Nora was just five days old when her parents took her to the Alberta Children’s Hospital with a high fever. Soon after arrival, she tested positive for COVID-19. Nora’s mom Ceyda, dad Ben and sister Hazel had all been sick at home for a few days and awaiting their own COVID-19 results, and later also tested positive. Ceyda remained by her baby girl’s side in hospital, under strict pandemic safety protocols. When Nora struggled for air and eventually stopped breathing, doctors performed an emergency intubation, using a device called a video laryngoscope to swiftly insert a tube into her trachea so a ventilator could take over her breathing. Nora would have only had about 30 seconds before her oxygen levels became dangerously low. She was rushed to the Pediatric Intensive Care Unit (PICU) where she remained under the close watch of specialists. While advanced equipment and specialized care were vital to Nora’s recovery, Ceyda is also grateful for the human touches of hospital staff: one nurse bringing a colourful blanket to soothe Nora, another donning PPE to cuddle with her overnight while Ceyda rested. After 13 days in the hospital, Nora had fought off the virus and returned home safe. Nora is believed to be the youngest person in Canada to be hospitalized for COVID-19.

The bigger picture: More than 75,000 times a year, a child is rushed to the Emergency Department at the Alberta Children’s Hospital. Last year, Nora was one of more than 800 kids who needed one-on-one care in the PICU, and one of about 120 who needed emergency intubation so a ventilator could take over their breathing. The Alberta Children’s Hospital has an 85% first-intubation-attempt success rate – well above the North American children’s hospital average.

As the only hospital in the province devoted exclusively to the care of kids, BC Children’s Hospital treats the most serious injuries or critical illnesses. When the pandemic hit and it was designated one of 19 primary COVID-19 care sites, its experts had to mobilize quickly to ensure that they were prepared to meet these rapidly evolving needs while continuing to deliver the best possible care to patients. Within a few weeks, BC Children’s Hospital Foundation had partnered with BC Women’s Health Foundation to raise funds for critical virtual health technology to help more kids and families across the vast province receive specialized pediatric care when they needed it, right in their own communities. This newly acquired, state-of-the-art telecommunications equipment, fully funded by donors, is now being used by experts throughout the hospital to let patients and families receive care from the safety of their homes.

The bigger picture: Every year, BC Children’s Hospital treats over 96,000 kids, many of them battling devastating diseases and chronic conditions that demand the specialized expertise of our pediatric team. When the COVID-19 pandemic made it more difficult for children to come to us, donor-supported equipment enabled our highly skilled teams to reach beyond the walls of our hospital and reach kids and families wherever they were.

Children’s health care needs did not stop because of COVID-19 – so when daily arrivals at CHEO’s Emergency Department fell from 200 patients a day to 50, the CHEO team inferred that pandemic fears were keeping patients and families away. “We were concerned that kids were sick and not getting the care they needed because families were afraid to come to the hospital,” recalled Dr. Maala Bhatt, Research Director for the Division of Emergency Medicine and a pediatric emergency medicine physician at CHEO. To ensure that children and youth continued to have access to treatment and support, CHEO created a Virtual Emergency Department, using a digital platform to assess patients and offer guidance on whether they should be seen in person. The success of CHEO’s Virtual Emergency Department led other parts of the hospital to adopt the same technology, and the program has now become the standard of care when no physical test or procedure is required. Teams offering mental health support to children and youth found the technology beneficial, and, CHEO’s psychiatry team also began partnering with the emergency team. “If a child presents with a mental health concern, a crisis worker can join the online meeting,” Dr. Bhatt explains. “Once we address the medical needs, the crisis worker can refer the family to an in-person assessment or connect them with available resources in the community to support them.”

The bigger picture: Children’s hospitals are always seeking new ways to enhance the care they offer to young patients and their families. As CHEO worked to respond quickly to the imperatives of the pandemic, our teams also sought opportunities for new approaches to not just keep patients safe from the virus, but to use this crisis as an opportunity to enhance care. In the midst of the pandemic, donor-supported digital equipment was an important tool for the CHEO team as they worked to reduce barriers to access and smooth care pathways between emergency assessment, psychiatric care, and community supports.

