COVID-19

What parents need to know about COVID-19

COVID-19 appears to generally cause mild illness in children. Only 1 in every 100 cases diagnosed in the UK have been in children and infection is generally far milder in children than it is in adults, although we do not yet understand exactly why this is the case.

However, at this time, when everyone is preoccupied with COVID-19, it's really important to realise that not every illness your child has is due to COVID-19. All the 'normal' infections that can make children and babies really unwell still remain and there is a major risk that parents may delay bringing their child to the attention of a healthcare professionals even if they are unwell. If you are not sure if your child is unwell and whether they need to be seen by someone, click here to help you decide. GPs and hospitals are still providing the same safe care that they always do for children.

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Should you be worried?

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. Only about 1 in every 100 cases of COVID-19 diagnosed in the UK have been in children. And if children are infected, they generally experience mild illness. Only about 3 in 100 school age children who have been infected have required admission to hospital. 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).

If any member of your family is infected with COVID-19, 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.

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.

Red Features

If your child has any of the following:

  • Becomes pale, mottled and feels abnormally cold to the touch
  • Has pauses in their breathing (apnoeas), has an irregular breathing pattern or starts grunting
  • Severe breathing difficulty - too breathless to talk / eat or drink
  • Is going blue round the lips
  • Has a fit/seizure
  • Becomes extremely distressed (crying inconsolably despite distraction), confused, very lethargic (difficult to wake) or unresponsive
  • Develops a rash that does not disappear with pressure (the ‘Glass test’)
  • Babies under 1 month of age with a temperature of 38°C / 100.4°F or above
  • Has testicular pain, especially in teenage boys

You need urgent help:

Go to the nearest A&E department or call 999

Amber Features

If your child has any of the following:

  • Is finding it hard to breathe including drawing in of the muscles below their lower ribs, at their neck or between their ribs (recession)
  • Seems dehydrated (sunken eyes, drowsy or no urine passed in 12 hours)
  • is becoming drowsy (excessively sleepy) or irritable (unable to settle them with toys, TV, food or picking up) - especially if they remain drowsy or irritable despite their fever coming down
  • Has extreme shivering or complains of muscle pain
  • Babies 1-3 months of age with a temperature of 38°C / 100.4°F or above
  • Infants 3-6 months of age with a temperature of 39°C / 102.2°F or above
  • For all infants and children with a fever of 38°C or above for more than 5 days.
  • Has persistent vomiting and/or persistent severe abdominal pain
  • Has blood in their poo or wee
  • Any limb injury causing reduced movement, persistent pain or head injury causing persistent crying or drowsiness
  • Is getting worse or if you are worried

Immediately contact your GP and make an appointment for your child to be seen that day face to face.

We recognise that during the current COVID-19 crisis, at peak times, access to a healthcare professional may be delayed. If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, then consider taking them to your nearest ED.

Green Features

If none of the above features are present

  • You can continue to provide your child care at home. Information is also available on NHS Choices
  • Additional advice is available to families for coping with crying of well babies
  • Additional advice is available for children with complex health needs and disabilities.
  • If your child has been burned, click here for first aid advice and for information about when to seek medical attention

Self Care:

Continue providing your child's care at home. If you are still concerned about your child, call NHS 111 - dial 111.

Is it safe for children to go back to school?

The discussion about reopening schools has generated much anxiety amongst parents. However, the government has made it clear that they expect all children to return back to school in September and have put systems to place to make this as safe as possible. This even includes children attending special educational needs schools and extremely vulnerable children who were previously shielding. However, there is so much conflicting information that parents are finding it really hard to know what the right thing is to do. However, being aware of the current data on COVID-19 is essential for reassuring parents and teachers that it is safe to send children back to school this September.

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 0.03% (3 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 primary school children are far less likely than adults to catch COVID-19. Children also appear to transmit COVID-19 less readily than adults; there have been very few reported COVID-19 outbreaks in nurseries or schools, either in countries like Denmark that reopened their schools early in the pandemic (15th April), or countries such as Iceland or Sweden that didn't close their schools at all during the pandemic. And the R number didn't go up after schools reopened in Denmark and in Sweden children continue to have the lowest rates of COVID infection despite being at school. Almost all of the cases in education settings had arisen from infection within the family as opposed to infection in school. This shows how important it is to keep COVID-rates in the community as low as we possibly can, even if it involves once again closing gyms, pubs and non-essential shops in order to reduce the risk of outbreaks in schools.

Reassuringly, teachers in Sweden didn't have higher rates of COVID than the general population (and they had lower rates than professions such as supermarket workers and taxi drivers).

However, it’s important to accept that we don’t yet have all the answers 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 fail-safe. 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. However, we cannot afford to be complacent. Test and trace systems are in place to ensure that children and teachers are tested rapidly if they develop systems of COVID-19, with the government hugely increasing testing capability over the past few months. So if we do observe an unacceptable rise in cases in schools, we can act rapidly and appropriately. Local infection and public health experts will be constantly reviewing these tests results so that in the unlikely event of an outbreak in a school, this will be identified early to minimise the number of children and teachers affected.

Most importantly, we need to acknowledge that doing nothing is not a feasible option at this point,. Our children's education is suffering, along with their mental heath. And the impact of school closures has been hardest on 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.

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.

She has also produced the following information for children about returning to school this September - click here.

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

COVID-19 associated inflammatory syndrome (PIMS)

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.

Talking to children about COVID-19

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.

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.

In addition, the following information has been produced for children about returning to school this September - click here.

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

Protecting your child from infection

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.

Face masks and children

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.

What should you do if your child comes into contact with COVID-19?

  • The incubation period of COVID-19 is up to 14 days. 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 14 days from the date of that contact.
  • 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. 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.

COVID-19 and ibuprofen

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.

What if your child displays symptoms of COVID-19?

  • The most common signs of COVID-19 are cough and fever.
  • If your child develops symptoms of COVID-19, they will need to be tested. Whilst waiting for the result, your family will need to self-isolate. 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.
  • 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.

Making the process of testing for COVID-19 less scary for children

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.

6-8 week mother and baby check and the importance of childhood vaccines

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.

Keeping up to date with the situation

  • 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.

Getting back to activity post lock down

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

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