Kids health

Can headphones really cause hearing loss in kids?

Here’s what you need to know about protecting your kid’s hearing when they’re using headphones.

Between online schooling, downtime gaming and binge watching Netflix, many kids have spent much of the past year with an added artificial appendage: headphones or buds plastered to their ears. Which makes many parents wonder if headphones can cause permanent hearing damage. The answer is, yes and no. 

“Headphones are not specifically more dangerous compared to other sources of noise. However, they can be a vehicle for dangerous noise exposure if used incorrectly,” says Boris Chang, an audiologist with Hearing Life in Scarborough, Ont. 

Susan Scollie, director of the National Centre for Audiology at Western University and professor at Western University in the Faculty of Health Sciences, explains it this way: “The danger is listening to something really loud for a long time. You need to limit the volume and duration.” Noise-induced hearing loss is cumulative. If your kid is frequently exposed to loud noises for long durations they risk doing permanent damage.

What the research says about kids’ headphones

Most of the data on long-term hearing loss is from studies on adults’ workplace exposure to noise. Eight hours of exposure to sounds at 85 decibels (dB), which is equivalent to the noise in a crowded restaurant or heavy traffic, is considered harmful. So if your kid is listening to movies, music or video games at 85 dB or higher for that length of time at once or cumulatively throughout the day, they could be at risk. 

Volume is the key factor. Sound levels of 70 dB (equal to the hum you hear driving in a car at highway speeds) or lower can be listened to for any length of time without any risk. Sounds above 100 dB can cause permanent damage within minutes; above 125 dB (what you’d hear at a loud concert or trackside at a car race without ear protection) and the damage starts within seconds and could be irreparable. 

Children under 5 years of age have shorter ear canals than older kids and adults, which amplifies sound. As Chang explains, it’s generally understood in acoustics that the smaller an enclosed space, the larger the volume. Audiologists will regularly compensate for ear canal volume differences when fitting hearing aids, he says. The same concept can theoretically be applied to headphone use and volume. This is all to say that extra vigilance should be placed on minimizing exposure to loud sounds with babies, toddlers and preschoolers

Are earbuds bad for hearing? 

One potential problem with earbuds (and some models of over-the-ear headphones) is that they’re designed to be “acoustically open,” meaning they allow ambient noise in. That’s a good thing if you’re, say, jogging and need to hear cars and other hazards around you. The problem is our tendency to try to block out that background sound by turning the volume up. 

Again, there doesn’t seem to be any child-specific research on the issue, but a 2007 study in the journal Ear and Hearing compared the listening habits of adults using earbuds versus those using over-the-ear headphones and found that “listening levels are higher with [earbuds] compared to the over-the-ear style. Moreover, as the noise level in the environment increases, earbud users are even more susceptible to background noise and consequently increase the level of the music to overcome this.”

Another potential side effect is that earbuds, particularly those with deep-seated rubber tips, can cause impacted ear wax. “I have actually seen the shape of the earbuds in the wax,” says Chang. This is treatable but will diminish hearing until the impacted wax is removed.

What can a parent do?

Luckily, parents do have some options to help avoid hearing damage in their children, and the key is to limit the volume and the length of time kids spend using earphones. 

Many devices have settings that allow you to control the maximum volume output. With an iPhone, for example, in the settings look for “Sounds & Haptics” and then the “Headphone Safety” tab. This will let you adjust the maximum volume from 100 dB down to 75 dB. 

You can also buy volume-limiting headphones that cap the sound output reaching a kid’s ears, no matter how high the volume is on the device they’re using. “Those are legit, they are really good,” says Scollie, who used them with her own children when they were younger. 

When travelling on a subway or airplane, or spending time in a loud space, the background noise is elevated so the tendency is to crank up the volume. “If you can hear the signal coming out of your child’s headphones or earbuds, it is too loud,” says Chang. You can look for deep-seated earbuds that have a snug fit in a child’s ear or alternatively, headphones that are “noise cancelling,” meaning they block out external sounds while being used so that users can lower the volume on their device and still hear clearly. 

Children (and adults) should also give their eardrums time to rest. Chang recommends a two to one ratio, “If you’re wearing headphones for two hours, take an hour off to give your ears a bit of a break.” 

Finally, some kids are more predisposed to hearing loss. If your child has already been flagged for concern, either during infant hearing screening or following a diagnosis by a paediatrician, Chang advises frequent checks up and being extra cautious with the maximum volume you allow.  

Kids health

What parents need to know about Canada's expected RSV resurgence

COVID-19 isn't the only respiratory illness physical distancing measures helped control. Experts say as Canada reopens, RSV is set to spike.

As if parents don’t already have enough to worry about with COVID-19, doctors are now warning about another virus that should be on our radar this summer—respiratory syncytial virus (RSV).

RSV is a common respiratory virus (it existed pre-COVID) that resembles a common cold with symptoms like nasal congestion, runny nose and coughing. Pre-pandemic, most kids would experience their first case of the virus (having it once doesn’t grant permanent immunity) within their first two years of life and then build immunity to it over time and exposure. About 2.7 million kids worldwide come down with the virus in a typical year, but new research published in the Canadian Medical Association Journal (CMAJ) shows the virus virtually disappeared during the pandemic with only 239 positive tests recorded in Canada between August 29, 2020, and May 8, 2021, versus 18,860 positive tests between August 25, 2019, and May 2, 2020.

While it’s likely that strict physical distancing measures have led fewer babies and young children to encounter the respiratory virus over the course of the pandemic, both Australia and the United States have seen a resurgence of RSV with the relaxing of physical distancing protocols. In Canada, cases usually spike each year from late fall to early spring, but researchers say we could see an RSV resurgence as early as the next few weeks as protocols are lifted and reopening plans move forward.

Is RSV serious?

The virus is typically mild (and sometimes asymptomatic) in healthy adults and older children, but it can be problematic for babies or infants, particularly those who are born premature or have pre-existing lung or heart conditions, says Pascal Lavoie, a paediatrician at BC Children’s Hospital and first author of a new research article featured in the CMAJ. Severe cases can result in pneumonia or bronchiolitis (inflammation of the lungs), which causes breathing difficulties and wheezing in young children. Usually mothers pass down RSV antibody immunity to babies during pregnancy and through breastfeeding, but Lavoie says it’s possible that due to low RSV exposure, maternal immunity levels are lower and therefore so are their baby’s.

