COVID-19

It is important not to panic. Your child is only likely to get infected if they come into close contact with someone with COVID-19 who has symptoms of infection (cough, difficulty in breathing or fever). Close contact is defined as either direct face to face contact or being within 2 metres of that person for 15 minutes or more.

Reassuringly, COVID-19 seems to infect children far less frequently than it does 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. Although we do not yet fully understand whether any specific groups of children are at higher risk of severe disease than others, NHS advice is currently that children vulnerable to influenza are also likely to be more vulnerable to COVID-19. However, from what we know so far from China and Italy, there have been extremely few severe cases in children, even those with cancer or weakened immune systems.

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).

As of 16/03/2020, the UK government has taken a far more robust approach to reducing the spread of COVID-19, which was made even more stringent on 23/3/20. People should only be leaving their houses for one of four reasons:

1. To travel to and from work where absolutely necessary
2. To shop for essential items
3. To fulfil any medical or care needs
4. To exercise once a day

If any member of your family develops a fever or persistent cough, then your whole family needs to self-isolate for 14 days. The main reason for this is to protect those most vulnerable to severe COVID-19 from infection. This includes all people over the age of 70 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.

Families of the most vulnerable children will be contacted directly and asked to start shielding their child from COVID-19. This is the most drastic form of social distancing and involves staying at home and avoiding any face to face contact with anyone outside of their household unit for at least 12 weeks. For more information about shielding including which patients fall into this extremely vulnerable group, click here.

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 features below to help you decide.

The discussion about reopening schools has generated much anxiety amongst parents. So far, children in reception, year 1 and year 6 have returned to school. It appears unlikely that any other children will be returning to school before September.

There is so much conflicting information that parents are finding it really hard to know what the right thing is to do. This is reflected in the findings from a recent survey that suggested that fewer than half of parents would send their child back to school if they had the choice.

So what do we currently know about COVID-19 and children? They definitely get far milder illness than adults. The mortality (death) rate among children is currently estimated to be 0.01% (1 in 10,000 cases), which is similar to the rate for ‘normal’ flu and far lower than a lot of other infections. There is also increasing evidence showing that children are far less likely than adults to catch COVID-19 following exposure. Children also appear to transmit COVID-19 far less readily than adults; there have been no reported COVID-19 outbreaks in nurseries or schools, either in countries like Denmark that reopened their schools over a month ago (15th April), or countries such as Iceland that haven’t closed their schools at all during the pandemic or even from NHS nurseries that have been open for the children of key workers throughout the pandemic.

However, it’s important to accept that we don’t yet have all the answers (especially as we’ve only known about COVID-19 for the past few months) and that whatever we do is an educated guess, based on the scientific data available at the time and from the experiences from other countries; no current approach to reopening nurseries and schools is failsafe. However, based on the data we currently have, we are not expecting that reopening schools will result in a surge of unwell people that will overwhelm NHS services. Most importantly, we need to acknowledge that doing nothing is not a feasible option at this point, especially for the most vulnerable children in society. We currently have over 4.5 million children in the UK living in poverty (over 1 in 3 children). These are the children that have suffered most from lockdown, either from an educational perspective due to less access to home schooling compared to children from better off families, or as a direct impact on their physical or mental wellbeing in households with domestic abuse, parental substance misuse or parental mental health issues. These issues have worsened over the period of lockdown and have widened the inequality gap. Keeping schools closed will worsen social mobility and the future costs to the education system of attempting to rectify this will be substantial. The economic cost of lost income and productivity among parents, many of whom will have had to work less in order to provide childcare and home-schooling also falls disproportionately on lower-income families, where parents are less likely to have jobs that allow them to work from home in flexible ways.

The NHS changed its way of working overnight and schools are doing the same in order to keep teachers and children safe. Parents need to make sure that social distancing rules are maintained at drop-off and pick-up times. And we need to keep protecting those at highest risk of severe infection – the elderly should not be in contact with others at this point. And the government has hugely increased testing capability over the past month to allow symptomatic children to be tested rapidly to limit onward transmission to others. So if we do observe an unacceptable rise in cases in schools, we can simply reverse any changes we have made.

One size doesn’t fit all - there are obviously children who will be unable to return to school when they reopen; those being shielded or living in families where other individuals are shielding. These children may need to remain at home until either an effective vaccine has been developed or an effective treatment is found. However, this group make up a very small proportion of the 12.5 million children under the age of 16 in the UK.

So when it comes to making the decision about whether to send your child back to school, you need to not only think about the potential risk to your child and family if they do attend school, but just as importantly, the very real harm resulting from children not returning to school, both for your own child and for children across our wider society.

The Children's Commissioner for England, whose job is to promote and protect children's rights, has written about this in more detail here.

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 weeks, 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 250,000 deaths across the world from COVID-19 (updated 4/5/20), extremely few have been in children. Of the 3.5 million people diagnosed with COVID-19 across the world, less than 2% of infections had occurred in children. And 8 out of 10 people who get COVID-19 only experience mild symptoms.

And of the adults that have died, you can see from the picture below that it's those with multiple health problems involving various body systems that are most at risk.

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 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 need to be shielded from others for at least the next 12 weeks 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

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.
• Even if your child displays symptoms of infection (cough, breathing difficulty or fever) up to 14 days after a contact with someone with confirmed or suspected COVID-19, they are unlikely to become severely unwell. 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.

• The most common signs of COVID-19 are cough and fever.
• If your child has mild symptoms, they will not be tested for COVID-19. Instead, your whole family will be told to self-isolate for 14 days. Click here for information on self-isolation and for info for other household members. Only children who are admitted to hospital with moderate/severe symptoms of COVID-19 are being tested. This is because there is a limited supply of testing kits available and children being admitted to hospital need to be prioritised to avoid the spread of infection within the hospital.
• 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.
• If your child develops moderate breathing difficulty (amber features) whilst your family are self-isolating, you will either need to contact NHS 111 online or call NHS 111. They will arrange for your child to be seen by a healthcare professional. If your child develops severe breathing problems (red features), call 999.

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.

1) The reason that you've been brought to the hospital is that you've become poorly and are finding it hard to breath. If you're so poorly that you need to stay in the hospital (be admitted), we will test you for COVID-19. COVID-19 is a tiny germ (virus) that so small that you can't see it. We don't think that it will make you very poorly but we don't want it to spread to other people

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) Once you've been tested, you will be looked after in the hospital. It might take 2-3 days for the test result to come back. You may be in hospital for some or even all of that time (or even longer if you're still finding it hard to breath).

When you're allowed to go home, it's really important that you 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.

• 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 Public Health England.