Toronto pediatrician and kids health expert Dr. Dina Kulik joined us March 11, 2020 to answer your most pressing questions about the coronavirus with a special focus on children.

Kulik is the the founder and director of Kidcrew and works as an Emergency Medicine physician at The Hospital for Sick Children.

As the coronavirus continues to spread in Canada and around the world, many questions remain on how COVID-19 could impact children.

According to the Washington Post, one of the few mercies of the spreading coronavirus is that it leaves young children virtually untouched. Some experts have floated a theory that because children are so heavily exposed to four other mild coronaviruses, which circulate every year and cause the common cold, that may give kids some kind of strengthened immunity.

You can follow Dr. Dina Kulik at her website, on Twitter and on Facebook.

Note from Dr. Dina Kulik: I am committed to bringing you information on babies and children. While I am a physician, I’m not your physician. All material provided here is for your informational purposes only. It is not to be taken as medical advice or recommendations. Any health concerns or conditions should be addressed by your physician or health care provider. The information and opinions found here are written and shared based on the best data available at the time of this writing and are believed to be accurate according to my best discernment. Those who do not seek counsel from the appropriate health care authority assume the liability of any illness or injury which may occur. Views expressed are my own.

All answers below from Dr. Kulik:

From Carmen: Hi doctor, since this started a few months ago, we have limited the activities outside the house with the baby to almost 2/mo. Apart from the necessary ones like grocery shopping. Do you think this is necessary/recommended?

A: Hi Carmen. I don’t think we need to all self quarantine! I want you to feel great and for baby to feel great. Staying at home all the time won’t make you feel good! There are plenty of ways to get out but not risk much exposure. Even going for a walk outside, especially as it gets warmer outside can make you feel much more normal and less isolated.

From Allison: Thanks for taking questions on covid-19. My questions: 1. What advice would you give nursing mothers? I have a 3 month old, so isolation would be very difficult, as would limiting physical contact. 2. If someone contracts covid-19, are they then immune from getting it again?

A: Hi Allison. I too am very interested in breastfeeding. Unfortunately, one challenge with COVID is that it is NOVEL. So we don’t know as much as we’d like right now. I am unaware of transmission of COVID in breastmilk. Most illnesses we continue to recommend mom continue to breastfeed. Baby gets some antibodies from mom’s milk. That being said, if a mom is unwell, with coughing, sneezing etc, best to minimize exposure to droplets, and frequent hand washing is important.

From Jill: Hi Dr Dina, I have a newborn at home (5 weeks). I was finally excited to get out of the house. Any restrictions now? Should we just stay home and walk around the neighborhood instead? Thank you!

A: Hi Jill. Congratulations. I think avoid sick people, crowds, public transport and parties until we see how this goes. You can certainly go for a walk outside. But as always, avoid sick people and ensure whoever is near baby (and you) is not coughing, has a fever or otherwise unwell. I always recommend this.

From AA: If our caregiver has family members who travel to the U.S. daily for work (western N.Y.) is this a concern for our family?

A: Hi! This is tough. We don’t have clear guidelines for this. But I would suggest that if an individual is travelling to areas with higher prevalence of COVID, I would self quarantine. And perhaps minimize travel at the moment. We are seeing many more cases of COVID a day in the US.

From AA: If our kids have cold symptoms but no fever, can we assume it isnt COVID-19? What should we look for to make us assume it’s more than a cold?

A: Thanks for the question. Most children and adults will have mild illness. Most cases of COVID will not be tested, as those individuals will have ‘cold’ symptoms and not be worried enough to seek care. Most cases of COVID will have no fever at all.

From Maureen: We have 3 kids under 11 and two parents (one with mild and controlled asthma and lupus) flying to Orlando for the March break. It’s their first trip there and has been in the works for a year — trip of a life time. Should we cancel?

A: Hi Maureen. I am getting asked this a lot. Personally, I would not travel to the US now. Sadly. I was very cautiously optimistic, and even booked my own trip with my family in April. But the numbers are going up exponentially. I worry about resources. What if hundreds of thousand get sick? Where will all these people go? What if they run out of masks? Isolation rooms? ICU beds? What if staff are exposed and need to be quarantined? What if health care providers are sick? Who will be available to see patients? Of course this is worst case, but with the huge increase in cases in the US this week, I am concerned.

From Adriana: What about kids with pre-existing conditions like asthma? Are they more likely to suffer from complications compared to the milder cases that seem to be affecting typical children?

A: Hi Adriana. Excellent question. So far I am unaware of any deaths in kids less than 10. But pre existing conditions will often increase the risk of serious illness. We are seeing this with older adults who get Covid, with pre existing health conditions, as they are more likely to need hospitalization and have a higher risk of death. The question of kids though is not clear yet.