A surge in RSV cases is concerning due to these lower immunity levels in infants and young kids, which puts them at a greater risk of contracting the virus and developing a more serious case. It’s also possible that virtually all babies who would have gotten the virus earlier will get their first exposure at the same time. Australia not only reported an increase in RSV cases, but also an increase in severe cases requiring ventilation, which Lavoie says could happen in Canada too. In fact, if Canada sees trends similar to those in Australia, the sheer amount of cases—especially serious ones—could max out resources in paediatric intensive care units (PICUs).

What symptoms should I watch out for?

The virus shows up differently in kids depending on their age, says Lavoie, adding that typically most healthy babies and children recover just fine. In babies less than 6 months old, RSV symptoms include irritability, decreased activity and appetite, and excessive sleeping or tiredness. In severe cases babies may also experience apnea (pauses in their breathing), sometimes turning blue from a lack of oxygen. If parents notice any of these symptoms, especially unexplained lethargy and breathing problems, Lavoie says they should head straight to the hospital as the baby may need to be given oxygen. In older babies and toddlers, Lavoie says symptoms include cough, runny nose, nasal and lung congestion, and not eating or sleeping well. They may also have a high fever and simply appear cranky or unsettled. If you’re concerned about your kid’s symptoms, Lavoie suggests seeing your doctor, who may recommend a nasal spray to help with congestion and things like eating and drinking well. If symptoms worsen, go back to the doctor or to the hospital.

Should I continue to isolate because of RSV?

In terms of parents taking precautions to protect their children, Lavoie says there’s no need to continue isolating: “Kids need social interactions, it’s urgent that they see other kids.” It’s also important to remember that kids will eventually get RSV, so while it can be put off, it isn’t exactly avoidable. However, Lavoie does recommend sticking with good hand washing and keeping kids (especially those 2 and under) away from anyone who has cold-like symptoms.

So while we will likely see a spike in RSV in the coming weeks, we won’t need to change our behaviours drastically. Proper hand hygiene and keeping kids away from those with coughs or runny noses are all things we’ve already been doing throughout the pandemic anyway.

Kids health

Teaching your kid mindful breathing can help ease their tantrums

Here's how to help your kid learn to calm themselves down in the moment.

My two-and-a-half year old shrieked and stomped, tears welling like tiny rainclouds ready to burst. Her dad was trying to put on her snowsuit. “Mommy do it,” she pleaded, so I grabbed the pants and put her on my lap. “Take a deep breath, in and out,” she whispered, closing her eyes, taking in a deep inhale and exhale. Her energy visibly shifted to a calmer state and minutes later we were all outside playing in the snow, the tantrum a mere blip in the day. I was shocked—usually her tantrums lasted at least five minutes (or what feels like an hour).

After recounting the incident to a caregiver at her daycare, she said they were encouraging the class to recognize their emotions and take a deep breath when they felt frustrated or upset. While I was surprised my daughter could remember to use this skill in the moment, it’s clear what they were teaching her was working. 

I’ve since learned that mindful breathing is an accessible, easy to do and effective way to help your child manage their emotions. And it’s never too early to start encouraging it. 

What is mindful breathing 

Slow, easy breathing has positive effects on the mind and body, including training your brain to focus, decreasing anxiety and helping with emotional regulation. 

“When we have a long exhale it activates the parasympathetic nervous system, which helps us calm down,” explains Sara Marlowe, a Toronto-based registered social worker and writer of children’s books about mindfulness and self-compassion.  

A 2019 study with 61 preteens found after 18 minutes of yoga breathing their attention improved and anxiety decreased. Positive results also came out of a study from Ottawa, where two paediatric residents led bi-weekly mindfulness workshops at an at-risk elementary school. The program included mindful breathing, and after their sessions, the students were better able to recognize emotions and use tangible relaxation techniques.

When can kids start learning mindful breathing

Marlowe says you can introduce mindful breathing to a child at any age, including mindfully breathing with your baby. She gives an example of doing a song circle with parents and babies, where she would introduce them to mindful breathing using the lyrics, “Breathing in I am calm. Breathing out I smile.” Breathing mindfully with their infant helps parents respond to their baby’s emotions in a more soothing manner which, according to Marlowe, overtime nurtures emotional regulation. By age 2 kids can start engaging in more intentional breathing exercises that involve counting or focusing on the breath. 

Don’t try to introduce mindful breathing in the middle of a tantrum, though. Telling a kid to “take a deep breath” while they’re in the midst of screaming over you using the wrong coloured plate isn’t going to get you anywhere. Instead, “Introduce mindfulness during calm times and talk about how it might be used in difficult times,” suggests Erin Woo, assistant director of Mindfulness in Education, at the Mindfulness Center of Brown University. She says depending on the child, suggesting they pay attention to their breath when they’re having a tantrum can be helpful if they’re open to it, but it can also be counterproductive and turn them off it altogether. Part of this is because when a child (or adult for that matter) is having an intense emotional reaction, the flight or fight response kicks in and you become disconnected from your prefrontal cortex (the part of your brain that helps you reason). So trying to teach anyone to pay attention to their breath when they’re not connected to the place where it could happen, doesn’t make sense. “It’s not something we can impose. Allow them to make the connections when they’re ready to use it,” says Woo. 

It’s important to note that not all children resonate with mindful breathing. “I don’t think mindfulness is for everyone,” says Woo. “It’s important to recognize it’s not for all.” Meaning if you find your child consistently resisting your mindful breathing suggestions, you should back off. 

How to teach your kid mindful breathing

Being playful and fun when you initiate mindful exercises or activities is key. Marlowe says it’s important not to force it or have rigid expectations of how they should engage with mindful breathing. It could be as simple as taking a dandelion and saying, “Let’s see if we can pretend to blow all of the seeds, but do it one at a time.” This way you’re not asking a child to be calm and take a deep breath. Instead you’re turning mindful breathing into play. 

I shared my daughter’s experience with Woo who explained how children start to make those connections, “She’s realizing that she’s angry and she’s focusing her attention on her breath. For many people that’s very calming and a way to detach a bit of the intensity of that emotion.” 

