Doctors say Ontario children suffering from 'social malnutrition' during COVID-19 pandemic

Ontario doctors say some children and teenagers are suffering from "social malnutrition" during the COVID-19 pandemic because they are physically isolated from their peers due to provincial restrictions.

Toronto's SickKids ER has seen a 25% increase in visits involving suicidal ideation

Children leave school on Apr. 6, 2021, after Toronto Public Health ordered all schools in the city to close amidst a surge in COVID-19 cases in Toronto. (Evan Mitsui/CBC)

Ontario doctors say some children and teenagers are suffering from "social malnutrition" during the COVID-19 pandemic because they are physically isolated from their peers due to provincial restrictions.

Dr. Saba Merchant, a pediatrician based in Vaughan, Ont., said she has seen "significant" changes in children's lives since the pandemic hit Ontario more than a year ago. Children have been unable at times to attend day care, school and extracurricular activities and that has meant a disruption in routines and structure. All of the changes have led to social isolation, she said.

Financial stress in families has led to housing and food insecurity in children. Children in dysfunctional families have suffered neglect and abuse. Because of these adverse experiences, Merchant said there has been a decline in mental health, social and emotional development, cognitive development, and to a certain extent, delays in language development.

"I must say that what we are seeing is just the tip of the iceberg," she said at a news briefing organized by the Ontario Medical Association (OMA) on Wednesday.

Merchant, owner and director of Maple Kidz Clinic in Vaughan, said she has seen a "skyrocketing" number of cases involving anxiety, depression, suicidal thoughts, inattention, obesity, eating disorders, obsessions and compulsions in children.

"And the list just goes on," she said.

She noted that peer interactions among children form the "building blocks" for emotional and social development and these interactions have dropped. She encouraged families to do the following:

  • Form small bubbles with families and friends in keeping with public health guidelines to enable children and teens to interact with each other where and whenever possible.
  • If a teen asks for more screen time to socialize, consider that request.
  • Encourage group activities in school, whether online or in person, as long as it is safe.
  • When seeing early signs of a decline in mental health in a child, call the family doctor or pediatrician. "We know that, in children, intervening early leads to better outcomes."
  • Everyone should get vaccinated.

The pandemic has negatively affected the mental health of children and teens, OMA doctors said Wednesday at the news briefing. They expressed concern that the effects could last for years after the province emerges from the pandemic.

WATCH | CBC's Jessica Ng reports on how the pandemic is negatively affecting children in Ontario:

Doctors identify alarming pandemic trends for children

1 year ago
Duration 2:11
Ontario doctors say kids and teenagers are being badly affected by school closures and lockdowns. While many people recover from COVID-19, physicians say the psychological and social consequences will be long-term for young people.

Dr. Daniel Rosenfield, a pediatric emergency medicine specialist at Toronto's Hospital for Sick Children and an assistant professor of pediatrics at the University of Toronto, said the hospital's emergency department has seen a 25 per cent increase in cases involving suicidal ideation or suicide attempts in 2020, compared to that of 2019.

"I know other places across the country have seen the same," he said.

Rosenfield said the number of emergency visits did drop significantly since the start of the pandemic, but the number of injuries, poisonings and ingestions did not decrease last year. 

The majority of injuries, including from cycling and tobogganing crashes, were minor in nature. For example, there were 300 cycling injuries among children that involved emergency visits in 2019, while there were more than 700 in 2020. 

When teens ingest such things as prescription drugs or household products, it is usually intentional and could be a sign of boredom and experimentation and sometimes indicate a suicide attempt. When toddlers ingest such things, it is usually not intentional, he said.

The emergency department at Toronto's Hospital for Sick Children has seen a 25 per cent increase in cases of suicidal ideation or suicide attempts in 2020, compared to that of 2019. (Tony Smyth/CBC)

Dr. Vicky Fera, an infectious disease physician at Markham Stouffville Hospital and an emergency department physician at the Hospital for Sick Children, said she hopes some children will be able to get immunized before the next year school in September. Children are not yet eligible to receive any COVID-19 vaccines in Canada. 

Fera said preliminary data from Pfizer-BioNTech's clinical trial on children aged 12 to 15 suggested high efficacy in that age group. Another Pfizer trial on those aged six months to 12 years is in the enrolment phase now. The goal is get data by the end of 2021 and start vaccinating by early 2022.

Moderna's clinical trial on children aged 12 to 18, meanwhile, has completed its enrolment stage, she said. The goal is to get emergency approval quickly and to begin vaccination in the fall.

Other Moderna trials on younger children, involving three age groups, six months to two years, two to five years, five to 11 years, have begun their enrolment stages in the U.S., she said. 

"Both mRNA vaccines look very promising in the pediatric population," she said.

Chloe Lui-Smith, 7, in Grade 2, sits on a pink four-wheeled bicycle to celebrate her birthday. Her mother describes her as 'very social little butterfly' who misses going to school. (Submitted by Sharon Lui)

The OMA, for its part, said also troubling is the decrease in the number of children who saw a doctor in 2020 compared to 2019. The number dropped 31 per cent, according to OHIP billing records. 

Interactions with doctors dropped 39 per cent for children aged four to eight, and dropped 24 per cent for newborns and children aged three and under.

Drop in doctor visits could have long-term effects on health

"Fewer Ontario parents have been seeking care from doctors for themselves and their children during the pandemic," OMA president Dr. Samantha Hill said in a news release on Wednesday. 

"Children have been subjected to significant disruption over this year, which has experts concerned about consequences on their development and overall well-being. This new data has us worried, because if the decreased number of visits is not the result of decreased need, there may be further long-term effects on children's health."

Hill said it's not immediately clear why there has been a decrease in visits. She said it's possible that children had fewer illnesses and that families deferred immunizations and health care not considered urgent because they had concerns about the virus. She said the drop could contribute to a backlog of deferred and delayed health care. 

In April 2020, there was a huge drop in doctor visits for adults and children, the OMA said. For adults, the drop was 35 per cent compared to the same month in 2019, while for children, the drop was 55 per cent. Visits picked up over the summer and dropped off again in December. 

The data comes from OHIP billings by Ontario's doctors between April 2019 and December 2020 and includes in-person and virtual visits to doctors.

With files from The Canadian Press, Jessica Ng