COVID-19

Data (based on the original strain of COVID-19) suggest that children (especially children aged less than 12 years of age) are less likely to be infected compared to older children and adults. And if children are infected, they generally experience mild illness. So far, most severe cases have been in elderly people with medical conditions such as heart problems or lung disease. There have been very few children across the UK admitted to hospital with severe COVID infection. This includes children with other health conditions, including those undergoing treatment for cancer or those with weakened immune systems or respiratory conditions - even they have generally experienced mild infection when infected with COVID. Reassuringly, during December 2020, when children were still at school and the new COVID strain was circulating, very few children were admitted to hospital with severe COVID infection.

A group of children who appear to have an increased risk of severe infection is those with severe neurological (brain) conditions. Unfortunately, COVID vaccine trials have only just begun in children and so there are very limited data on their safety and effectiveness in this group. There are some safety data on the Pfizer vaccine in children aged 12 years and over. For this reason, the current national recommendation is to consider administering either the Pfizer or the Oxford / AstraZeneca vaccine to older children with severe neurological conditions who spend regular time in specialised residential care settings for children with complex needs.

For specific information for children and young people with cancer undergoing cancer treatment, click here.

If you are worried about your child's breathing and are not sure if they need to be seen by a healthcare professional, click here to help you decide. Our local and regional paediatric services are well set up and have detailed plans in place to treat and support all children who have severe COVID-19 disease. There is a national plan in place for children that require intensive care support (PICU).

If any member of your family is infected with COVID-19, then your whole family needs to self-isolate for 10 days. The main reason for this is to reduce the risk of the virus being transmitted to others outside of your household. There is a high risk of other household members being infected and if this occurs, you need to restart the 10 day period of self-isolation for those not already infected.

Avoiding infection is obviously most important for people at the highest risk of becoming unwell from COVID-19. This includes the elderly and adults with long-term health problems such as breathing problems, heart problems, chronic kidney or liver disease, those with central nervous system conditions and those with weakened immune systems. This approach is called social distancing and is the most effective way of minimising the impact of this pandemic. For parents, this means trying to minimise the contact that your child/children have with people from vulnerable groups. This is because children may have the infection with almost no symptoms and potentially may infect other people. This is the reason that the government have decided to prioritise the vaccine for those most vulnerable to severe disease. Even following the vaccine, it takes 21 days to develop good levels of protection. Minimising contact between children and the most vulnerable individuals awaiting vaccination is important whilst this new stain is circulating.

It is extremely important to realise that not every child with a fever has COVID-19. All the other conditions that can make children unwell are still ongoing during the COVID-19 pandemic. If you are not sure if your child is unwell and whether they need to be seen by someone, take a look at the red / amber / green criteria below to help you decide.

This advice applies to children who are still attending school during lockdown.

The commonest symptoms of COVID in children are a high temperature and/or persistent cough. However, it’s important to remember that most illnesses that children will get this winter will not be caused by COVID-19 and that COVID-19 generally causes far milder illness in children compared to adults.

If your child has a high temperature (hot to touch on your chest or back), a new, persistent cough (coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours) or loss of taste/smell, then your whole family needs to isolate and you need to arrange for your child to be tested for COVID via the NHS website or by calling 119. Your family needs to isolate until you have your child’s test result back (inform the school of the result as soon as you get it). If they are negative, your child can return to school once they are better. If they are positive, continue to isolate with everyone in your household as directed by government guidance.Your child will need to stay at home for 10 days from when they become poorly. All other household members will need to remain isolated for 10 days from when your child became poorly. If you are worried that your child is unwell, look at the red/amber/green section below for information about what you should do.

If your child has none of the symptoms above but is poorly with headache, muscle aches, fatigue, abdominal pain, diarrhoea and/or vomiting or lethargy, they should remain at home until they feel better (click here for more information. They do not need to be tested for COVID and other family members do not need to isolate. If they have diarrhoea or are vomiting they should not return to school until 48 hours after last having diarrhoea or vomiting. If you are worried that your child is unwell, look at the red/amber/green section below for information about what you should do.