She says after you go through a mindful breathing activity, ask your child how they felt. Often they will comment they feel calm or relaxed. You could say: “If you noticed that you felt more calm after mindful breathing, when is a time you might use it to help yourself?” Woo says children will often have great ideas and if they don’t suggest when they’re upset, you can suggest it and offer specific times. 

With continued practice, your little one will be able to start recognizing their emotions and will be able to diffuse themselves faster. The caveat of course is these mindful muscles take time to develop (not to mention the prefrontal cortex isn’t fully developed until we’re about 25). 

The most powerful way to teach your kids to use mindful breathing in the moment is with modelling. “It’s teaching our kids in a non-pressured way that we all have these different emotions all the time. By taking breaths when we’re upset, kids will start to model that and learn that too,” says Fulroop Sidhu, a child psychiatrist in the Infant Psychiatry Clinic at B.C Children’s Hospital in Vancouver. Say for example you stub your foot and it hurts. Say out loud, “That really hurts, so I’m frustrated right now. Maybe I just need to take a few deep breaths. One. Two. Three.” 

Keep working those mindful breathing muscles

Although my daughter used mindful breathing on that brisk winter day to tame her frustration, there have been many more tantrums where she didn’t—and perfectly revealed to me why you shouldn’t ask your child to take deep breaths in the middle of a meltdown. (I tried and she replied, “No deep breathing.”) 

Your kid won’t be able to remember to use these techniques in every tantrum, but over time you’ll see changes in how they manage their emotions. We may not think our efforts are paying off (tantrums will keep happening), but in time they will. Case in point: I have noticed my daughter’s tantrums are much shorter and less intense than they used to be.

“Mindfulness can really help us when we’re struggling,” says Marlowe. “When we need it the most it can be the hardest to access, so we want to be practicing and developing the muscles, so when we need it, it’s accessible.” 

Below are four expert-recommended breathing exercises you can try with your little one. 

Blowing Bubbles

Age: 2+

How to do it: Get some bubble mixture and a wand. Have your child try to blow bubbles by blowing into the wand. They might blow really hard and not be able to blow a bubble. Suggest they blow gently and tell them to pay attention to what that feels like. 

When to use: When you want to wind things down, like in the bath or during playtime before nap.

How it can help: Visualization— you can see your breath create the bubble—encourages children to connect with their breath. In addition to calming the mind and body, this exercise can also promote focus and self-regulation.

“I stop and feel my breathing”

Age: 2+

How to do it: Before you and your child are going to start an activity together, ask your child to stop, pause and feel their breath. When stopping to feel their breath, children can place a hand on their belly to feel it rising and falling as they breathe, explains Samantha Snowden, a kids and family mindfulness expert at Headspace.  

When to use: It’s meant to be brief (vs. the more focused Bear Breath, below). Try it before a meal, brushing teeth or getting into the car to go to school. 

How it can help: “Rituals are especially helpful during transitions, when children may have a hard time switching from one task to another,” she says. “They help children accept aspects of routines like taking a bath or brushing teeth that may be difficult at first.” Adding the mindful breath in before the transition starts, allows your little one to practice emotional regulation.   

Bear Breathing

Age: 3+

How to do it: Tell your child to pretend they are a bear, hibernating for the winter and explain that when bears hibernate they breathe slowly. Ask them to follow your lead as you inhale deeply. Count out loud to three or four as you inhale and then pause for a count or two. Then exhale, counting out loud for three or four counts and pause again, repeating a few times. Ask your child if they feel relaxed and cozy in their bear cave.   

When to use: Before a nap, story time or a creative activity.

How it can help: This deep breathing technique helps to promote relaxation.

Belly Stones/Stuffie

Age: 4+

How to do it: Either with a small stone they have found or their favourite stuffed animal, have your child lay on their back with the stone or stuffie on their belly. Ask them to watch the object move up and down with their breath.

When to use: Before a nap or bedtime.

How it can help: Because children have to focus on their belly for this exercise, it helps to teach them that paying attention to their body can help them relax.

Kids health

Why this popular flotation device could actually be really dangerous for your kid

According to swim experts, puddle jumpers teach unsafe swim habits and can contribute to drowning.

Puddle jumpers are practically a toddler and preschooler uniform at the beach or pool and it’s easy to see why these flotation devices—which also go by names like life vest and swim aid and are similar to a pair of water wings but with a vest attaching the two padded arms—are so popular. They’re not as bulky as a lifejacket making them easy to put on and more comfortable for the kid. They’re also usually brightly coloured or covered in beloved animated characters which makes kids want to wear them.

But, despite their popularity, puddle jumpers are actually really unsafe, say swim safety experts. There are a few issues here. One is their suitability as a flotation device. “I wouldn’t classify them necessarily as a toy, but they haven’t undergone the same kind of rigorous testing and they’re not made of the same material as a life jacket or a PFD,” says Pamela Fuselli, president and CEO of injury prevention non-profit Parachute, who notes they aren’t approved for boating use by Transport Canada.

Another issue is the position the vests put kids in in the water. Because of their design, the device puts swimmers in an upright position— head up, feet down and arms floating to the sides. This is actually referred to as the drowning position and is dangerous for kids to get comfortable in. “Kids will build muscle memory from being vertical and this is a very scary situation,” says Rishona Hyman, owner of Aqua Essence Swim Academy in Winnipeg. “If they forget to put [the puddle jumper] on or they fall in, they will revert to this position as it is all they know and then tragedy can strike.” Many parents have taken to the internet to say that they believe this drowning position—coupled with the false sense of security the puddle jumper gave their kid, contributed to their death.

So, what should you do instead of putting your kid in a puddle jumper? The first step is making sure your kids are comfortable in and around water. Fuselli recommends kids start learning to swim as early as lessons are available. Hyman adds that, “Parents should start teaching kids to swim at four to six months of age. Babies naturally know how to swim and it is an excellent way to start building skills, bonding with your baby and showing them how safe and fun water can be.”

Once your child has learned the basics of swimming and is comfortable around water, instead of using a puddle jumper, both Hyman and Fuselli recommend using a lifejacket whenever hands-on supervision is not possible. Unlike with puddle jumpers, if a child were to fall in the water, “a life jacket will actually turn [them] from face down to face up in the water,” says Fuselli. Life jackets also allow for kids to swim horizontally and get their legs up to kick, creating better swimming habits for when they start swimming without a flotation device. It is important to remember, however, that even if your child is wearing a lifejacket or is swimming with a different approved PFD, they should always be supervised. Depending on their skill level, this could either mean being in the water with them, or at an arm’s reach away.

