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COVID-19 appears to generally cause mild illness in children.
However,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.
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.
Although there are very little data to clearly identify any specific groups of children at risk of severe infection, it appears that children with severe neurological (brain) conditions that affects their breathing, as well as children with Down's syndrome and those with weakened immune systems are perhaps at higher risk of getting unwell if they contract COVID. For this reason, the government has announced that vaccination should be considered for children aged 12-15 years with these conditions (as of 4/8/21, COVID-19 vaccination is recommended in all children aged 16 years and over). At present, there are no COVID-19 vaccines licenced for children below 12 years of age. For more information about UK COVID-19 vaccine recommendations in children, click here.
For specific information for children and young people with cancer undergoing cancer treatment, click here.
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 will not be caused by COVID-19 and that COVID-19 generally causes far milder illness in children compared to adults.
If a child or young person aged 18 or under tests positive for COVID-19, they should try to stay at home and avoid contact with other people for 3 days. This starts from the day after they did the test. Children and young people tend to be infectious to others for less time than adults. If they’re well and do not have a temperature after 3 days, there’s a much lower risk that they’ll pass on COVID-19 to others. However, try avoiding them meeting people at higher risk from COVID-19 for 10 days, especially if their immune system means they’re at higher risk of serious illness from COVID-19, even if they’ve had a COVID-19 vaccine
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.
If your child has any of the following:
You need urgent help:
Go to the nearest A&E department or call 999
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.
If none of the above features are present
Self Care:
Continue providing your child's care at home. If you are still concerned about your child, call NHS 111 - dial 111.
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 2020, doctors in the UK first started to see children with serious inflammation throughout their body, which seemed to be linked to COVID-19. 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 body. If this happens, it is important that children receive urgent medical attention.
Doctors are concerned that in some children with PIMS the inflammation can affect the blood vessels (vasculitis), particularly those around the heart. If untreated, the inflammation can cause tissue damage, poor function of vital organs or potentially even death.
Some of the symptoms of PIMS can overlap with other rare conditions, such as Kawasaki disease and Toxic Shock Syndrome which is why it has been described as ‘Kawasaki-like’. Complications from each of these conditions 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. Treatments to reduce inflammation in the body may need to be given.
Researchers are working to find out more about PIMS and which treatments are the most suitable treatments for each patient.
What symptoms should I look out for?
All children with PIMS will have a fever, which persists over several days. There’s a very wide range of other symptoms that children might have, including: tummy pain, diarrhoea, vomiting, rash, cold hands and feet and red eyes. These symptoms can be found in other illnesses too.
While most won’t be seriously unwell, 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.
If the child has a temperature of 38⁰ or higher, cold hands and feet and is sleepy, call your GP or 111. If symptoms persist and you have not been able to speak to either a GP or 111, take your child to the nearest A&E.
If your child doesn’t have these signs of being seriously unwell but you are still concerned, talk to your 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. However, between April and June 2020, doctors reported seeing around 200 children with the condition. We are now in the second wave of COVID-19 and doctors expect to see more cases of PIMS over the next few months as the numbers of people in the country with COVID-19 is currently high.
Doctors are continuing to collect information about the ways that PIMS affects children. It is possible that more children have had the condition but were very mildly affected and recovered without seeing a doctor.
Have any children died from PIMS?
We don’t know for sure because there isn’t a test for this condition, however this would be extremely rare. Most children would be expected to make a full recovery. All children with PIMS will receive a medical follow up. Doctors think two children may have died with PIMS in the UK, but they can’t be certain that there weren’t other reasons why the children died. Doctors believe deaths in children related to PIMS, throughout the world, are exceptionally rare. In the UK, 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 can tell doctors 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.
Are black or Asian children more likely to be affected?
Children from all ethnic minority backgrounds have been affected by PIMS. There have been more children affected by PIMS who are from Black and Asian backgrounds, but it is not clear what the reasons for this are at the current time. It is possible that this is because there were higher numbers of COVID-19 cases in these communities. But it is important for families with all ethnic 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.
Here are a few animations answering questions commonly asked by children and young people:
What is a virus and how does our body fight COVID-19?
What is Coronavirus, how did it start and how does it spread?
Will i get COVID-19 and how do i stay safe?
Is there a cure for Coronavirus, when will life go back to normal and will the virus ever go away?
What is a vaccine, how does the coronavirus vaccine work and can you still catch COVID-19 if you have had the vaccine?
What is it like having a COVID test?
Annabelle’s lateral flow swab test
Who needs to have a COVID lateral flow test at school?
All children and young people aged 5 to 15 (on 31 August 2022) are eligible for 2 doses of the coronavirus (COVID-19) vaccine. The number of additional doses they may be eligible for depends on their age and if they have any additional risk factors. If your child turned 5 after 31 August 2022 and has no additional risk factors or is not living with someone with additional risk factors, they are not eligible for the coronavirus vaccine. Click here for information about additional risk factors.
Children and young people aged 5 to 15 with additional risk factors are eligible for a coronavirus winter booster vaccine. The winter booster dose will be offered from 12 weeks after the second or third primary dose. This will help to improve protection from coronavirus this winter. If your child is eligible for a winter booster vaccine they'll receive an invitation letter with an appointment to get the vaccine.
COVID-19 is spread by droplets. 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.
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
Hips
Heart
If the answer to any of these is "yes", you should speak to someone the same day:
The routine 6-8 week review is also anopportunity 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
'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:
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.
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:
"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.
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:
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