If your child has a runny nose, sore throat or occasional cough, but none of the symptoms above, they can go to school. Your family does not need to isolate and your child does not need a COVID test.

Click here for regional flowchart - COVID symptoms and attending school / college.

If your child is confirmed to have COVID, your entire family will need to isolate for 10 days. Click here for information on self-isolation and for info for other household members.

• To reduce the risk of spread to other household members, get them to cover their mouth and nose with a tissue or sleeve when coughing and sneezing and to throw used tissues in the bin immediately. They should also regularly wash their hands with soap and water (for at least 20 seconds each time).
• In addition, keep shared spaces and surfaces visibly clean using household detergents, washing hands after cleaning. Household bleach using in accordance with the instructions can be used to disinfect surfaces. Use hot water and detergent or a dishwasher for crockery and cutlery.

Click here to watch a video of some really useful practical tips about looking after a children with presumed COVID-19 and click here for more information if you or other family members become unwell with COVID-19.

Although the UK entered its 3rd lockdown on 5/1/21, a considerable number of children continue to attend school. These include vulnerable children, those without access to a computer and the children of keyworkers.

The honest truth is that we’re still learning about the new strain of COVID. It definitely transmits more readily between people of all ages. For this reason, rates of COVID in children and adults are far higher than they were in September 2020. We know that the original strain appeared to infect children (especially children aged less than 12 years) less frequently than older children and adults. Data from the original strain also suggested that children transmit COVID-19 less readily than adults - which means that they were definitely not super-spreaders of COVID-19. None of the data about the new strain seems to contradict this, although these data are being constantly reviewed.

Most reassuringly, children get far milder illness than adults; the mortality (death) rate among children is currently estimated to be 0.03% (3 in 10,000 cases), which is similar to the rate for ‘normal’ flu and far lower than a lot of other infections. This appears to be the same with the new strain of COVID.

In order to reduce the risk of outbreaks in schools with this more transmissible new strain, it is essential that we make every attempt to reduce the rate of COVID in the community. This relies on all of us following lockdown rules. Although children need to continue to comply with regular hand-washing and that children attending secondary school adhering with face-covering and maintain social distancing in communal areas, only by controlling local COVID rates will we effectively reduce the risk of transmission of COVID in schools. If we fail to control local prevalence rates of COVID, it is highly likely that there will be a significant number of outbreaks in schools.

For more information about the role of school settings in the transmission of COVID-19, click here.

Here are a list of questions that have been answered via videos that parents are commonly asking about the new strain of COVID and schools:

• How is the new strain of COVID different to the original strain?
• Why are so many school age children getting COVID?
• My 15 year old has asthma - should she be putting herself at risk by going to school?
• Are more children becoming unwell with this new strain of COVID?
• Is it safe for me to send my child to school with the new strain circulating?
• What is the plan for COVID testing in schools?
• What is the difference between lateral flow (rapid) testing and PCR testing?
• Why doesn't the schools testing programme include primary schools?
• How can I get mental health support for my child?
• Will my child be getting the COVID vaccine?

We have also been asked a number of questions by children that we have tried to answer:

• Am I safe at school with COVID around?
• We already wash hands and stay in bubbles in school but is there anything else we should be doing in schools to reduce the spread of COVID?

The risk of transmission of COVID appears to be higher in secondary schools/colleges than in primary schools. And risk of transmission is higher with the new COVID strain than with the previous strain. For this reason, the government has decided to introduce rapid COVID tests (lateral flow testing) in secondary schools and colleges. The aim is to reduce the risk of transmission in schools and to try to keep children in school where possible. If emerging data demonstrate significant transmission in primary schools, UK scientists and the government will decide whether the testing programme should be extended to include primary schools.