When taking your kids swimming, keep these extra safety tips in mind:

  • Put your kid in a brightly coloured swimsuit so they’re easy to spot in and out of the water. In a pool, your best options for visibility are neon pink and neon orange. In a lake, go for either neon yellow, neon green or neon orange.
  • Make sure whoever is on supervision duty is aware they are on duty and are actively watching
  • When supervising, don’t drink, go on your phone or engage in any other activity that could distract your from the kids
  • Go over water safety with your kids before taking them swimming
  • Remember, drowning is quick and silent. Even a quick glance away can lead to tragedy, so always be an active supervisor
  • If you are going to be supervising kids around water, ensure that you yourself are a confident swimmer. It’s even recommended to take a course in CPR and standard first aid to be extra cautious

Kids health

Should you worry if your kid is short?

How to know when your kid’s height—or lack there of—is normal or a problem.

They say no two kids are alike, and that’s especially apparent in Catherine Dollemont’s home in Trent Lakes, Ont. “I have two kids who are off-the-charts tall and a third who’s always been third percentile,” says Dollemont.

Their doctor has never been worried about the height of Dollemont’s youngest, who is now five. “They said from the beginning that she was following her own curve, so as long as she didn’t drop lower, they weren’t concerned.”

For many parents, though, having a child on the smaller side can be unnerving. “It’s a very common concern that parents have, especially if their family is on the taller side,” says Janice Heard, a Calgary paediatrician and a member of the Canadian Paediatric Society’s Public Education Advisory Committee. While being on the shorter side is usually nothing to worry about, it can sometimes be a sign of an underlying problem, so it’s always worth getting checked out.

When being short is normal

Take a peek into a preschool class and you’ll see a wide range of heights, but chances are, most children are perfectly within normal range. “When you look at a growth curve, the 50th percentile means if you have 100 kids, 50 kids would be taller than that line and 50 kids would be shorter,” explains Preetha Krishnamoorthy, a paediatric endocrinologist at Montreal Children’s Hospital.

According to the World Health Organization growth chart, which has been adapted for Canada, the range between a four-year-old boy at the third percentile and one at the 97th percentile is 16 centimetres (or just over half a foot). If you consider that there will also be a range of ages in a class, some kids are bound to tower over others.

For the most part though, how tall your kid will end up is based on genetics. “You don’t expect that a child will be very tall if you have two parents who are not very tall,” says Krishnamoorthy. And although people assume the size of their baby at birth is an indication of what the future holds, it’s unrelated, says Heard, affected by early delivery or many factors that influence growth in utero, including maternal nutrition or maternal stress.

That said, when your kid grows into their adult height can vary. Some children have what’s called “constitutional growth delay,” meaning they hit puberty (and experience their accompanying growth spurt) later than their peers. Kids can show signs of being a “late bloomer” even as toddlers, says Heard. “What happens is, the bone-age structure is younger than the chronological age,” she explains. “Even a two-year-old could have a bone age that’s more like a one-year-old.”

Though the signs are there if you look for them, doctors don’t normally diagnose this condition until the puberty years, when the child is just so far behind their classmates; it’s just a matter of waiting for their growth spurt. “They eventually catch up and reach a normal adult height. They’re the kid that goes away over the summer of grade 11 and comes back a foot taller,” says Heard.

When to be concerned

Sometimes there’s a medical reason for a kid having a short stature—and in many cases, by identifying and treating the problem early, a child can go on to reach the height potential that their genes would dictate, says Krishnamoorthy. That’s why it’s important for your kiddo to be seen once a year by a doctor to have their height and weight plotted on a growth chart. “You want to address issues sooner rather than later, because once they’re pubertal, it’s harder to do something about it,” says Krishnamoorthy.

Doctors worry about height when it doesn’t make sense based on genetics (for example, if the parents are both tall) or when a child’s growth rate changes or “falls off their growth curve,” says Krishnamoorthy. Another red flag is if their weight is at a much higher percentile than their height, which could indicate a thyroid issue, says Heard. Other medical reasons for poor growth include undiagnosed Crohn’s disease, celiac disease, poorly controlled asthma, congenital heart problems and kidney disease. Sometimes a condition is first noticed because of shortness, such as Turner syndrome, where a female is missing or partially missing an X chromosome. And in rare cases, there could be a human growth hormone deficiency.

Kassandra O’Donnell of South River, Ont., first noticed a difference in height between her identical twin girls when they were around four or five. “Every year the gap between their heights was just getting bigger and bigger. Their dad is a smaller guy, so people would say, ‘She’s just like her dad.’” It wasn’t until a year ago, when the smaller twin got sick with pneumonia and didn’t seem to be recovering well, that she was finally diagnosed with celiac disease. By that point, she was four inches shorter and 30 pounds (13.5 kilograms) lighter than her sister. But after going on a gluten-free diet, she gained 14 pounds (6.5 kilograms) and grew two and a half inches. “Food doesn’t make her sick or scared to eat anymore,” says O’Donnell.

Supporting small kids

If your paediatrician is concerned about your child’s growth rate, you can expect, at the very least, a few extra doctor’s appointments as they follow the growth to see if it improves. The doctor will ask you about the heights of your family members to see if there’s a family history of being short. “Sometimes those genes hide for a while and one little kid gets them a few generations later,” says Heard. They’ll ask about when both parents went through puberty, and about nutrition and diet, to try to determine if there is an underlying cause. They may run blood tests to screen for chronic ill- nesses or a thyroid issue, and order an X-ray to check for bone age. In some cases, you may be referred to a paediatric endocrinologist, who might want to test for human growth hormone, says Krishnamoorthy.

Regardless of whether there’s a problem or not, Krishnamoorthy emphasizes to never make your little one feel like there’s something wrong with them because of their height. “By all means, ask the questions and seek medical attention if needed. But if you’re reassured that all is normal, don’t make a big deal about their size. It’s much better to be healthy and normal, but short, than to deal with all the other medical issues that go along with getting treatment for various reasons,” she says.“Some kids are destined to be smaller and some kids are destined to be taller. As long as they are healthy, we should be focusing on our children’s strengths and building their confidence.”

