White Coat, Black Art·The Dose

Here's how to know if your kid has COVID — and what to expect if they do

With children in Canada mostly back in classrooms, kids and COVID-19 are top of mind for parents. So how do you know if your kid has COVID? Infectious disease physician Dr. Janine McCready breaks down the symptoms, the best tests for kids and the risks if your kid is sick.

Tips on how to spot symptoms, kid-friendly COVID tests and lowering risk

Graciano Dela Paz and May Dela Paz, with their three children, sons Francis and Adriel and daughter Maegan. All five had COVID-19 at the end of December. (Submitted by Graciano Dela Paz)

Graciano Dela Paz said it was the sickest he'd ever seen his three kids.

"It's scary," he said of their bout with COVID-19. "You know that people die because of this sickness. I would visit them in their beds to make sure they were breathing."

It was the end of December and his wife, May Dela Paz, a personal support worker at a retirement home in St. Catharines, Ont., had already tested positive for the illness. The family had been scrupulous about isolating from her, but it wasn't enough.

A few days after his wife fell ill, Graciano spiked a fever. And then, like dominoes, each of his three children, two boys ages 14 and 16, and his nine-year-old daughter, got sick with COVID. All three had fevers, chills, coughs and headaches, and his 14-year-old son also experienced nausea and vomiting.

Students at Our Lady of Lourdes Catholic school in Toronto. Most kids in Ontario are back in the classroom. Although there have been school outbreaks, experts say the risk is fairly low. (Evan Mitsui/CBC)

Even as COVID-19 has taken its gravest toll on seniors, the Dela Paz family's ordeal underlines how it can affect people of any age and keep parents worrying, especially with most kids back in school. Here's a look at what parents should know about COVID-19 and their children.

'Not a huge amount' of transmission in schools'

Dr. Janine McCready is an infectious disease doctor at Toronto's Michael Garron Hospital, who started a school support program in the east end of Toronto to help kids get tested faster.

"Generally there is not a huge amount of transmission in schools", McCready told Dr. Brian Goldman, host of The Dose and White Coat, Black Art.

She said most COVID-19 cases are transmitted out in the community, not in schools. Still, some outbreaks are occurring in schools across the country, including of the variants of concern, leading to school closures.

Symptoms of COVID in kids 

McCready said parents should look for the following symptoms:

  • Fever, even if it's only present for an hour or two.
  • Headache. 
  • Runny nose.
  • Sore throat.
  • Vomiting or diarrhea (typically more than one episode). 

But there's only one way to know definitively if your kid has COVID: "You've got to get a test."

Infectious disease physician Dr. Janine McCready spearheads a program to make testing easier for kids. (Courtesy of Michael Garron Hospital )

All the control measures implemented against COVID have resulted in a drastic decrease in flu levels, as well as other respiratory viruses, said McCready. That means if your kid is sick, it may be more likely than you think that COVID is the culprit.

"So that makes it even more important that if your kid has any symptoms, to go get them tested."

Even if they only have one symptom, McCready said, you should keep your child home from school and get them tested. 

Luckily most kids aren't hit that hard by COVID. But that also means the symptoms can be quite mild and hard to spot.

A fever, even for a short duration, is one of the symptoms of COVID-19 in kids. (George Rudy/Shutterstock )

McCready says many parents are "shocked" when she tells them their kid has COVID because the child only had minor symptoms. 

MIS-C risk

Multisystem inflammatory syndrome in children, called MIS-C, is a rare condition that can be triggered by COVID-19, causing severe inflammation in organs weeks after infection.

But McCready said parents shouldn't worry about it too much. While it's still not clear what the risk factors are for developing the syndrome, the good news is that — even in the very unlikely event your child develops MIS-C — kids who get it tend to do well with treatment. 

The best way to minimize the risk is to follow all the local public health guidelines, especially if there are high COVID numbers in your neighbourhood, she said.

The nasopharyngeal swab test for COVID-19 is not popular with children, so Toronto doctors have developed a less invasive mouth and nose swab that kids can even do themselves. (Elaine Thompson/The Associated Press)

Kid-friendly tests 

McCready is leading a project to conduct COVID-19 tests on-site at various schools in Toronto's east end. And now with the variants of concern circulating, she'd also like to see asymptomatic testing ramped up in Ontario schools, something the provincial government has promised to do. 

"I've been pushing for more.… Trying to make testing as easy as possible so we can really see the whole picture," said McCready.

One of the barriers to getting kids tested is that kids are not fans of the common nasal swab test.

Watch | Researchers from Western University and Lawson Health Research Institute in London, Ont., demonstrate how far a swab needs to go into the nasal cavity:

McCready's colleague Dr. Christopher Kandel is an infectious disease physician at Toronto's University Health Network and at Michael Garron Hospital. He's the lead on a team that developed a non-invasive COVID-19 testing method that involves rubbing the inside of one's cheek, the back of the tongue and the front of the nose with a swab.

He says the inspiration for this test was his own young kids. 

"We were trying to find alternative ways to diagnose COVID without the nasopharyngeal swab because kids really don't like it."

The nasopharyngeal swabs involve sticking long swabs into the nasal cavity. It's considered to be highly accurate. It can also be uncomfortable and, according to Kandel, sometimes a real obstacle for kids getting tested.

Kandel says the accuracy of the mouth nose swab is comparable to the nasopharyngeal swab, and a big benefit is that it can be self-administered — even by a young child. 

Watch | A child demonstrates how to self-collect an oral nasal swab to test for COVID-19: 

"One of the criteria for designing the test is that my four-year-old could do it herself."

It took two tries, but Kandel says his daughter successfully conducted the test. 

Kandel says, as far as he knows, this test method is being used in Toronto only, but other non-invasive test methods are being used in different provinces. In September, for example, B.C. introduced a mouth rinse, gargle and spit test for kids and teens to make it easier to check if they have COVID-19. Parents can ask their local public health unit about the availability of less invasive tests. 

Vaccines for kids

There are currently no vaccines approved for use in kids. Of the three vaccines approved in Canada, Pfizer-BioNTech can be used in people 16 years and older. For Moderna and AstraZeneca-Oxford it's 18 years and up.

Various vaccine trials involving kids are underway, but McCready says the earliest those vaccines might be available is at the end of this year or early 2022.

Until then, McCready said parents should err on the side of getting their kids tested if they have any symptoms and to trust their intuition: "If there's something in your head that makes you think, you know, this doesn't seem right or this doesn't seem like they're normal," then take your kid for a test.

A runny nose is one of the symptoms of COVID-19 to look for in kids. Experts say you should keep your child home from school and get them tested if they have one or more symptoms. (Chepko Danil Vitalevich/Shutterstock)

Dela Paz said while it was a frightening experience having the whole family fall sick with COVID-19 at the same time, they are lucky because it could have been worse. He said family life is back to normal — or "pandemic normal" at least — and he's grateful for that. 

Still he warns other parents to not be complacent.

"People say, 'Oh they're young. Kids won't get it.' This proves even if you're young, COVID can hit you."

Written and produced by Willow Smith