From P: Have any prevention plans been put in place in elementary schools — i.e. families with students who have travelled to and/or are in close contact with people who have travelled to affected places must alert the school or if a school has a student who gets it or has a family member who gets it will they notify the whole student body?

A: This is a great question. I think this should be in place, but I am unaware of this at the moment. We know that people that have travelled outside of Canada should be quarantined for 2 weeks after while we wait to see if they develop symptoms. Will people do this? I don’t think everyone will...

From Ann: Is it possible for a grandparent with severe asthma to spend time with their young grandchildren who go to school — and stay safe from the Coronavirus? How?

A: Great question Ann. If a child is sick I would minimize exposure to older adults. This I always recommend. If rates of COVID increase I would minimize exposure even more. That being said, influenza is still MUCH more prevalent in Canada and the risk to the elderly from influenza remains high. So in viral season I think everyone should avoid exposure to others, elderly or otherwise, when unwell.

From Yuri: My wife and I have been trying to get an answer for weeks now. What is the COVID-19 guidance for women who are pregnant? Why has there been no official information provided for them? There are, as far as I am aware, any treatment options available. Surely we should be providing proper guidance for women who are pregnant. This information needs to be provided to employers as well. There should be official medical guidance provided for those in our communities who are most at risk. I hope that The Star can ask this question — I have sent emails to Toronto Public Health, Ontario Health and also my MP. No answers to date. We have guidance for EI but nothing for a woman who is carrying a child. This is absolutely wrong.

I am asked this often. Like children, pregnant women seem unusually protected from COVID infection, and severe illness. A study in China showed that pregnant women had milder illness and babies born from these women were healthy. So, as always, practice good hand hygiene, stay away from sick people, minimize travel and hopefully stay healthy. Influenza poses a bigger risk in pregnancy and remains a bigger threat at the moment.

From Brian: My 5-year-old child currently has pneumonia with ongoing fever and cough. How do you determine whether you need to get her tested for coronavirus or not?

Sorry to hear this Brian. Right now, the only way to be tested for COVID (in Ontario) is in hospital. So if you are concerned about your child, this is the only way to screen, isolate and test. It is impossible to determine without testing.

From Brant: Should parents delay some vaccinations (MMR) etc. during this outbreak to ensure we reduce the risk of overloading child’s immune system in case they contract covid-19 while also building immunity to other diseases? How do we way the risk factor?

A: Thanks Brant. Giving vaccines does not ‘overwhelm’ the system. A child is capable of building immunity to multiple viruses and bacterial infections at one time, hence we give multiple vaccines at once sometimes. I do recommend doing routine vaccines at the usual times even during the outbreak. We still continue to see illnesses such as from pneumococcal bacterial, whooping cough and Haemophilus Influenza all year, which are prevented with routine vaccines. I would not want your child to be at increased risk of contracting a vaccine-preventable illness due to delayed vaccination.

From Darryl: 1. Are there any additional precautions pregnant women should take (specifically with taking public transit or large crowds at work conferences, sporting events, etc.) and same for young children as we approach nicer weather and naturally a busier time in the city. 2. Will the symptoms show up the same in someone who is pregnant or in young children?

A: Thanks Darryl, please see above. Same recommendations as always, wash hands well, avoid sick contacts, stay home if unwell, and avoid touching your face. Pregnant women and kids seem to have milder or no symptoms in general. Often epidemics decrease in the summer as we are more free to move around and viruses diminish. SARS for example settled over the spring/summer.

From Ingrid: Hi there — Is there any information available regarding infants and the coronavirus? We have plans to fly from Toronto direct to Victoria, B.C. next week and are wondering how best to protect our 7 month old (whose hands are always touching everything and then being put in his mouth), or if it’s recommended to avoid air travel with babies at this time? Additionally, are there any confirmed cases of someone contracting the Coronavirus from being on the same flight as an infected person?

A: Hi Ingrid, I am unaware of cases of COVID being contracted in an airplane, but one thing to note about COVID is the vast majority of cases are mild. So mild there may be no symptoms, or very mild symptoms. Unless every single person is tested (which I DO NOT recommend!) we won’t know the true prevalence. So it is possible people have become infected in airports or planes and we do not know. There have been cases of infection in individuals with no travel history or known exposure to COVID patients. Where they got infected from may be a mystery for some. Keeping children healthy is best done with excellent hand hygiene. You can read some more tips about this on DrDina.ca, or on my social media.

From Alfred: Have any children been infected? Are they more immune to it than adults?

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A: Hi Alfred. Please see above. Kids have been infected but most cases are very mild. I am unaware of childhood deaths in kids less than 10 years.

From Sivaraj: We are planning on traveling with an infant to B.C. What precautions should I take to ensure my infant’s safety in the airport and on the airplane to avoid infection? Should we avoid travel altogether?

Hi Sivaraj. Please see above. We are reassessing the situation every day. It’s hard to predict how safe within-Canada air travel will be week by week.