In O’Donnell’s house, though, her daughter is pleased to be finally catching up to her twin. “It was awful before. People would say to my smaller daughter, ‘How are you even twins?’” Thanks to the diagnosis, she’s eating better, she is just happier overall and has improved self-esteem.

Now six, Dollemont’s daughter is taking her stature in stride. “She’s certainly the feistiest of the three. If she’s too short to do something, she just climbs everything like a monkey and makes it happen anyway.”

Kids health

How to manage the stress of your child’s Type 1 diabetes diagnosis

Getting a Type 1 diabetes diagnosis can be incredibly hard on both the child and their family. Here’s how to manage the stress and keep your mental health on track.

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School-age

How can we make schools safer next fall? It will take more than vaccines

If ending (and mending) the disruption to students is actually important to us, we’ll do what wasn’t done last year: Invest in smaller class sizes and improved ventilation.

It was a lousy school year for Canada’s elementary and high school students, as well as its teachers. As COVID waves crested and fell, schools opened and shut, then opened and shut again. Ontario’s nearly two million elementary and high school students received the least amount of in-person learning of students across the country: Most got just five months under their belts.

And for some, that may be the sum of their school year. “I have some kids that haven’t shown up in my virtual classes at all,” says Parmeet Singh, an elementary school teacher in Brampton, Ont., which has consistently been one of the country’s infection hotspots.

Focussing on improving the situation in hard-hit places like Brampton would help get all of Canada’s kids back in class in September, for good. And while the country’s vaccination program is going well and will do much of the heavy lifting for us, it can’t do all of it.

While there’s no crystal ball when it comes to the pandemic, there is a rearview mirror. If ending (and mending) the disruption to education is actually important to us, we’ll do what wasn’t done last year: Invest in smaller class sizes and improved ventilation, changes that over the long term pay out in more than just infection control.

Here, experts and educators share their thoughts on safe schools in the age of COVID-19.

Were schools safe last year?

University of Ottawa epidemiologist Raywat Deonandan doesn’t think “safe” has ever been defined clearly when it comes to schools. “For the most part, schools have always been ‘safe,’” he says, since outbreaks are relatively few, and students are unlikely to have severe outcomes. That said, while kids have largely escaped serious consequences in Canada, over 400 youth ages 19 and under have been hospitalized with COVID-19 in Ontario since January 2021 alone. Four have died in that time period, including 13-year-old Brampton teenager Emily Viegas.

The real question, Deonandan says, should be “do schools drive community transmission?” For a long time, the Ontario government’s official answer was a firm no. “Transmission is not happening within school,” said Minister of Education Stephen Lecce in the legislature in November 2020, as Covid-19 case rates rose in Ontario.

But as internal documents obtained by the Toronto Star later revealed, ministry officials weren’t as confident. One wrote in a memo, “Is there any transmission happening in schools? We don’t know.” A few months later, Ontario schools would record their highest case counts since schools opened in fall.

Anna Banerji, a pediatric infectious disease specialist at the University of Toronto, believes the fact that kids are largely safe from serious complications unfortunately led some governments, school boards and boards of health to weaken policies that could have protected everyone from increasing transmission.

In September 2020, for example, Ontario students required a test to return to school if they had any COVID symptoms. But when long lineups drew complaints, “they changed the policies so that kids with runny noses or headache didn’t need to be tested, they could just stay home for a day or two and then go back,” says Banerji. In effect, the policies created a blindspot for schools when it came to transmission. It also reduced pressure on the province to create better access to rapid testing or support for parents who had to take time off.

Even as the Ministry of Education and the premier’s office refused to publicly connect the dots between their respective policies and transmission rates, evidence increased to suggest that school openings and closures do affect community rates. In November 2020, an article in the science journal Nature Human Behaviour analyzed the effectiveness of various government interventions around the world. The findings suggested that school closures reduced the reproduction rate of the virus by between 16 to 20 per cent. (Banning small gatherings was the most effective intervention.)

It’s not clear why closing schools is effective, but University of Toronto epidemiologist Ashleigh Tuite speculates it’s a combination of how it limits contacts for kids and, perhaps more significantly, adults. Miserable work-from-home parents with kids in virtual school are less likely to circulate widely, which you can take as a silver lining in a pandemic, I guess.

That effect, however, comes at a “tremendous cost,” she says. That cost is borne by kids who are pulled out of class with their friends and dropped in front of screens alone, and by parents (mothers, mostly) who have to stop working, work less or operate like some kind of parent-teacher-schoolmate machine.

Tuite doesn’t think school closures are a “good tool for controlling transmission,” but during Ontario’s dire third wave they were a necessary one. “There are other ways [to control transmission], but we didn’t do them,” she says. For many months, the Ford government resisted calls to implement mandatory paid sick leave, for example, and there is still minimal political will to focus on workplace safety for high risk occupations, such as food processing.

Instead, the Ontario government has decided that schools do contribute too much to community transmission. In late May, an Ontario Science Table presentation suggested a return to in-person learning this June would have increased daily cases by six to 11 percent. It was a rise the table deemed worth the risk, given the disruption to education and the psychological effects school closures can have on kids. The mantra “first to open, last to close” was also invoked, one that has never been put into practice in Ontario.

Regardless, Ford declined to reopen schools to in-person learning, arguing that it would increase daily case counts to 2,000 to 4,000 new cases by the end of July.

The role of the vaccine rollout

Ontario’s kids never really had a powerful ally focused on their best interests and following expert advice. Now they do—vaccines that work.

As of June 16, over 9.5 million Ontarians age 12 and up have been given a first dose of a Covid-19 vaccine, and it’s looking likely that most in that age group will be able to get their second dose before September.

Vaccinations, in addition to falling case rates, bode well for a safer fall re-opening for schools, says Amy Greer, Canada Research Chair in Population Disease Modelling at the University of Guelph. She’s optimistic that we have a real chance to enter into fall “with very low rates of community transmission, which sets schools up in a way that previously we did not have.”

If COVID-19 does manage to squeak by a well-vaccinated community into a school, it will encounter a significant population of vaccinated adults (and, in high schools, students). While some people will get the virus anyway, either because they aren’t vaccinated or as a result of breakthrough infections, those cases will be easily contained.

