COVID-19: Returning to school or day care for the child with a chronic illness

Below are some recommendations from our experts on the return to school or day care by medical condition: 

We understand that this is a very stressful time for everyone, particularly for parents with children who have chronic illnesses. We share your concerns and will try to provide answers as much as possible.  There are still many unknowns about COVID-19, and we continue to learn more daily.

Is it really safe for children to return to school?

Many experts agree that it appears to be safe for children to return to school. The risk of serious illness from COVID-19 in children is very low.  There have been no deaths in Canada in children and very few worldwide. Very few children have been hospitalized for COVID-19 infections in Canada. 

Transmission of viruses between children and from children to adults is common with other types of viruses, so similar transmission with COVID-19 is possible. However, there are also good reasons to believe that children may be less likely to catch and transmit COVID-19 than other viruses. 

What is worse for children? Isolation or the risk of COVID-19?

It is very important to recognize that COVID-19 will likely be around for a long time, or at least until there is an effective vaccine. Children cannot be kept out of school forever. There are also risks related to isolating children at home that must be considered. The longer we keep our children isolated, the more the bad sides of isolation show. Eventually, most people will probably agree that continued isolation is not the answer. Every family will have a different way of deciding when the risks of staying isolated at home outweigh the risks of returning to school. Every family has to make this decision based on what feels right for them.  It is NOT compulsory to send your child back to school right now.

We are still learning about the virus and its effects on children with chronic illness. As far as we know, most children with chronic illness are at low risk of having complications from the COVID-19 infection. Right now, and until we understand better, there are some children who we are recommending NOT to return to school this academic year. It is likely that we will eventually recommend that almost all children return to school. What we are suggesting now is that it may be more cautious to send the healthier children back first.  

If you do not feel comfortable sending your child to school after reading this document, you should keep your child at home.

We realize that not everyone is in a situation that enables one parent to stay home with children. We hope that the information we are giving you will help you decide what to do for your child.

If my child returns to school. do they need to do anything special to protect themselves? 

Whether or not you decide to send your child back to school, social distancing (staying 2 metres away from others) when in public, and frequent, effective hand washing for 20 seconds with soap and water are essential.  Children need to follow these physical distancing and handwashing recommendations while at school, and when they return home from school.  Right now, masks are not essential when leaving the house, but should probably be used when it is not possible to ensure 2 metre physical distancing. Masks may be very difficult to use properly in very young children, and therefore are not necessarily recommended.

If your child has any symptoms that may be caused by COVID-19, they should NOT go to school (these symptoms include; fever; cough; stuffy nose; runny nose, sore throat, headaches with muscle aches, vomiting or diarrhea).

What about the siblings (brothers and sisters) of my child with a chronic illness? Can they go to school? Can parents go back to work?

If you are keeping your child home for health reasons, most experts think that healthy siblings can return to school (but this too is NOT compulsory), and parents can return to work. Of course, anyone out in public needs to practice social distancing and frequent effective hand washing. After returning home, siblings and parents should practice effective handwashing, and some may also recommend showering and changing clothes.

If a healthy sibling develops any symptoms that may be caused by COVID-19 (these symptoms include; fever; cough; stuffy nose; runny nose, sore throat, headaches with muscle aches, vomiting or diarrhea), if possible, they should be isolated in the home, away from the child with the chronic condition, and should not go to school. Transmission of the virus from person to person in the same home is quite unlikely if the sick person is isolated from the others and people in the home wash their hands often.

General guidelines

The majority of the children followed for chronic health conditions at the Montreal Children’s Hospital can go to school and should not develop significant symptoms from COVID-19. However, there are particular conditions or some children with severe forms of disease who may be more affected by COVID-19 and who should stay home until the end of this academic year. 

As you can imagine, it is hard for our doctors and nurses to answer every question personally. That is why we invite you to read the sections that are most relevant to your child before calling your doctor or nurse. If, after reading this, you still have questions, please contact us. Contact information for each department is included above.

Recent concerns anbout Kawasaki disease

Kawasaki Disease has been on the news a lot lately for the possibility of a link with COVID-19. We know that this is a stressful and unknown time for everyone. We want to reassure you that the news about Kawasaki Disease is about new cases only. We don't suspect that children who previously had Kawasaki Disease are at higher risk. It is very rare to have Kawasaki disease a second time.

Despite this news, we are still recommending that children restart school, however the decision to return to school or daycare remains a personal choice.

If at any time, your child displays symptoms suggestive of Kawasaki Disease (Fever for 4 days or more, associated with either: conjunctivitis (red eyes), red/cracked lips or red tongue, rash, swelling or redness of the hands or feet, or swollen gland in the neck), please seek medical attention directly with your family doctor or pediatrician.