeram, aren’t counting on a normal school year. “I’m expecting them to have to be at home at some point,” Lakheeram admitted. “I don’t really know how we’re going to manage. I just hope schools have really thought about how to educate people in this digital age. I feel it’s going to come back to that.”

For now, those realities seem an eternity away. As I took an evening walk in late May, though, there were signs of change. Packs of kids were out together on bicycles or playing. In a kindergarten playground, a teen hangout was under way. And on some sidewalks, in place of drawings of rainbows and cheerful thank-yous, were a new set of chalk slogans: “Black Lives Matter”; “Silence is Violence”; “Justice for George Floyd.” I was reminded of walking into my child’s school one afternoon last fall. It was the day of the climate strikes, during Greta Thunberg’s visit to New York, eons ago now. The yard was covered with chalk drawings and writing: “Save the Turtles”; “HELP! We don’t want to be extinct in 30 years!”; “Earth is burning!” I imagine there were school yards like it all over the country. It struck me that night that, to this cohort of children, a pandemic may not seem insurmountable. They were already facing worse. Maybe, in the words of the old song, they will be all right.