“When we have fewer cases, public health units will be able to rapidly test and contact trace when we do get positives,” says Greer.

There are caveats, however. Elementary schools won’t be as protected, since kids under 12 won’t be vaccinated for fall and aren’t likely to be eligible until early 2022. That runs up against the presence of variants, particularly the Delta variant, B.1.617.2, which appears to be both more severe and more transmissible than the B 1.1.7 or Alpha variant, which brought on Ontario’s third wave.

While it’s not entirely clear how variants could impact kids’ health, a recent study from Scotland found younger, unvaccinated populations to be the most vulnerable to infection from Delta. More recent research reveals that kids and youth are leading the case surge in the UK.

In Canada, the Delta variant is already proving worthy of concern. In early June, the remote First Nation community of Kashechewan, on the coast of James Bay in northern Ontario, saw rising numbers of Covid-19 cases occurring mainly in children, since most of its adult population was vaccinated. One child’s case was reportedly serious enough to warrant an airlift to hospital. In the Yukon, another outbreak is linked to high school grad parties, an elementary school and adults in a bar.

Stop ignoring ventilation

Unvaccinated kids and the looming threat of the Delta variant make a strong case for maintaining masks and distancing measures in schools for at least some part of the fall. That reality also underscores the importance of improving ventilation, an infection control measure that has been mysteriously neglected in Canada and beyond.

Ventilation refers to how you bring fresh outdoor air indoors. It is a fundamental public health measure we could take to make schools safer even aside from Covid-19, says Jeffrey Siegel, an air quality expert and professor of civil engineering at the University of Toronto. Good ventilation helps protect people from inhaling everything from pollutants to other airborne viruses.

“We know that if we have improved air quality, students will have improved cognitive function and higher test scores; they’ll have fewer chronic health issues and less absenteeism,” says Siegel. “This is an investment, and we are foolish for not making it.”

And now we have Covid-19, and its infectious, respiratory droplets that can hang in the air in poorly ventilated spaces, even bypassing some types of masks. Increasing ventilation in indoor spaces is a necessary infection-control measure that, along with mask use and distancing, can reportedly reduce transmission by nearly 40 percent. (The Elementary Teachers Federation of Ontario would like to see masks for teachers upgraded to N95s, in addition to ventilation upgrades.)

While you can bring in outdoor air by opening a window or door, the most effective way to increase ventilation is mechanically through an HVAC system. In addition to heating or cooling a building, an HVAC system can bring fresh air inside, to dilute pollutants and infectious particles.

The Ministry of Education did commit $1o0 million to upgrading ventilation in schools for the 2020-2021 school year, an amount it says resulted in some improvements in 95 per cent of school boards. (The federal and provincial government jointly kicked in another $450 million, bringing the total to $550 million.) But what those improvements are is hard to figure out.

Ryan Bird, a representative for the Toronto District School Board, said that over 11,000 HEPA air purifiers have been installed since last fall, in Toronto schools that don’t have HVAC systems. Those with HVAC systems need time to upgrade them, said Bird, who couldn’t provide the number or names of schools doing so.

To find out your child’s school has done an upgrade, Siegel recommends asking the principal. “The actual answer may not be helpful but the willingness to engage on the subject tells you a lot,” he says.

Banerji would like schools to get proactive about ventilation, too. If they can’t improve their systems before September, she says they should think outside the building. “Take them somewhere else that has better ventilation, like a community centre, so the kids are safe,” she says.

Optimism for fall

Most experts are optimistic about fall, but always with caveats. They all agree that we can’t rush to end the public health restrictions currently in place as we race to vaccinate the population. We must continue to view infection control measures, such as masks, social distancing and working from home, as important for school openings as we head into fall, even if community rates among vaccinated adults suggest otherwise.

Tuite believes caution is warranted when it comes to planning for kids’ safety next year.

Assumptions about kids being okay are getting more complicated as we push further into the pandemic,” she says. “Even with pretty strong mitigation measures, 1,200 kids have been hospitalized in Canada. That’s something to think about as we relax mitigation measures and at the point when it’s becoming more transmissible and more potentially serious.”

Greer wants to see provinces rely on a transparent, scientific and data-based framework for de-escalating infection controls at schools, such as taking off the masks and restarting assemblies and music classes. “Those sorts of decisions are in some ways harder to make than escalation measures,” says Greer. She doesn’t know what the basis of those decisions are yet, but she believes we should spend the next few months establishing clear, science-driven metrics for determining when and what makes it safe to do these things.

With everything we know now, it is impossible to pretend that a poorly ventilated classroom packed with 28 kids is okay, especially if it’s located in a community in which parents are likely to work in poorly ventilated environments themselves, without mandated Personal Protective Equipment or sufficient sick leave. It’s even less okay if we put unvaccinated kids in this situation as Delta moves through Canada.

All of the knowledge gained should strengthen governments’ resolve to open better and smarter than they did last year. This time, there are no excuses for ignoring the lessons learned, or failing our children.

Kids health

Has COVID turned our kids into permanent homebodies?

We're so used to stay-at-home orders, lax schedules, no activities, and nowhere to be, that when things open up again, it’s going to be weird—especially for our kids.

Are your kids refusing to sign up for their usual sports teams, group activities or day camps, even if restrictions soon lift and they’re deemed safe again this summer? It’s distressing when our children announce they’d rather stay home and play Roblox than meet up at the park for a masked playdate with buddies. On the one hand, it’s great that so many kids have adapted and settled into being at home so much–we’re all trying to see the positives of a situation we cannot control. On the other hand, parents may be wondering if their children have become permanent homebodies with no desire to see the outside world. Many of us have had kids in remote school indefinitely, or switching back and forth all year, and all of our social skills are atrophying. After so much time at home, it’s distressing to picture what it will feel like when we ease back into some version of a normal life again. 

In my practice as a parenting coach, I’ve also heard from some families that their kids are already anxious about returning to in-person school next September. 