All children returning to secondary school and college in January 2021 are likely to be tested for COVID. This is likely to involve your child being tested twice (with 3 to 5 days between each test). You will be asked to provide consent for this testing to be done (if your child is 16 or over and understand why the test is being done, they can provide consent themselves). If your child is positive on either of these tests, you will be asked to arrange a COVID PCR test via the test & trace system. The rapid COVID test (lateral flow test) is not quite as accurate as the PCR test and a small proportion of tests are falsely positive– your child and your family only need to isolate if their confirmatory PCR test is positive. In addition, all staff in primary and secondary schools will be tested weekly using lateral flow tests.

In addition, any secondary school child or young person at college who comes into close contact with a confirmed case of COVID in school/college will be offered the option of serial contact testing rather than having to automatically isolate for 10 days (assuming that consent is provided). This involves your child having a daily lateral flow test performed for 7 days (see below):

It can be confusing to know what to do when your baby is unwell during the coronavirus pandemic. Remember that the NHS is still providing safe care. GP practices and hospitals have made changes to help reduce the risk of infection. Only one parent/ carer will be able to attend A&E with their child. Please use the hand sanitisers provided, wear a face covering in enclosed spaces and maintain social distancing.

Click here for a downloadable version of the Red, Amber and Green table above.

What is PIMS?

In April, doctors in the UK reported cases of serious illness in around twenty young patients, some of whom needed to be treated in intensive care.

The children had serious inflammation throughout their body. Inflammation is a normal response of the body’s immune system to fight infection. But sometimes the immune system can go into overdrive and begin to attack the whole body and if this happens, it is important that children receive urgent medical attention.

Doctors are concerned that in severe cases of PIMS the inflammation can spread to blood vessels (vasculitis), particularly those around the heart. If untreated, the inflammation can cause tissue damage, organ failure or even death,

Some of the symptoms of PIMS can overlap with other rare conditions, such as Kawasaki disease and Toxic Shock Syndrome. Some people have referred to the condition as ‘Kawasaki-like disease’. Like PIMS, complications from Kawasaki can cause damage to the heart. Kawasaki tends to affect children under five whereas PIMS seems to affect older children and teenagers.

Can PIMS be treated?

Yes. Doctors know what to look out for and will do tests to diagnose what’s wrong and what treatment to give the child. Even where doctors aren’t 100% sure whether a child or teenager has PIMS, they know how to treat the symptoms associated with it. Doctors use the same type of treatments to ‘reset’ the immune system for both PIMS and Kawasaki disease.

Researchers hope to find out more about how to diagnose patients as quickly as possible and which are the most suitable treatments for each patient.

What symptoms should I look out for?

There’s a very wide range of symptoms and children with PIMS can be affected very differently. Some children may have a rash. Some, but not all, may have abdominal symptoms such as stomach ache, diarrhoea or being sick. All the children diagnosed with PIMS had a high temperature for more than three days, although this can be a symptom in many other illnesses and on its own is not a sign of PIMS.

While most won’t, some children may be severely affected by the syndrome. The most important thing is to remember that any child who is seriously unwell needs to be treated quickly – whatever the illness.The advice to parents remains the same: COVID-19 is extremely unlikely to make your child unwell; if you are worried about them, take a look at the red/amber/green symptom guide and if required, contact NHS 111 or your family doctor for urgent advice, or 999 in an emergency, and if a professional tells you to go to hospital, please go to hospital.

If your child doesn’t have these signs of being seriously unwell but you are still concerned, talk to you GP.

How many children have been affected?

It’s difficult to say because doctors are still in the process of reporting back – and also because there isn’t a definitive test. We think around 75-100 children may have been seriously affected and admitted to an intensive care unit. Almost all these children have since recovered.

A survey has been sent to 2,500 paediatricians (doctors who treat children) to gain a more complete picture of the condition. It asked doctors for details of every potential case seen since the beginning of March so we expect it to report a lot more cases – eg around 200 cases in England. But many of these children will not have been seriously ill and almost all children diagnosed with PIMS are now well again. The survey is likely to pick up cases which later turn out to be a different illness, eg Kawasaki disease. Some doctors believe a much large number of children may have had the condition but were very mildly affected and recovered without seeing a doctor.

