COVID-19: Information for parents of immunocompromised children and children with chronic medical conditions

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Children who are immunocompromised and children with chronic medical conditions may be at higher risk of serious illness with COVID-19.

Key points

  • SickKids is safe for you and your child to come to for assessment as directed by your primary care team.
  • Children with chronic medical conditions may be at higher risk of developing serious illness if they do get COVID-19.
  • Washing your hands frequently using an alcohol-based hand sanitizer, or by using soap and water for 20 seconds will help to prevent you from getting COVID-19.
  • Your child should continue to take their regular medications as prescribed by their primary care team unless specifically instructed otherwise.

Children who are immunocompromised and children with chronic medical conditions may be at higher risk of serious illness with COVID-19.

Is my child immunocompromised?

Immunocompromised children have weak immune systems. A weak immune system could be caused by many different medical conditions or medications. Some examples include children who have:

  • had a solid organ transplant (i.e., heart, kidney, lung, liver, intestinal)
  • had a bone marrow transplant
  • cancer
  • congenital or primary immunodeficiency
  • rheumatological disease
  • gastrointestinal disease
  • severe burns

And those who are:

  • taking selective immunomodulators (i.e., anti-TNF agents, azathioprine, MMF and all immunosuppressive agents).
  • taking long-term steroid therapy
  • in a severely malnourished state

If you are unsure if your child is immunocompromised, please check with your primary care team at the hospital.

Is my child at higher risk of getting COVID-19?

In general, it has been observed that serious illness from COVID-19 in children is less common than it is in adults.

Reassuringly, since the beginning of the pandemic, there have been very few reports of immunocompromised children who have developed severe illness from COVID-19. Moreover, in large cohorts of children diagnosed with COVID-19, no association between previous immunosuppressant use and critical care admission was found.

A small number of studies have suggested, however, that children with underlying chronic health conditions such as obesity, severe neurodisability, chronic respiratory and cardiac conditions may be at higher risk for serious illness compared with other children their age.

How do I know if my child has COVID-19?

Based on what we have learned so far about COVID-19 and children, it does not appear that immunocompromised children or children with underlying conditions have different symptoms than otherwise healthy children with COVID-19. Immunocompromised children, however, may have symptoms that last longer. Children with underlying medical conditions (as described above) may be more likely to have serious symptoms.

Your child may have COVID-19 if they have some or all of the following symptoms:

  • fever
  • cough or sneezing
  • sore throat
  • difficulty breathing or fast breathing
  • body aches
  • headache
  • chills
  • fatigue
  • diarrhea and vomiting
  • runny or stuffy nose that progresses to one of the above symptoms
  • loss of the sense of smell or taste

While fever may be the main symptom, not all children with COVID-19 will have a fever. Some people with COVID-19 have mild symptoms or no symptoms at all. In more severe cases people can have difficulty breathing and pneumonia in one or both lungs.

There is a rare condition that is related to COVID-19 that develops in children one to two months after they have had the infection. This condition is called multisystem inflammatory syndrome in children (MIS-C). This condition is a delayed immune response marked by fevers and inflammation of organs in the body, including the heart, lungs and brain. There are effective treatments for this condition and most children recover. Based on what is known so far about MIS-C, immunocompromised children or children with underlying medical conditions are not at increased risk of MIS-C. Read the article on MIS-C to learn more about this condition.

Should I come to the hospital if I think my child has COVID-19?

If your child has symptoms of COVID-19 contact your primary care team at the hospital before coming. They will help you determine if your child needs to be seen and where you should go.

You should come to the hospital right away if your child has the following symptoms:

  • fast breathing or trouble breathing
  • bluish skin color
  • not drinking enough fluids
  • not waking up or not interacting
  • being so irritable that the child does not want to be held

In an emergency, please call an ambulance and tell the emergency services team that you are concerned your child may have a COVID-19 infection.

Is testing for COVID-19 available at SickKids?

Testing for COVID-19 may be offered at SickKids for children with certain underlying medical conditions and symptoms that are consistent with COVID-19. If your child develops symptoms of COVID-19 and you are unsure if they need to get tested, you should contact your primary care team.

Testing may also be indicated as a screen before a planned procedure. A test that is commonly used involves putting a swab into a person’s nostrils in order to get a sample from the back of their nose (referred to as an NP or nasopharyngeal swab). This is the preferred test as it is the most accurate one available at present. If your child has had multiple NP swabs and finds them very distressing, please talk to your health-care provider about the pros and cons to other possible options.

