Is COVID-19 still an issue for kids? Do I need to worry about head lice? We asked a pediatrician 5 burning back-to-school health questions

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For many kids, the start of the school year is a magical time. It's a fresh beginning and a chance to reunite with friends and break in a squeaky clean set of school supplies. But despite the excitement, it can also be a time filled with stress — especially for parents who are worried about viruses and more.

Is COVID-19 something we should still be worried about? What about head lice? And how can you ensure your kid is up to date on their vaccinations? Dr. Dina Kulik, a pediatrician and the founder and director of Kidcrew clinic in Toronto, shares her thoughts on all the most pressing back-to-school concerns.

What's the state of COVID-19 in schools this year?

If it seemed like a lot of people were getting sick over the summer, you weren't imagining things. "COVID is high across the U.S. and Canada," says Kulik — at least according to the wastewater data that's available.

"In my opinion, we still want to be mindful of COVID. Luckily, most children and young people who get COVID don't get very sick," she says. "But repeated infections are not great for you." In fact, the effects can be cumulative and increase the risk of long-term heart, lung and brain issues.

"Illness also causes a burden for adults and parents that have to miss work, or kids that miss school or daycare," Kulik explains. "It's something I still strive to prevent with my own kids."

Are there other viruses parents should watch out for?

Though many areas of Canada don't record wastewater data for influenza, North Toronto was showing high levels of influenza A as of Aug. 11. "That's atypical for the season," Kulik cautions. "Usually we see influenza in the wintertime."

Aside from the flu, "it's really the whole gamut of viral illnesses from pink eye to gastrointestinal bugs to croup to chronic coughs," she adds. "All the viral stuff tends to hit when kids go back to school and they're in close quarters indoors."

RSV has also seen some activity, with moderate levels detected in the wastewater of Toronto Humber and Halifax Dartmouth, and several provinces have also seen a spike in whooping cough cases.

How can parents ward off illness in the home?

There are standard precautions you can take to reduce your child's risk of illness and prevent the spread if they catch something. "Minimize contact with people who are sick, mask when possible and wash your hands frequently," Kulik says.

She also says her family has continued to wear masks in public. "Knock on wood, that's prevented a lot of illness for my family in the last few years," she adds.

If you do end up getting sick, whether you have COVID, influenza, RSV or some other contagious illness, Kulik encourages kids and parents to stay home. "My rule of thumb has always been that if you have a fever or you're unwell, stay home for at least 24 to 48 hours after the fever is resolved." Not only does that help to prevent viruses from spreading, but rest (including plenty of sleep) is also better for recovery.

What are the signs that it's time to see a doctor — or head to the emergency room?

Trust your gut. If you're worried about your child, take them to see a professional. One example Kulik gives is if you're child has had a fever for three days.

"A bacterial infection may be hiding such as strep throat or an ear infection," she says. You should also "get their chest listened to rule out an infection like pneumonia."

That said, only go to the emergency room if it's an actual emergency, like your child is "having difficulty breathing, losing consciousness or can't keep any fluids down."

Which vaccines do kids need?

There are a range of vaccinations that kids get between two months and six years of age, including diphtheria, tetanus, whooping cough, polio, measles, mumps, rubella and chickenpox (a.k.a. varicella). You can check your child's vaccination schedule online to see which immunizations they should already have based on their age and birth month.

School immunization programs vary by province and territory, but HPV, hepatitis B and meningitis are typically done from grades 6 to 9. Around age 14, boosters may be given for tetanus, diphtheria and whooping cough.

How do parents know if their child is overdue for their immunizations?

"The topic of immunization is an important one," Kulik says. "A lot of children fell behind on their routine vaccines during COVID and now, with the rise of pseudoscience and social media myths, there's hesitancy around vaccines that wasn't there before." That means preventable illnesses, like whooping cough and measles, are also on the rise.

"If you have not seen your health-care provider in a while, touch base with them to review any vaccines that might be missing," she says. "It can legitimately save a child's life."

If you're unsure if your child has had all their vaccinations, ask for records from any providers you've seen throughout your kid's life. Many vaccinations are given before age 6.

And if you don't have access to a health-care provider, you can contact your local public health unit. Vaccinations for children older than five may also be available at some pharmacies.

Is head lice still a concern in schools?

"It's definitely still an issue," Kulik says. "I've actually seen quite a few cases of head lice in person at my clinic this summer."

Though lice are common in children, the Canadian Paediatric Society (CPS) says there's "no sound medical rationale for excluding a child with nits or live lice from school or child care." Instead, the CPS recommends "a full course of treatment and avoiding close head-to-head activities."

Lice cannot hop or fly. They can only crawl from person to person. To prevent the spread of lice, teach kids to avoid lying on shared pillows and blankets in the classroom and to never share baseball caps, toques or scarves.

Do over-the-counter head lice treatments work?

While over-the-counter insecticides used to be a quick fix for head lice, they're no longer very effective. "Rarely will they kill off every single louse and nit (the eggs of the lice)," Kulik explains. There's simply too high a level of resistance to these medicines.

Instead, she recommends going to "a lice facility where they can do a proper inspection, comb out and remove every single nit and provide certain shampoos." Every member of the family should go, even if lice isn't clearly visible. If a child has lice, "it's quite likely that other family members do as well."

She also suggests washing pillows, blankets, toques, scarves and anything else in the home that could be harbouring nits. "I would wash with the highest heat cycle and dry on the highest heat cycle you have."

How can parents handle kids' back-to-school anxiety?

A little anxiety is totally normal. Starting a new school year can be stressful, with its fresh routines, new teachers and different expectations.

If your child seems worried, timid or scared, give them the opportunity to discuss their concerns in a calm environment — and try to validate them. It's OK to be nervous sometimes!

To alleviate fear of the unknown, consider taking a tour of the new school or classroom, running through the schedule for the first day (or week) together or planning for morning drop-offs at the same time as a trusted friend.

You can also bring little doses of joy to the first week: Cool new clothes or school supplies, favourite treats to look forward to at lunch or a reassuring note placed in the backpack to offer a little comfort.

What if back-to-school jitters are something more serious? How can I recognize signs of anxiety and depression in kids?

You may have read the worrying report from the Centre for Addiction and Mental Health (CAMH), which compiled the results of a mental health survey conducted with 10,000 Ontario students in grades 7 to 12. It found 19 per cent of surveyed students had participated in self-harm and 18 per cent had serious thoughts about suicide over the previous year.

"I think mental health concerns for children really came to the forefront during COVID when kids were disconnected from their teachers and their friends and stuck at home," Kulik says. While the CAMH report doesn't make the connection between declining mental wellness and screen time, Kulik suggests "there's very good evidence that screen use, particularly social media use, can contribute to impaired mental health for young people."

Regardless of your child's age, there are signs of depression and anxiety you can watch out for. Distinct changes in eating and sleep habits can be side effects of declining mental health. Your child might also withdraw from friends and family, or no longer take pleasure in things they once enjoyed.

"Someone with anxiety might have a lot of fears or stresses that are impairing their life," Kulik says. "If a child doesn't want to go to school, they feel sick often, or they have excessive worries about their friends, their health or the health or safety of their loved ones, these are signs of anxiety."

If you're concerned about your child's mental health, speak to your health-care provider, Kulik advises. "There are definitely ways that we can help."

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