Doctors have reported seeing a big reduction in cases in recent weeks but this could rise if cases of COVID-19 go up again.

Have any children died from PIMS?

We don’t know for sure because there isn’t a test for this condition. Doctors think two children may have died but they can’t be certain that there weren’t other reasons why the children died. These deaths are very sad indeed but doctors believe deaths in children related to PIMS are very, very rare. Many more children die of other infections such as flu or even chicken pox every year.

Is PIMS caused by COVID-19?

PIMS seems to be linked to COVID-19 because most of the children either had the virus or tested positive for antibodies indicating they had been infected (even if they hadn’t seemed ill at the time). But a very small number of the children with PIMS symptoms didn’t test positive for either.

How can doctors tell if a child has PIMS?

There currently isn’t a test which will say whether a child definitely has the syndrome. A syndrome is a collection of many different symptoms which, together, can give doctors an indication of whether or not someone has a particular illness. Doctors will look for a pattern of symptoms relating to PIMS and then do more tests, such as blood pressure and blood analysis, to make a diagnosis. Researchers are currently trying to develop a blood test which can quickly indicate whether a child has PIMS.

Are black or Asian children more likely to be affected?

When the first few cases were identified in the UK there seemed to be a larger number of children from an Afro-Caribbean or Asian background. Doctors don’t yet know the reason for this and it may turn out that these children are not at a higher risk than other children – in some other countries where the syndrome has been written about the children were white. But it is important for families with these backgrounds to be aware of the signs and symptoms of the condition, however rare.

Doctors are learning more and more about this condition all the time and we hope to have more information over the next weeks and months. We will update our guidance regularly.

For more information, click here.

In the same way that we have all been talking constantly about COVID-19 over the past few months, so have our children.

Many of them (especially those with other underlying health conditions such as heart and lung problems, weakened immune systems or diabetes) are really scared that they will get extremely unwell or even die from COVID-19.

They need you to make time for them and listen to their concerns and reassure them. You need to explain to them that they are extremely unlikely to get unwell from the infection. As you can see from the following diagram, the people most at risk from severe COVID-19 are the elderly; of the 2 million deaths across the world from COVID-19 (updated January 2021), extremely few have been in children. And 8 out of 10 adults who get COVID-19 only experience mild symptoms. And the vast majority of children who get infected with COVID have very mild symptoms or no symptoms at all.

Primary school children

The World Health Organisation have produced a free book for primary school children called “My Hero is You, How kids can fight COVID-19!” which explains how children can protect themselves, their families and friends from coronavirus and how to manage difficult emotions when confronted with a new and rapidly changing reality. Staff from Southampton Children's Hospital have also written a brilliant free book about COVID-19 for primary school children - click here to read it with your child.

You can also listen to Dr Ranj answering questions posed by children about COVID-19

Secondary school children

The LifeLab team at Southampton have produced the following video about COVID for young people.

In addition, the Children's Commissioner for England has produced resources on COVID-19 for secondary school children - click here .

For more information about supporting your child/children during the COVID-19 pandemic, click here.

COVID-19 is spread by droplets. That means your child needs to be in extremely close contact with someone with COVID-19 (who is coughing) to become infected (within 1-2 metres of them). However, the droplets containing COVID-19 can survive for hours on hard surfaces (door handles, handrails etc). This means that your child is much more likely to get infected by picking up COVID-19 on their hands and then infecting themselves by touching their face (which allows the virus to enter via their mouth, nose or eyes).

This is why washing hands with soap and water is so important, especially after being in areas containing other people:

In addition, trying to stop your child touching their face (unless they have just washed their hands) will also reduce the risk of them getting infected:

For more information about reducing the risk of you or your child catching COVID-19, click here.