The pediatric cardiology clinic at Health Sciences Centre – Children’s Hospital Winnipeg was designed in 1987 to treat about 1,800 patients each year. Thirty years later, it was serving 6,000 children annually. The building’s constraints meant that patients needed to be moved more often – including to other facilities for some procedures – and staff often struggled to provide families with a sense of welcome, calm, and privacy. To address these challenges, in 2018, The Children’s Hospital Foundation of Manitoba launched a campaign to raise $3.5 million for a new Children’s Heart Centre (CHC) that could support more patients comfortably, and better accommodate advanced medical and laboratory equipment. The response from donors was overwhelming. The Foundation not only met the original target but raised their ambitions even further – adding two specialized laboratories, additional equipment, and vital-signs remote monitoring capabilities for all hospital inpatient units. In all, donors contributed a total of $15 million. The new Children’s Heart Centre, which will open in summer, 2021, will save, extend, and improve the lives of thousands of children, and offer families healing environments as they support children through their treatment and care.

The bigger picture: Kids with heart conditions are living longer, healthier lives than ever before. One area of important progress has been early diagnosis, which relies on advanced technology that the new CHC will support. Dr. Reeni Soni, Head of Pediatric Cardiology at the new Centre, notes that the facility will help children in Manitoba benefit from advances in the field: “The Centre will significantly improve our ability to diagnose cardiac conditions in babies before they are born. With that information, planning can be in place to optimize these babies’ chances of having a good outcome.”

When the COVID-19 pandemic became a concern in London, Ontario, Children’s Hospital at London Health Sciences Centre reacted quickly. The Paediatric Emergency Department, led by Medical Director Dr. Rod Lim, adopted many new practices and approaches to keep patients, families and staff safe. A reconfigured waiting room, new isolation spaces, and a new policy allowing select patients to wait in their cars for care were just a few examples of important adaptations. But perhaps the biggest new initiative that arose during the pandemic was the virtual emergency clinic. Launched in May, this clinic supports video chats between emergency room physicians and parents who believe their child may need emergency care; parents and clinicians can discuss their condition and necessary next steps, potentially avoiding an unneeded trip to the hospital during a pandemic.

The bigger picture: Children’s Hospital receives over 37,000 emergency visits annually, many of them stressful for both children and families. That is why even while juggling the complexities of a pandemic, Dr. Lim was committed to ensuring that his entire team was able to continue to create a compassionate and optimistic environment – and flexibility wherever possible. Acknowledging the challenges of the pandemic, he reflects, “We’ve had to change a lot of the ways we do things. But our community needs us and we’ve dedicated ourselves to create that environment in order to meet their needs.

Fifteen-year-old Mateo sustained devastating injuries when, exploring an abandoned building with friends for the first time. Upon leaving, Mateo was electrocuted and then fell into a high voltage area. An electrical arc shot through his body and he was badly burned (a friend used his backpack to put out the flames on Mateo’s body). Emergency responders extricated Mateo from the site and rushed him to CHU Sainte-Justine, where he was placed in a medically-induced coma for three weeks. After four months of intensive treatment, he went home from the hospital – but much of his recovery still lay ahead. His wounds were not easy to heal, pain management was an ongoing struggle, and rehab exercises were demanding. A year later, however, Mateo was back at school and even playing sports; he graduated from high school in June of 2020. To show his gratitude for those who helped him reach this milestone, Mateo has raised a remarkable $30,000 for Sainte-Justine, with his family’s help.

The bigger picture: Every year, 75% of serious pediatric accidents in Québec are treated at CHU Sainte-Justine. Although not every injury is as serious as Mateo’s, any family in the region might need to draw on the complex web of resources that enabled Mateo’s extraordinary recovery – from well prepared first responders to extensive critical care resources, and long-term therapeutic and community supports.

Katie was diagnosed at birth with laryngeal cleft type 4, a condition that meant the tissue between her larynx and esophagus was not fully fused, creating life-threatening respiratory and feeding issues. Now eight years old, Katie has had dozens of corrective surgeries. Most recently, surgeons at IWK Health performed a complex procedure to reconstruct her entire trachea and esophagus. “In Katie’s short life,” her mother Tami reflects, “she has been touched by donors at every turn.” For example, 43 of Katie’s surgeries have relied on a surgical telescope, a donor-funded tool that lets surgeons see the throat clearly without large, invasive incisions. Last fall, doctors were even able to remove a tracheostomy tube Katie had needed for most of her life to help her breathe. “When you see how well she’s doing today,” her mom says, “it drives home how grateful we are for donors’ support.”

The bigger picture: Katie is one of 4,413 children and youth who had inpatient stays at IWK Health in 2019/2020. An additional 9,706 moms and newborns also received inpatient care at the IWK. Although not every patient’s needs are as complex as Katie’s, every patient and family benefits from the knowledge that their regional hospital is equipped with the tools and expertise to deliver the highest level of treatment and care when necessary.