You may also refer to the most updated Ontario general guidelines for information on who should be tested for COVID-19 and ways of accessing testing.

If my child is diagnosed with COVID-19, how long will they be sick?

Children with COVID-19 typically recover within one to two weeks. However, children with weakened immune systems may be sick for a longer period of time than other children. How long will vary from child to child.

What are effective measures to prevent COVID-19 spread?

  • Vaccination has been shown to be effective against infection and hospitalization for COVID-19. Individuals who are eligible to receive the COVID-19 vaccine, including children six months of age and older, should stay up-to-date on their COVID-19 vaccines. Read the article on COVID-19 vaccines to learn more about them.
  • Like other respiratory viruses, including influenza, it is recommended that you wash your hands frequently by using alcohol-based hand sanitizer, or by using soap and water for 20 seconds.
  • Limit touching your face, nose and eyes.
  • Avoid close contact with people who have a fever or cough.
  • Practice cough etiquette by keeping a distance from other people, coughing and sneezing into your sleeve or a tissue or a respiratory mask, and practicing frequent hand washing.
  • Consider wearing a mask, if you are at high risk for severe COVID-19 and/or if you have symptoms of COVID-19 and are out in public spaces.

Are there additional precautions my child can take to reduce the risk for COVID infection?

Encourage your child to wash or sanitize their hands frequently. For example, if they are in school, you can provide older children with a bottle of alcohol-based hand sanitizer. Hand sanitizer can be dangerous if swallowed. Be careful to keep it away from young children. Avoid having your child be in close contact with anyone who has symptoms of COVID-19. Be vigilant for signs of infection in your child.

Should my child wear a face mask when in public?

Parents can speak to their child’s primary care provider to assess their child’s risk and need for masking in public, day-to-day. This will help you make an informed decision about masking based on individual circumstances.

If your child (two years of age and up) has symptoms of COVID-19 and has to be in public, Public Health Ontario recommends masking, if possible.

When visiting SickKids, masks are recommended to children able and willing to wear masks safely – generally children two years and older. SickKids is providing masks to all family caregivers and children. Masks will be provided at the entrances to the hospital.

Should my child continue on their immunosuppressive medications?

Your child should continue to take their regular medications as prescribed unless directed differently by your primary care team at the hospital. Make sure you have enough medication and supplies on hand to last for 30 days, in case you need to stay home for a prolonged period of time.

Can my child go to school?

The majority of children and youth who are immunocompromised or who have underlying medical conditions should be able to safely attend school provided that the appropriate enhanced safety measures are in place. However, it is recommended that parents and caregivers discuss this with the child’s health-care providers so that they can make an informed decision based on individual circumstances. For more details and information about sending your child to school, please refer to the SickKids COVID-19 Guidance for School Reopening.

What should I do if I am unwell myself, or my child’s sibling becomes unwell with symptoms of COVID-19 infection?

It is advised that in such circumstances you practice physical distancing at home as much as possible and consider masking to prevent any potential spread. You can also refer to Ontario general guidelines of who should be tested for COVID-19 and ways of accessing testing at

If my child requires assessment for symptoms other than COVID-19 infection what should we do?

Continue to follow the recommendations for getting your child assessed according to your primary care team’s instructions, as you would do normally. For example, if your child is on medication that causes them to have a low white blood cell count and they develop a fever, you should still go to the hospital for assessment and let the primary care team know about your child’s symptoms as per normal procedure.

Should I reschedule my upcoming routine appointment?

Clinic appointments do continue and can be offered either in-person, or by virtual care (video or telephone), depending on the care required during the appointment, and as deemed appropriate by the medical teams. Please contact your primary care team at the hospital for questions regarding your upcoming appointments.

I am concerned about my child getting a COVID-19 infection when I visit the hospital. Is it safe to come to SickKids?

Yes, the hospital is safe for you and your child to go to for assessment as directed by your primary care team. At all times SickKids has clear procedures in place for protecting your child from getting an infection when visiting the hospital. During this time additional measures to protect you and your child have been put in place. Please follow SickKids instructions regarding the number of visitors permitted to accompany your child. Please see for further information.

Last updated: November 29th 2022