Specific groups of children who are at the highest risk of severe infection were initially shielded from others for the first 12 weeks of the pandemic to minimise the risk of them getting infected. Children that fall into this group are:

• solid organ transplant recipients
• children being treated for specific cancers (leukaemia, lymphoma), or having had a bone marrow transplant in the last 6 months or those on specific forms of immunotherapy
• children with cystic fibrosis or severe asthma
• children with rare genetic conditions that significantly increase their risk of infection or those on immunosuppressive therapy

Although the government is no longer advising vulnerable children to continue shielding (this changed on the 1st August due to rates of COVID having fallen significantly), it is still extremely important that you and your child maintain social distancing and hand washing recommendations. Clinically extremely vulnerable children should attend education settings in line with the wider guidance on reopening of schools and guidance for full opening: special schools and other specialist settings.

If you are not sure whether your child falls into this category, contact their consultant or specialist nurse who should be able to offer advice.

The rules about people being made to wear face masks / face covering on public transport and in shops applies to children aged 11 years of age and older. However, for younger children it is up to the parent/carer as to whether they wear a face mask or not.

However, face masks should NOT be used for babies and children under 3 years or those who may find it difficult to manage them properly.

Wearing a face mask in this age group can put babies and children at serious risk of harm or death:

• Babies and young children have smaller airways so breathing through a mask is harder for them
• Masks could increase the risk of suffocation because they are harder to breathe through
• Babies are unable to remove the mask should they have trouble breathing
• Infants could be at risk of becoming tangled, especially if they try to remove a mask, potentially causing serious injury
• Older infants or young toddlers are not likely to keep the mask on and will touch their face more to try and remove it.

• The incubation period of COVID-19 is up to 14 days. However, the vast majority of cases occur within 10 days of a significant contact with someone with COVID-19.If you or your child have been in close contact with someone with confirmed COVID-19, you will be contacted by a tracing team and will be asked to isolate for 10 days from the date of that contact.
• Even if your child displays symptoms of infection (cough, breathing difficulty or fever) after a contact with someone with confirmed or suspected COVID-19, they are unlikely to become severely unwell. If they develop symptoms, you will need to arrange for them to be tested for COVID-19. However, if your child has moderate breathing difficulty (see amber features), they will need to be reviewed by a healthcare professional. NHS 111 will arrange this (contact NHS 111 online or call NHS 111). If your child has features of severe breathing problems (see red features), call 999.

There is no evidence showing that ibuprofen is associated with harm in children with COVID-19. If your child has symptoms of COVID-19 such as fever and headache, you can treat your child with either paracetamol or ibuprofen.

1) The reason that you are being tested for COVID-19 is that you have developed a cough or high temperature. Although we don't think that COVID-19 will make you poorly, we don't want it to spread to other people - this is why we are testing you for it.

2) Although the people doing the testing look scary, they are just normal people underneath the funny mask and clothes:

3) They will gently swab your nose and throat. It might feel a little uncomfortable but it won't hurt. You usually won't require any blood tests.

4) It might take 2-3 days for the test result to come back. longer if you're still finding it hard to breath).

It's really important that you continue to regularly wash your hands and make sure you cover your mouth when you cough and nose when you sneeze - and throw the tissues straight in the bin afterwards.

Your baby should have had a routine physical examination at 6 to 8 weeks, usually by your GP. As you know, COVID-19 has placed a huge challenge on the on the NHS and, if this screening opportunity has been missed due to current circumstance, here is some advice about what you should look out for.

Your baby should have had a full physical examination soon after birth. This will have picked up many, but not all, of the problems which we look for during the 6-week postnatal check.

If your baby does not have a 6-8 week check, you should ask yourself the following questions. If the answer to any is “yes”, you should contact your health visitor or GP.

Eyes

• Do you think your baby can’t ever fully open both eyes?
• Do you think your baby doesn’t make good eye contact and hold his/her gaze at you?
• Do you think that your baby doesn’t follow your face if you move your head from side to side when standing near him/her (less than 1 metre)?
• Do you think that your baby’s eyes shake/flicker/ wobble?
• Do you think there is something unusual about, or in, your baby’s eyes, for example, the dark central area (pupil) looks cloudy or the eyeball is an unusual shape or size?
• If the whites of your baby’s eyes are yellow, contact your health visitor or GP.