From Amanda: My 6 year old son had pneumonia in Oct/Nov 2019. It ended up leading to HSP. Due to it being caused by respiratory illness and the possibility it may return I am a little concerned about my son getting sick. What should my caution level be in sending him to school? His brother also attends the same school. He is 10. Thanks.

Hi Amanda. I dont think a previous pneumonia would increase your child’s risk now. Influenza still remains my bigger concern for kids with respiratory compromise. And the same prevention remains — washing hands well, avoiding touching your face, staying away from sick people and staying home if you’re sick.

From Saleem: I appreciate your taking time out to answer these questions related to Covid-19. If a 15-year-old kid is on immunosuppressant medications such as Cellcept/MMF would you characterize them as high risk? Also, do you have any information from China/Italy/Iran on outcomes for kids who are immunocompromised due to taking these immunosuppressant mediations? Do we take any extra precautions to protect such kids from getting infected with Covid-19.

A: Great question. I suspect people with immunosuppression are more vulnerable. This is true for all illness. The data is not available for this from other countries, as far as I am aware. Many countries are not even reporting the age or health status of the patients. As always, minimizing exposure to illness in viral season is important for all kids, especially those with weakened immune systems.

From Apostolos: Dear Dina, we currently have travel plans for Europe with our 2 year old boy. Fortunately to a not highly affected area. Would you recommend against travelling? What measures and precautions would be useful during the flight and trip?

A: Hi! It is hard to counsel without knowing where you plan to travel and when, but in general this is a rapidly evolving pandemic and I recommend minimizing travel right now. Kids or no kids. There were tens of ‘no risk’ countries a week ago that now have cases. So I wouldn’t count on any country being spared. People travel a lot. With travel comes the movement of illness across borders. With March Break in our wake, we may seen tens or hundreds of thousands of new cases in the coming weeks.

From Danielle: Hello, I was thinking of taking my kids to Orlando in the middle of March. My one child is a teen but my other is a toddler (almost three). In your expert opinion would we be better off postponing our trip (Disney and Universal are on the menu = crowds)? If we do go how do I keep the toddler safe? He touches EVERYTHING. Thanks so much.

A: I personally would not be travelling to the U.S. now, especially not to an area where people congregate from all over the world, like amusement parks.

From Marie: My husband and I have a 5 month old baby. His parents are coming for four months to see their granddaughter for the first time. They arrive March 18th from Perth, Australia, with a stopover in Hong Kong. Should we ask them to self isolate at the place they are staying before we see them? How long should we wait to see them?

A: At the moment many countries are suggesting a 14 day quarantine period for people who have travelled outside of Canada. I think this is wise.

From Elle: If one gets the coronavirus and is asked to quarantine at home ... but they have children and family members living with them ... is it inevitable that everyone in the house will get it as well? People can’t hide in the basement for 14 days & not take care of their kids. Need more details about this.

Good question, this is hard. Minimizing exposure is the best way we know to prevent spread. The quarantined person should stay away from others as best they can. Use good hand hygiene. The sick person should wear a mask (to prevent their droplets from going near others). This is when people should rely on their ‘village’ of helpers to help with child care. Otherwise we risk the spread to other family members, and to people they interact with and to their contacts etc. If the buck can stop with the one quarantined person we can dramatically decrease how many people get sick, period.

From Aly: Do you have any information or tips regarding newborn babies and the virus? There has been some info about the virus and pregnancy and the elderly with weakened immune systems but I have yet to hear/see anything regarding newborn children.

A: Thanks Aly. I don’t have specific info about newborns. But we do know babies and children less than 10 are not getting sick as often or as much as older adults.

From Carly: We are travelling to Cuba on Friday at a resort For a week would you advise against going?

Hi Carly. Cuba now has a case of COVID. Perhaps there will be no additional cases. Perhaps there will be thousands. It isn’t predictable unfortunately. I am suggesting people strongly reconsider travel plans with so much uncertainty. In addition, on your return, you may be asked to self quarantine for 14 days. I don’t think many people know this, and this can be devastating if you’ve taken a week’s vacation and return to 2 further weeks away from school and work.

From Mark: Good evening, I am a 58-year-old married man, overweight but otherwise in good health. I received the pneumonia shot about 12 years ago after a particularly bad bout of it in my 40s. Will this vaccine help guard me against the worst effects of COVID-19?

A: Hi Mark. I am not aware of any protection gained from the pneumonia vaccine. The pneumonia vaccine protects against bacterial strains. Not coronavirus. There is no known vaccine for COVID right now.

From Joshua: What do you think about going to restaurants around the city at this time?

A: Hi Joshua. Excellent question. I don’t see restaurants as high risk environments at this time. We do have more cases daily, but still around 100 in all of Canada. I would avoid very busy spaces like concerts and conferences and the like, but think you can eat in restaurants for now. Maintain the hand hygiene though!