Kids with COVID-19 symptoms may need a test to go to day camp. Here’s how to explain the nasal swab | #covid19 | #kids | #childern

With the launch of CampTO this week, thousands of Toronto kids will be leaving their homes, some after weeks of isolation, for daylong fun in parks and recreation centres across the city.

Along with the chance of sunburns, scraped knees and other summertime mishaps, kids will also have an increased risk of getting COVID-19 — even with the strictest safety precautions in place.

CampTO, the city’s scaled-down summer program for children ages six to 12, starts July 13 and will have COVID-19 precautions.

Among its detailed safety protocols, which include wearing masks indoors, assigned individual start times and daily health screenings, CampTO requires any camper with symptoms to get tested for COVID-19 — and have proof of a negative result before returning to the program.

Parents may fear that few kids, from toddlers to teenagers, will welcome a long, thin flexible swab up their nose. But Natalie Wilson, a certified child life specialist at the Hospital for Sick Children, said that with help from a trusted caregiver, many kids cope well with the nasopharyngeal swab to test for COVID-19.

As of July 4, some 61,555 children under the age of 19 had undergone COVID-19 testing in Ontario, according to data provided to the Star by Ontario Health. The data, compiled by the Institute for Clinical Evaluative Sciences, shows the following age breakdowns for those under 19 who got tested: 28,435 teens between the ages of 15 and 19, 9,996 children between the ages of 10 and 14, 9,263 children between the ages of five and nine, 6,380 children between the ages of two and four and 7,481 children under the age of two.

Wilson, who has more than eight years experience assisting children through difficult and sometimes painful medical procedures, said it’s crucial to set kids up for success for their first COVID-19 swab, especially as some will need to be tested more than once during the pandemic.

“If they feel a sense of accomplishment and mastery — a feeling of ‘oh, that wasn’t so bad’ — they can reflect on those positive experiences to increase their coping and co-operation if they have to have a swab in the future.”

Here, Wilson offers advice on how parents and caregivers can help kids through the uncomfortable — but absolutely necessary — COVID-19 test.

How can I prepare a child for a nasopharyngeal swab?

It’s important to explain to children why they need a nasal swab and provide that information in a way that’s appropriate for their developmental age, Wilson said. This helps take away the fear of the unknown, which can lower some of their anxiety and increase their co-operation with the procedure.

For school-age children and preschoolers, Wilson suggests a short, straightforward explanation; too many details can be overwhelming. “It can be something like: Our noses have information inside them that let a doctor know if your body is growing a virus or not. This will let them know if your body needs some extra help to get better in case the virus is inside your body.”

Older children and teenagers are likely to have a greater understanding of the pandemic’s impact worldwide and might be scared about the virus hitting close to home. Wilson said it’s important to listen to the fears of older children, clear up any misconceptions they might have and explain that getting tested for COVID-19 is safe and something many kids and adults are doing now.

“You want to normalize it, let them know it’s not something specific to them.”

Should I tell kids what to expect at a COVID-19 assessment centre?

Explaining the specific steps of a nasal swab — giving children some predictability in the process — is another way to help reduce their anxiety, Wilson said. Older children can have the information ahead of time to process it and ask questions, while younger children can be told what is happening right before the procedure or as each step unfolds.

First, tell kids the people they meet at the testing centre will be wearing personal protective equipment. “Do this in advance so they aren’t overwhelmed to see someone wearing a mask and face shield and gloves.”

Next, explain their specific role, which is “to sit as still as possible and look up at the ceiling so the nurse can see their nose better,” Wilson said.

Then briefly describe how the nurse will put a thin, flexible swab into one of their nostrils for about five seconds, take it out and put it into the other nostril for about five seconds.

“It’s important to be honest about what they will see, hear and feel,” Wilson said. “We usually let kids know it will feel strange or a bit uncomfortable for the few seconds the swab is in their nose but there are ways to make the process a little easier.”

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How can I help a child during a nasal swab?

A hug-like hold from caregivers can make young children and school-age kids feel more comfortable during the procedure — and help them stay still, said Wilson, adding that this trusted adult can also help kids tilt their chins back.

Taking big breaths through their mouth and squeezing a caregiver’s hand or a stress ball during the procedure helps many kids. As well, a favourite song or show are good distractions during the procedure, she said.

“A caregiver can hold a tablet or phone above a child’s head to encourage them to look up.”

If a child gets upset after the swab goes in the first nostril, Wilson recommends a brief break — three big, deep breaths, for example — before the nurse swabs the second.

Throughout, it’s important for caregivers to validate a child’s feelings, no matter their age, Wilson said. “Whether it’s stress or fear or anxiety, let them know it’s OK to feel that way and that you are going to do this thing together.”

Is there something I can do to help a child after the procedure?

No matter how a child coped, Wilson said it’s important to follow up with positive messages and provide specific praise for the things they did well, such as sitting still or looking up at the ceiling.

“Something specific like ‘I know that was hard for you, but you did a great job squeezing my hand’ … rather than ‘I’m so proud of how brave you were.’ Being specific about what they did well can be helpful for a future swab because you can go back and remind them of those positive things they did.”

Offering a small token or reward or doing a favourite activity when they get home after the swab is another — and often very welcome — way to provide positive reinforcement.

And it’s really important, even in the heat of a stressful moment, not to promise that a child won’t have to have another swab. “With the pandemic, it’s always a possibility; we don’t want to make promises that could potentially break a child’s trust.”

How can I help a child who is worrying while waiting for test results? What can I say to a child after a positive test result?

For kids who worry, remind them nasal swabs are common right now because everyone is being extra careful, said Wilson, adding that health experts recommend adults talk specifically about COVID-19 to differentiate this virus from other illnesses. And be sure to explain that just because you got a nasal swab doesn’t mean you have COVID-19.

For those who do test positive — or if a family member tests positive — it’s critical to remind children of any age that it’s not anybody’s fault, Wilson said.

“Younger, school-age children might have the misconception that they did something wrong,” she said. “For example, they might think that yelling at their sibling is why they are being punished with having COVID-19. Older children might think they didn’t wash their hands enough or follow precautions enough and feel guilty.

“Children need to know it’s not anybody’s fault. That even though everyone takes the proper precautions, the virus is very contagious and can still get into our bodies. And if they do get COVID-19, they need to know there are lots of people to help them.”

Megan Ogilvie

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