Hips

• When you change your baby’s nappy, do you find that one leg cannot be moved out sideways as far as the other?
• Does one leg seem to be longer than the other?
• Do you have any other concerns about your baby’s hips?
• Heart (If the answer to either of these is “yes”, you should speak to someone the same day)
• Does your baby seem breathless or sweaty, at any time, especially when feeding?
• Does your baby have blue, pale, blotchy, or ashen (grey) skin at any time?
• Remember: If the answer to any of the questions above is “yes”, you should contact your health visitor or GP.

The routine 6-8 week review is also an opportunity for you to talk to your health visitor about any other issues you may have with your baby and to talk about how you are feeling. Further information regarding the 6-week postnatal review can be found on the NHS website.

VACCINATIONS

COVID-19 has shown how important it is to protect ourselves against infections. Vaccinations are by far the most effective way of achieving this. That’s why is so important that your child still receives their normal childhood vaccinations; to protect them not just during the COVID-pandemic but also for the rest of their lives. Make sure that your child doesn’t miss out - your GP practice is still open to administer them. Click here for more information.

All children between 2 and 11 years of age (year 7) should receive the children's flu vaccine. This is not only to stop them getting unwell with flu, but also to stop them spreading flu to other members of your family. If your child is at school, the school will arrange for them to be vaccinated.

This year, it is especially important that your child receives their flu vaccine. By being vaccinated, your child is less likely to develop a flu-like illness (cough/fever). If your child develops such symptoms this winter, they will be excluded from nursery or school until they have a negative COVID-19 test (through the test and trace system). In addition, if they get flu, they may need treatment in hospital and/or may transmit flu to other family members who may become unwell (children are super-spreaders of flu).

There are other groups of children with long-term health conditions that should have the flu vaccine every year. This includes children with weakened immune systems (including those on steroids or with problems with their spleen), chronic heart or lung problems, diabetes, asthma, chronic kidney or liver disease. It is especially important that these children are vaccinated because they have the greatest risk of becoming very unwell if they get flu. Children aged from 6 months to 2 years who are at risk from complications of flu should be given the inactivated (injected) flu vaccine rather than the intranasal vaccine.

Click here for more information

Common myths about flu and the flu vaccine

'Flu isn't serious, so my child doesn't need a flu vaccine' and 'My children never get ill, so they don't need the vaccine'

It is tempting to think that flu is no worse than a bad cold, but in fact it is a serious disease which can infect anyone. Although most children do not become severely unwell with flu, in children with other medical conditions (heart or lung problems or weakened immune systems), flu can lead to hospitalisation or even death. In addition, children are superspreaders of flu, which means that even if they are mildly affected, they can easily infect other family members, such as grandparents or people with medical conditions who may become extremely unwell.

'My child is outside of the age range for routinely receiving the flu vaccine. Should I arrange for them to have it anyway?'

Although it is recommended that all children between 2 years of age and up to the 1st year of secondary school (year 7) have the flu vaccine, there are a large number of children outside of this age range that should also have it. This is because they have medical conditions that mean that they are at higher risk of getting severe infection if they are infected with flu. This includes children with:

• Respiratory (lung) diseases, including asthma
• Heart disease, kidney disease or liver disease
• Neurological (brain or nerve) conditions including learning disability
• Diabetes (see a short film of a woman with Type 1 diabetes talking about why she gets the flu vaccine)
• A severely weakened immune system (immunosuppression), a missing spleen, sickle cell anaemia or coeliac disease
• Being seriously overweight (BMI of 40 and above)

If your child falls into any of these categories and is not due to have their flu vaccine at school, please book them in to your GP practice to have it given (pharmacies are unable to give the flu vaccine to children).