First of all, rest assured that this is to be expected, and from my expertise as a parenting coach, our kids definitely aren’t “broken.” We all adjusted to the new COVID normal: lots of time at home. That’s what we do as humans—we adjust when we need to. But just because we can and do adjust, that doesn’t mean it’s easy. Transitions are always hard. (If you’ve had a child who refuses to get in the bathtub and then once they’re finally in, they refuse to get out, you know what I’m talking about.) We’ve gotten so used to stay-at-home orders, lax schedules, no activities, and nowhere to be. When we start opening up again, it’s going to be weird—especially for our kids.

Let’s look at the science behind it, too. Our brains are wired to prefer certainty and familiarity. This is why going out and seeing people again may be anxiety-inducing. Our amygdala (the part of our brain that keeps us safe) loves it when life is predictable and comfortable. When we feel we are in times of transition and unfamiliarity, our amygdala can take over and goes into high alert. This is why staying at home and playing video games can feel a whole lot “safer” than going back to our old activities and school routine. Our amygdalas hate a challenge, even if, logically, we know it’s for the better.

OK, so if we know that transitions are hard for kids at the best of times, and that our brains love the certainty of the known, what can we do to help our kids as they navigate this? 

First, teach your kid how their brain works.

Explain to your kid that their amygdala can act like a smoke alarm that goes off when the toast burns. It might feel like an emergency, but they are actually safe. We can hear the messages coming from our amygdala: “Stay home! It’s nice and safe here!” and choose not to act on them. Those thoughts are like the “junk mail” of our brains. Observe the thoughts, recognize it’s a false alarm, and toss them out. 

Normalize their reluctance. 

We can say, “Of course you’re hesitant, and maybe even a little worried. This is a big change and we’ve been at home for so long. It’s totally normal to feel this way.” Knowing it’s normal to be afraid helps us to be brave. 

Reassure children that whatever happens, we can handle it. 

We’ve told kids for so long that it’s not safe to be out and close to people, but soon we’ll be telling them that certain activities are OK. It’s understandable that our children might be a bit worried. To help them feel less anxious, we need them to understand that no matter what happens, we can handle it. (“We can handle it” is the anti-anxiety rallying cry.)

Role play and practice. 

If you have toddlers or young children, you can play with stuffies or action figures and act out some of the new scenarios. You should pretend to be the hesitant toy who is feeling resistant to the transition, and let your child be the hero who solves the problem. If you have older children, you can play “What will you do when…” or “What could you do if…” This helps their brains move from the abstract to the concrete and prepares them for actual situations. 

Remind them how fun life was pre-COVID. 

Get out some pictures, slide shows, or phone videos of all the fun things we used to do. Share memories of favourite experiences. Anxiety can make us forget the past and that we actually can handle new or challenging situations. 

Make time for intentional connection. 

When kids feel secure and connected,  it’s easier for them to venture out into the big world. Remember the toddler at a playgroup who would alternate between “checking in” with a parent and exploring? They had to be sure their mom or dad was still there before they could venture out on their own. What I call “Daily Special Time”—15 minutes a day of one-on-one time spent immersed in your child’s world of play, whatever it is—really helps kids feel more connected. It’s hard when you’re distracted by work and household responsibilities that need to be managed, too, but zeroing in on your kid for a very focused, undivided period of time will help. For this undivided 15 minutes, avoid screens and structured things like board games. Walk the dog together, ask your kid to play their fave songs for you, or shoot some hoops. This kind of connection also helps ease the ordinary daily transitions, like getting ready for bed or getting out the door in the morning. These transitions are often tough because we, as adults, are busy getting ourselves or other children ready. But if we can stop to play with them at their level for even just five focussed minutes, it can help. 

Be a strong and enthusiastic leader. 

Look for things to do as a family that involve getting back out into the world again, together. Start small—maybe it’s just going for a jog or a bike ride together. If your local library has opened, look into family-friendly programming. Maybe there’s a pottery studio with classes for adults and kids. When you sign up for some of the things your children used to love doing, make an extra effort to enroll them with a friend or two. Be positive but firm, and convey that participating in activities or interests is not negotiable. “You are going to Circus Camp with Maddie and Lily this summer!” Take electronics off the activity menu. (The choices aren’t “stay home and play Fortnite or go to soccer; the choices are go to soccer or stay home and be bored.) 

Get laughing!

Our bodies create stress chemicals and hormones when we feel anxious. These are useful if we have to actually mobilize for a fight or flee from a predator. But if we don’t find a way to shed these chemicals, they can build up and make us feel even more anxious. Laughter flushes the stress chemicals from our bodies, reduces anxiety and eases tension. Silly kitchen dance parties, encouraging at home-pranks (kids love whoopee cushions), keeping a few joke books around the house, and physical activity like daily roughhousing sessions with your children can release tension and get everyone laughing. (And by the way, roughhousing doesn’t actually have to be rough—it’s anything silly that gets them giggling.) 

Above all else, take a deep breath and give yourself some love. The pandemic has been hard on the children—and their parents. For over a year, we’ve been trying to juggle work and home while adapting to our kids’ moods, big feelings, and ever-changing needs. But with time, we will adapt to life after COVID, as well. 

Sarah Rosensweet is a certified peaceful parenting coach, speaker, and parenting advice columnist. She lives in Toronto with her husband and three big kids (ages 13, 16, and 19). You can read more from her at sarahrosensweet.com.

Kids health

The colour of your kid's swimsuit could save their life

Dressing your kid in vibrant colours makes them easier to spot in a crowd—and under water, too.

Summer is just around the corner, and with it comes days by the pool, trips to the beach and weekends at the cottage. While all these outings can be tons of fun for the family, it’s important to be aware of the risks that come with being around water—and how little things, like something as simple as the colour of your kid’s bathing suit, can help keep them safe.

That’s right, dressing our children in bright colours doesn’t only protect them in a crowd. While your kid can disappear at an amusement park in the time it takes for you to check your phone, having good visibility is also crucial when they’re in or around a body of water.

After all, drowning is one of the leading causes of accidental deaths in children: It’s quick, it’s quiet and it can happen to anyone (even good swimmers!). This is why water safety company ALIVE Solutions Inc. conducted a study to see how colour impacts visibility. The company took swimsuits in a variety of hues and submerged them in both a lake and a pool to test which colours were easiest to see underwater, so if your kid does start to drown you’ll be able to spot them quickly.

Photo: Courtesy of ALIVE Solutions Inc.