Canada’s children’s hospitals strive to create healing environments for patients and families. When the pandemic struck this year, Dr. Natalie Bridger set her sights far beyond the walls of her own hospital, collaborating broadly to fight the spread of COVID-19 inside and outside health facilities in Newfoundland and Labrador. Dr. Bridger, Clinical Chief of Infection Prevention & Control at the Janeway Children’s Health and Rehabilitation Centre helped health care institutions across the province prepare for the pandemic, identifying and addressing gaps in knowledge, infrastructure, and policies. As cases began to appear, she collaborated with health authorities, Memorial University’s Faculty of Medicine, all levels of government and community stakeholders to ensure a coordinated response. For Dr. Bridger, a safe, healing environment means more than rigorous clinical protocols. “It is a difficult balance to stay vigilant and safe without becoming mired in fear,” she says. “I hope that the work of my team gives people the tools to keep themselves safe while diminishing some anxiety.” Dr. Bridger was recognized with a 2020 COVID Leadership Award from the Pediatric Chairs of Canada (PCC), representing the pediatrics departments of 17 medical schools across Canada.

The bigger picture: While children have generally been at low risk of suffering serious health effects from COVID-19, children’s hospitals – and leaders like Dr. Bridger – have been vital to the collective effort to combat the virus and help children and families navigate its effects. Dr. Bridger’s award-winning work to educate, inform, and collaborate across institutional boundaries is a powerful example of the contributions children’s hospitals have made to the health of all Canadians this year.

Thirteen-year-old Nate of Maymont, Saskatchewan has been fighting for survival his entire life. Nate has gastrochisis: he was born with his intestines protruding from a hole in his abdominal wall. After years of surgeries and treatments across three provinces, Nate’s intestines and liver were failing. But in the fall of 2020, his family received the call they had been waiting for: a transplant was available. They were on a flight to Toronto within 12 hours. No transplant is minor, but this one was almost unmatched in its risk and complexity and is why they had to leave Saskatchewan. In a procedure spanning nearly 14 hours, three surgeons would transplant his small and large intestine, liver, a large portion of his stomach, his duodenum, his pancreas and the top part of his colon. Remarkably, Nate was back on the ward in just three days, “which is very fast – but he’s a fighter and always has been,” his mother Jennifer says. When Nate returns to Saskatchewan he will continue to receive follow up care at home at Jim Pattison Children’s Hospital.

The bigger picture: Nate and the many children who receive transplants each year benefit not only from decades of research, but from carefully orchestrated collaboration across provincial health systems, hospitals, specialists, and care teams. Understanding the scale of this effort better than most, Nate is active in lending his support. Weeks before his surgery, he raised more than $40,000 for the Jim Pattison Children’s Hospital Foundation Radiothon as a Miracle Child Ambassador.

In addition to adopting comprehensive on-site safety protocols during the pandemic, McMaster Children’s Hospital also worked quickly to shift essential outpatient services to virtual platforms. Clinical teams began using telephone and video communications to consult with medically fragile and complex-care patients remotely, helping families avoid unnecessary in-person visits. The Child & Youth Mental Health Outpatient Clinic at Ron Joyce Children’s Health Centre is just one of many clinics that adopted a range of virtual-care services. Among other adaptations, the Centre created an At-Risk Support Team to identify clients who might need additional mental health support and to put them in touch with appropriate resources. Similarly, the Autism Program created an Urgent-Response Clinical Team to provide support services for patients with new or escalating behavioural and mental health concerns. Virtual workshops for parents and caregivers of autistic children have been made available online, and resources like tip sheets and videos have been added to the program’s webpage for easy remote access. “Virtual care has been great,” says Katelyn from Hamilton, whose daughter Taylynn has regular appointments with the Developmental Pediatrics and Rehabilitation Program. “Through online consultation, the therapists are giving us the tools we need to continue care at home. We are so grateful.”

The bigger picture: Researchers and clinicians are only beginning to take stock of the mental health effects of the pandemic on children and youth. Many care teams report that young people’s mental health has been deeply affected by the upheavals of the past year. This context makes the adaptive and proactive work of McMaster Children’s Hospital – and children’s hospitals across Canada – all the more vital. More than ever, young people and their families depend on the expertise, compassion, and dedication of Canada’s children’s hospitals.

