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August 2020

Recommendations for returning to school or daycare for children with congenital or acquired heart conditions 

Dear Families,

We understand that this is a very stressful time for everyone, particularly for parents with children who have congenital or acquired heart conditions. There is still a lot that we do not know about COVID-19, and we continue to learn more daily. From what we do know, however, most children who get sick from this virus have mild symptoms.

If your child becomes ill with COVID-19, most likely they will have a mild illness unless they have other risk factors. Also, other family members may be at risk, especially the elderly and those individuals on immune suppression treatment or otherwise immunocompromised. You may need to talk to your family doctor about how to protect other family members who have medical conditions.

A small group of children with heart conditions are potentially at higher risk if they become ill.

Despite the absence of scientific studies, here are some sensible recommendations for children with congenital heart conditions based on observations of adults and our collective experience.

The following cardiac conditions are thought to increase the risk of serious illness with COVID-19 and we would be concerned about your child returning to school or daycare.

  1. Your child will be having heart surgery or cardiac catheterization in the near future.
  2. Your child has decreased heart function or is on medications such as diuretics (i.e. Lasix) due to his or her heart condition or symptomatic cardiomyopathy.
  3. Your child has significant pulmonary hypertension.
  4. Your child has significant narrowing or leaking of a valve especially if having symptoms.
  5. Kawasaki (newly diagnosed in the last two months) on Aspirin or has a large aneurysm.
  6. Your child has a poorly controlled arrhythmia and is on multiple heart medications.
  7. Your child has had a heart transplant or is on immunosuppression treatment.
  8. Some genetic conditions may have reduced immunity such as Trisomy 21, DiGeorge syndrome, heterotaxy.

If you do not feel comfortable sending your child to school or daycare after reading this, you should keep your child at home. We also realize that not everyone is in a situation that allows one parent to stay home with children. Whatever your decision is, it is important to continue practicing good hygiene including social distancing and frequent effective hand washing for 20 seconds with soap and water. Wear a mask when around others that are not in your family or limited social circle according to public health guidelines.

In summary, your daughter/son likely has the same risk as most normal kids such that they will likely have a mild illness if they do get COVID-19. For most of our patients, their heart issue does not add any extra risk.

We are starting to recommend everyone (kids and adults) take their temperature before leaving for work or school each day. If it is 38° or higher, please stay home. If you have any symptoms of respiratory illness, stay home. Please wash your hands when leaving or arriving anywhere, before and after meals, and before and after using playground equipment. Wear a face mask when leaving the house and when around strangers/non-family members. You can take off your face mask when outside for walks but maintain physical distancing. Take care when around friends or family who have health issues, especially the elderly.

It is recommended that you and everyone who can in the household get the flu shot this year as it can be as bad as COVID-19. This will reduce the number of sick children and adults this fall and winter and can reduce the crowding at hospital emergencies and walk-in clinics. It is very hard to distinguish between the flu and COVID-19.

Hopefully, this plan works until a vaccine becomes available (likely in early 2021). Get vaccinated when an approved vaccine is released, and the safety and effectiveness are demonstrated by the vaccine trials. In the end, it is your choice to do what is best for your family.

These are our recommendations for now. We invite you to share them with your friends and family. We cannot talk to all our families due to high volume of children we care for. If you still have a specific question, please email or call our office. Our contact information is listed below.

Kind regards,

Dr. R. Beaulieu, M.D. FRCP ( C )
Dr. S. Senthilnathan, M.D., FAAP
Dr. N. Jivani, M.D., FAAP, FACC



Sick Kids Hospital

Montreal Children’s Hospital

Mayo Clinic

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