In the lake, they observed the suits in 18 inches of water from three different perspectives (including the elevated position of a parent sitting on the dock) and found the top colours for visibility to be neon yellow, neon green and neon orange.

“Think bright and contrasting,” the company says in a post detailing their findings. They also noted that it’s important to consider other environmental factors that may impact visibility, including water clarity, lighting, currents and the weather.

Photo: Courtesy of ALIVE Solutions Inc.

In the pool, they tested visibility in both still and agitated water, and also found that bright and contrasting colours are your best bets. In this setting, white and light blue had the worst visibility, and neon pink and neon orange had the best.

“Although the darker colours show up on a light pool bottom,” the company wrote, “they can often be dismissed for a pile of leaves, dirt, or a shadow.”

While neons were the best options overall, it’s interesting to note that some colours, like neon pink, were easy to see in a pool but practically disappeared in the lake. It’s important to cater your kids’ swimwear to the type of water they’re visiting.

So next time you’re buying your kid a bathing suit, you might want to think more about colour than style. And keep these other water safety tips in mind:

  • Remember that drowning can occur in any body of water, not just a lake or a pool. Kids can drown in as little as two inches of water meaning bathtubs, buckets and even toilets are potential hazards.
  • Make sure whoever is on watch duty knows they’re on watch duty and will be able to rescue if needed. This person should avoid all distractions, including their phone, and be 100 percent focussed on the swimmers.
  • Having basic first-aid training and becoming CPR certified are great ideas for anyone planning to spend time by the water this summer— it may not be your kid that you have to save!
  • Teaching your kids how to swim and how to behave safely around water are also key ways to prevent drowning. Kids can start swimming lessons when they’re around one years old and should be taught self-rescue techniques on top of their basic swimming skills.
  • Keep your kids’ bicycles, scooters and other wheeled toys away from the water. They can easily skid out and fall into the pool unexpectedly, becoming trapped underneath the object they were riding.

Kids health

Kids Help Phone saw a 350% increase in calls during COVID

CEO Katherine Hay breaks down the surge in demand for support during the pandemic.

Katherine Hay is the president and CEO of Kids Help Phone, which provides mental health support to youth across Canada. During the pandemic, her organization has seen a huge spike in calls, texts and online messages. Hay spoke to Toronto Life about what’s causing the surge and how Kids Help Phone mobilized to meet the increased need for support.

How has the pandemic affected what you do at Kids Help Phone?
During the first two or three months after Covid hit, we saw a 350 per cent increase in calls. We didn’t go dark for even one minute. When the pandemic hit, we didn’t say, “Well, we better start innovating.” We were built for something like Covid. We offer several different services: our phone line; our text line, Good2Talk; and a crisis service. Though it’s still human-to-human communication, our crisis text line uses machine learning to triage based on a texter’s severity of need. It looks for particular words that are more likely to indicate that a texter is in need of an active rescue.

Has the demand continued throughout the pandemic?
Yes. Even putting aside Covid, it hasn’t been a happy, sunshiny year. We saw a spike across all our platforms when the Australian bushfires started at the beginning of 2020. We saw another spike with the Kobe Bryant helicopter crash. Again after the Nova Scotia shootings, when grief went through the roof. The number of kids reaching out to us about racism and discrimination doubled in the wake of George Floyd’s murder. This was not new for Black and Indigenous youth, who know social injustice intimately, but those were some of the most distressed texters we’ve seen. They were also most likely to talk about suicide.

What other kinds of issues are these kids seeking support for?
A year ago, we saw a big increase in conversations around isolation, fear, anxiety and depression. As the pandemic has worn on, we’re continuing to see fear—of the virus, of parents getting sick, of kids getting sick themselves. Kids have also experienced a huge amount of loss and grief. They’ve lost their regular routines, friendships, school, graduation. Kids are also experiencing a lot of issues around gender and sexual identity, because they’re isolated from some of the people and places—like school guidance counsellors, teachers and friends—that might have offered support. The intensity of emotion has increased exponentially, too. Young people are having longer, heavier conversations with our counsellors. But we actually saw a dip in suicide and suicidal ideation at the beginning of Covid.

Interesting. What do you attribute that to?
I can only theorize. But at the start of the pandemic, many kids were at home in supported environments, with parents around. On the other hand, we saw an enormous increase—about 46 per cent—in kids speaking to us about abuse, whether sexual, physical or psychological. There are homes that aren’t safe. Kids who might have been getting support at school now had nowhere to go.

I’ve heard that eating disorders have also increased during Covid because people are stuck at home. Have you seen any evidence of that?
Yes. Year over year, we’ve seen about a 110 per cent increase in the number of calls we’ve received about eating disorders. Young people are telling us that they’re bored and not getting enough exercise. Also, they’re not getting a real view of the world. The only thing they’re seeing is perfection—on TV, on social media. And they can’t be as perfect as what they’re seeing, so they feel really bad about themselves.

What kinds of support do these kids receive when they reach out to Kids Help Phone?
Our job is to be there for young people in the moment. The wait time for a young person to see a psychologist can be 12, 18, 24 months. Our wait times are under five minutes. We’re there to complement and support the mental health system, but we can’t be the only solution. When kids reach out, we can direct them to resources on youth mental health services across the country. For example, if you’re a young person in Dryden, Ontario, who wants to come out but can’t tell your parents, and you’re now out on the street, our counsellors can locate LBGTQ support groups, food banks and shelters in Dryden. From our data, we know that 80 per cent of our callers feel better after speaking to us. More than 55 per cent will tell us something that they’ve never told anyone before. Another eight per cent say that if they hadn’t spoken to us, they would have gone to the emergency room.

How do you make sure young people know about Kids Help Phone and reach out when they need help?
We’re the only 24/7 bilingual mental health service for youth in Canada. Young people know about us and will find us. We’re all over social media—Twitch, Instagram, gaming sites. We make a concerted effort to get into their spaces. For example, Facebook Messenger is a big tool for Indigenous youth and adults who live in remote areas that might not have reliable cell service. So we built the technology and implemented a Facebook Messenger service in September. These young people who reach out to Kids Help Phone have a tremendous amount of courage. They’re reaching out because they have hope. They’re trying to get to tomorrow. With that hope and resilience, we can step in and make a difference. It’s not unfixable. Our young people are showing us what they need. That’s a silver lining.