'The nasal spray that children get is a live vaccine - I'm worried that if my child has it they will infect relatives/grandparents'

There is no evidence that healthy unvaccinated people can catch flu from the nasal flu spray (either from airborne spray droplets in the room where the vaccine is given, or from vaccinated individuals ‘shedding’ the virus).

It is known that vaccinated children shed the virus for a few days after vaccination (through sneezing or coughing). However, the vaccine virus is weakened (it is “cold adapted” which means it dies at 37°C), so cannot infect the lungs and so it is much less able to spread from person to person. The amount of virus that children shed is normally below the levels needed to pass on infection to others. The virus does not survive for long outside the body.

It is therefore not necessary for children to be excluded from school during the period when the vaccine is being given. The only exception is the very small number of children who are extremely immunocompromised (for example, those who have just had a bone marrow transplant).

'Last year my children had the flu vaccine but they got ill anyway, so it doesn't work'

No vaccine is 100% effective, including the flu vaccine. However, the vaccine usually prevents about half of all flu cases. For people who get flu after being vaccinated, the disease is often less severe than it would have been. It is important to remember that the flu vaccine only protects against flu, but there are other illnesses which have flu-like symptoms which you can still catch after getting the flu vaccine. It takes up to two weeks for the vaccine to take effect, so you could still catch flu if you are exposed to the virus during this time. Getting vaccinated as early as possible in the season can help to prevent this.

Use this video to explain to your child why they are having the flu vaccine

A huge amount of information collected over the past 6 months suggests that COVID-19 is not associated with a significant risk of harm for either pregnant women or their babies. Click here for more information.

If you fall within one of the current priority groups for vaccination and you are breastfeeding, there is no known risk to you or your baby from having the vaccine.

There is currently a lack of data about the safety of the vaccine during pregnancy. If you you are in the extremely clinically vulnerable group or are a frontline health or social care worker, you should talk to a health professional to help make an informed decision about whether you have the vaccine or not.

Click here for more information.

Dietitians and the British Dietetic Association have been asked many questions about nutrition and dietary issues related to the COVID-19 / Coronavirus pandemic.

If you have more specific concerns, please contact NHS 111 or your local health services in a safe and appropriate manner online or by phone.

Should I continue to breastfeed my baby?

The Royal College of Paediatrics and Child Health and Royal College of Obstetricians and Gynaecologists have issued wide ranging advice relating to COVID-19 / Coronavirus and breastfeeding and pregnancy. They make the following recommendations:

"At the moment there is no evidence that the virus can be carried in breastmilk, so it’s felt that the well-recognised benefits of breastfeeding outweigh any potential risks of transmission of coronavirus through breastmilk.

"The main risk of breastfeeding is close contact between you and your baby, as you may share infective airborne droplets, leading to infection of the baby after birth.

"A discussion about the risks and benefits of breastfeeding should take place between you, your family and your maternity team.

"If you choose to breastfeed your baby, the following precautions are recommended:

• Wash your hands before touching your baby, breast pump or bottles
• Try and avoid coughing or sneezing on your baby while feeding at the breast
• Consider wearing a face mask while breastfeeding, if available
• Follow recommendations for pump cleaning after each use

"If you choose to feed your baby with formula or expressed milk, it is recommended that you follow strict adherence to sterilisation guidelines. If you are expressing breast milk in hospital, a dedicated breast pump should be used."

This guidance may change as knowledge evolves, so please refer to the RCOG or RCPCH website for up to date advice.

I'm concerned about the supply of formula milk - what should I do?

Images of empty shelves and stories of shoppers fighting for food provisions has triggered panic buying across supermarkets in the UK. The UK government has advised that people should plan ahead on what is needed for self-isolation in the specified time frame only. Do not be misinformed by articles suggesting stockpiling beyond government advice. Follow the advice of UK supermarkets to avoid risking food shortages to others.

The British Specialist Nutrition Association (BSNA), which represents manufacturers, have stated all infant formula companies are continually monitoring supply and demand in the UK. If you are concerned, or require specific information, all infant formula companies can be contacted via their careline services. In the extreme case of shortages, please look for guidance directly from the manufacturers on using appropriate alternatives.