Like other children’s hospitals across Canada, the Montreal Children’s Hospital (MCH) mobilized to support its patients and families in many ways this year. In an interview conducted during the first wave of the COVID-19 pandemic, the senior management team of MCH described a range of important steps their hospital had already taken – from on-site infection control protocols to extensive clinical collaboration to thousands of virtual care appointments. In addition to these efforts, the hospital also stepped up to help keep the public informed with important updates about the pandemic and related public health measures. Dr. Martin Gignac, the hospital’s Chief of Child and Adolescent Psychiatry, made media appearances to discuss topics such as children’s potential stress and anxiety ahead of their return to school. Infectious disease specialists appeared on the hospital’s Facebook Live platform to answer questions about the pandemic. Hospital communications teams also worked hard throughout the year to craft clear, timely updates and to deliver guidance for patients, families, the hospital community, and the general public.

The bigger picture: Accurate and clear information is an essential tool in the fight against COVID-19. While managing many other demands, children’s hospitals across Canada have helped to keep their communities informed about how to stay safe. They’ve also supported patients and families in managing the fear and worry that can come from confusing or overwhelming messages. With contributions from specialists, communications teams, and others, hospitals have delivered valuable information and advice even as they have continued to fulfill their essential clinical roles.

As Alexe was embarking on her first year of college study in 2020, she received unwelcome news: her cancer had relapsed for a fifth time. She would need to resume radiation and chemotherapy, now with a more limited set of treatment options – all at a time when she was excited to begin a new chapter of her life. Amid sustained health challenges, staff at Opération Enfant Soleil (OES) say Alexe has shown extraordinary maturity, resilience, and optimism – an outlook that is evident in her gratitude for the care she has received. Along her treatment journey, Alexe has noticed the signs of support. “I’ve benefitted,” she says of equipment financed by OES and its donors. “I see their little logos on many devices used to treat me.”

The bigger picture: For children and youth with persistent health challenges, donor-supported research and equipment help to expand the range of treatment options available, giving doctors the tools to minimize discomfort and disruption – a vital benefit for patients whose care extends over years.

Like health care institutions around the world, SickKids had to respond swiftly to the threat of COVID-19 – starting by protecting patients, families, and staff. Even as the hospital made immediate safety adaptations, research teams at SickKids quickly regrouped to join the global scientific race to combat COVID-19. They began working intensively to understand SARS-CoV-2, the virus behind the disease, and how best to fight it. SickKids scientists combined their expertise in infectious diseases, statistical modelling, and genetics to hunt for markers of susceptibility to COVID-19 in children and adults. Researchers also tackled a range of other topics, including infection and immunity in frontline health care workers across Ontario; the impact of COVID-19 and associated public health measures on the mental health and well-being of children and families; and why some racialized communities have been disproportionately affected by the pandemic.

The bigger picture: More than 100 COVID-19 studies were underway at SickKids in 2020, including 75 led by SickKids scientists. Donor funding helped give the hospital the flexibility to navigate a rapidly changing health crisis with speed, efficiency, and compassion—directing funds where they were most needed to keep delivering outstanding care for patients while contributing to the global race against the virus.

When a newborn is admitted to the Neonatal Intensive Care Unit (NICU), parents are often overwhelmed. They spend stressful hours in the NICU, reluctant to leave their baby’s side, even for a few hours of sleep. An innovative, donor-funded camera system called the NICView helps to relieve some of the stress. The NICView system lets families access a private online livestream of their newborn’s incubator from a smartphone or other device, giving them the comfort of seeing their newborn receiving care, even when they’re not right at the bedside. With $245,000 of support from the Stollery Children’s Hospital Foundation, 72 NICView cameras have been installed in the Stollery Philip C. Etches NICU at the Royal Alexandra Hospital site. NICView cameras are at the Sturgeon Community Hospital site and are coming soon to the newly renovated Stollery David Schiff NICU at the university site. In addition to reassuring parents, NICView brings distant loved ones close; people log into Stollery NICView cameras from around the world – and the system is gaining fans. Within a few months after it went live in fall, 2019, monthly logins had climbed from 9,000 to 15,000.

The bigger picture: In an average year, children’s hospitals work hard to create a welcoming atmosphere for parents, siblings, grandparents, and other family members because keeping patients connected to loved ones is a key part of creating a healing environment. During the COVID-19 pandemic, when rule changes aimed at limiting transmission meant patients could only have one visitor, the value of the NICView came into even sharper focus, allowing parents and others to safely watch over the Stollery’s youngest patients.