What parents need to know about coronavirus (COVID-19)

Novel coronavirus (COVID-19) appears to generally cause mild illness in children. Less than 2 in every 100 cases diagnosed in China have been in children and infection appears to be 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 infections that can make children really unwell are still going round and one of the main risks to children at this time is delays in being brought to the attention of healthcare professionals when 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.


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 novel coronavirus 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 not been extremely few severe cases in children, including 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.

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, click here to help you decide.

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 16,500 deaths across the world from COVID-19 so far, almost none have been in children. Of the 380,000 people diagnosed with COVID-19 across the world, less than 2% of infections have occurred in children.

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.

Staff from Southampton Children's Hospital have written a brilliant free book about COVID-19 for children - click here to read it with your child.

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

Protecting your child from infection including shielding the most vulnerable

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:

Although it can be difficult, try to avoid environments where your child is likely to come in to close contact with people who are unwell (with fever and cough) and just as importantly, if your child has cough and fever, make sure that you keep them away from other people until they are better. For more information, please 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.

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

  • The incubation period of novel coronavirus is up to 14 days. This means that if your child remains well 14 days after contact with someone with confirmed coronavirus, they have not been infected.
  • If your child displays symptoms of infection (cough, breathing difficulty or fever) up to 14 days after a contact with someone with confirmed coronavirus, you must go indoors and avoid contact with other people (as you would do with the flu) and contact NHS 111 online or call NHS 111. If your child has moderate breathing difficulty (amber features), they will need to be reviewed by a healthcare professional in hospital. NHS 111 will arrange this. If your child has features of severe breathing problems (red features), call 999.

COVID-19 and ibuprofen

Although there is no evidence showing that ibuprofen is associated with harm in children with COVID-19, until we have more information, we suggest that you avoid ibuprofen unless you have been told that paracetamol is not suitable for your child.

What if your child displays symptoms of COVID-19?

  • 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 in hospital. If your child develops severe breathing problems (red features), call 999.

Making the process of testing less scary for children

1) The reason that you've been brought to the hospital is that you've become poorly and are finding it hard to breath. We need to test you for a tiny germ 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.

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.
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