There have been claims that some infant formula companies are making free provisions to those unable to gain access to infant formula. This is not the approach of any infant formula company in the UK currently.

It is very important that you follow the manufacturers normal instructions on how to prepare your infant formula, unless otherwise advised by your healthcare professional. 'Watering down', manipulating or diluting the formula as a way to ‘ration’ your stock of powdered infant formula is not a good idea as the formula will no longer provide sufficient nutrition to your child.

For healthy infants over six months, cow’s milk (or alternatives where applicable) may be used in complementary foods, and as a main drink in those over one year. Offer other sources of calcium rich foods and continue to provide a varied diet, or where necessary, an age appropriate vitamin and mineral supplement daily.

If breastfeeding and using infant formula, consider replacing formula feeds with breastfeeds. If breastfeeding has been stopped, it is possible to re-start breastfeeding (contact the National Breastfeeding Helpline for assistance).

Some manufacturers have provided further information about accessing their products:

• SMA
• Cow and Gate
• Aptamil

Should I be considering early weaning if there are infant formula shortages?

There have also been claims that parents of infants should consider early introduction of complementary foods in light of the COVID-19 outbreak and potential infant formula shortages. This is not official advice.

Most infants should be offered complementary foods from around six months of age, only when they are developmentally ready. Some infants may begin complementary feeding after four months of age (but not before seventeen weeks). This should only start when developmental readiness has been achieved. Parents and caregivers should consult a healthcare professional when deciding to do this.

This Complementary Feeding Food Fact Sheet has lots more information about how and when to start this with your child.

Content: BDA

The COVID-19 pandemic has been hard for adults as well as children. More so than ever, it's important to set realistic expectations about what life should look and feel like; we need to recognise that nobody is doing fantastically well at the moment - the key is to just get through the next few weeks! Start by focusing on the basics - maintain a routine, eat properly, maintain good sleep habits and continue getting some fresh air. And most importantly, being kind to yourself.

For more info about focusing on the basics, click here.

Click here for some great tips for parents.

• The situation continues to change day by day. For the most up to date information on the situation, including advice about school attendance, need for testing or attendance to hospital for assessment, look at the updates provided by the UK government.

During lockdown most people, including children, have been much less active than normal because of the COVID19 restrictions. Children have not been walking to and from school, around school, playing at break times or taking part in their normal PE lessons and sports clubs. They have also had less contact with their friends and families where they may have also been physically active.

Although lots of families have stayed active within the COVID 19 restrictions, this has probably been to a different level and intensity than they would have been during a ‘normal’ week.

Our worry is that children may be less fit and strong than they normally are. This is sometimes described as being ‘deconditioned’. This could make their growing bodies more at risk of injury, as well as difficulties with overall fitness. Children may get puffed out more quickly and feel more tired after exercise.

We have provided some links to some useful information to help families increase their activity before going back to school. Everyone, adults and children, should build up their fitness slowly to make sure that they do not hurt themselves. By building up gradually children will have time to let their muscles grow and get used to doing more rather than it being a sudden change. We hope that this will help children to be fit and strong enough to fully take part in their normal activities when they re-start. We know that that may feel difficult right now so we have put some links with ideas and information below.

Links to helpful information about physical activity in children

• WHO Physical activity and young people

https://www.who.int/dietphysicalactivity/factsheet_young_people/en/

• NHS Physical activity guidelines for children and young people

https://www.nhs.uk/live-well/exercise/physical-activity-guidelines-children-and-young-people/?tabname=fitness-guides

• NHS - Couch to 5K

https://www.nhs.uk/live-well/exercise/couch-to-5k-week-by-week/

• NHS – Strength and flexibility

https://www.nhs.uk/live-well/exercise/strength-and-flex-exercise-plan/

• Change 4 life – Activities

https://www.nhs.uk/change4life/activities