COVID-19 information for parents/carers

Your child is only likely to get infected if they come into close contact with someone with Covid-19. Close contact is defined as either face to face contact under 1 metre for more than a minute or within 2 metres for more than 15 minutes. 

Many more children are being infected with Covid-19 but for most it remains a very mild illness. Most of the severe cases have been in elderly people with medical conditions such as heart problems or lung disease. Children with chronic health problems such as asthma do not appear to be at more risk, however all children aged five years and over are being offered a vaccination.

If you are worried about your child's breathing and are not sure if they need to be seen by a healthcare professional, more information on coughs and colds can 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 a COVID-19 disease. There is a national plan in place for children that require intensive care support (PICU).

If your child or a member of your family has Covid-19 then check the current NHS advice, and government guidance.

Social distancing is the most effective way of minimising the spread of COVID-19. You may choose to limit the close contact you have with people you do not usually live with. These are personal choices and it is important to consider that others may wish to continue to take a more cautious approach. 

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

Specific groups of children who are at the highest risk of severe infection were initially advised to shield from others.

Governments in England and Wales have updated guidance for children and young people with underlying health conditions. They will now be advised following the same guidance as the rest of the population on how to stay happy, healthy and well during the pandemic, and will no longer be seen as “clinically extremely vulnerable” (CEV) and will be removed from the Shielded Patient List.

More information can be found in the Royal College of Paediatrics and Child Health (RCPCH) guidance.

Shielding has now come to an end as more people have been vaccinated.

For more information on guidance for people previously considered clinically extremely vulnerable from COVID-19 see the government website.

For specific information for children and young people with cancer undergoing cancer treatment is available on the CCLG website.

If your child is aged 12 years or over and they are at highest risk of getting seriously ill from COVID-19, they are eligible for COVID-19 treatments if they have symptoms and a positive test.

If your child is under a specialist team in the hospital and you are worried about issues relating to their long term condition, contact your child's medical team in the usual way for further advice.

• Children and young people with mild symptoms such as a runny nose, sore throat, or slight cough, who are otherwise well can continue to attend school or college.
• Children and young people who are unwell and have a high temperature should stay at home and avoid contact with other people where they can. They can go back to nursery, school or college when they no longer have a high temperature and are well enough to attend.
• Nationally, education and childcare settings are open, and attendance is mandatory (for schools) and strongly encouraged (at childminders, nurseries and colleges)
• The Royal College of Paediatrics and Child Health has made it clear that the overwhelming majority of children and young people still have no symptoms or very mild illness only
• Children and young people previously considered CEV should attend school and should follow the same COVID-19 guidance as the rest of the population
• Face coverings are no longer advised for pupils, staff and visitors in classrooms and communal areas
• Contacts are no longer required to self-isolate or advised to take daily tests. Contact tracing has ended.
• Staff and pupils in mainstream school are no longer expected to take part in regular asymptomatic testing.
• All children aged five and over are now eligible for a COVID-19 vaccination

There is government guidance for people with symptoms of respiratory infections including COVID-19. If you have concerns about your child attending, you should discuss these with your school or college.

What is PIMS?

Paediatric Multisystem Inflammatory Syndrome (called PIMS-TS or PIMS for short) is rare. It occurs in less than 0.5% of children who have had COVID-19. Most children will not be seriously affected but in a very small number of cases it can be serious.

Children with PIMS have 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. 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 your 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 children as quickly as possible and which are the most suitable treatments for each child.

What symptoms should I look out for?

All children with PIMS will have a temperature which continues over several days. There is a wide range of other symptoms children may have including tummy pain, diarrhoea, vomiting, rash, cold hands and feet or red eyes. These 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. The advice to parents remains the same: COVID-19 is extremely unlikely to make your child unwell; if you are worried about your child, take a look at the red/amber/green symptom guide above and if required, contact NHS 111 or your GP for urgent advice, or 999 in an emergency. 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, call NHS 111 or contact 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.

Doctors are continuing to collect information about the ways that PIMS affects children.

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 these 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 showing 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.

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 tests, 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.

There is more information available from the Royal College of Paediatrics and Child Health.

COVID-19 is spread by droplets (mucus and saliva) and aerosols (tiny particles in the air). Your child needs to be in 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.

Trying to stop your child touching their face (unless they have just washed their hands) will also reduce the risk of them getting infected.

If the number of positive cases significantly increases in your nursery, school, or college, or if your nursery, school, or college is in an enhanced response area, you might be advised that face coverings should temporarily be worn in communal areas or classrooms (by pupils, staff and visitors, unless exempt).

Decisions about mask use in children should be based on the best interest of the child.
Children need to continue to be able to play, go to school and go about their everyday activities. These activities are an important part of child development and health.
No child should be denied access to school or activities because of lack of a mask.

Face masks should not be used for children aged 5 years and under, this is from WHO & UNICEF advise.

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.

Individuals are not required to self-isolate if they live in the same household as someone with COVID-19, or are a close contact of someone with COVID-19.

Children and young people who usually attend school who have been identified as a close contact should continue to attend school as normal.

You should avoid contact with anyone you know who is at higher risk of becoming severely unwell if they are infected with COVID-19. Limit close contact with people outside your household where possible. Older children and young people are advised to wear a face mask in crowded, poorly ventilated spaces.

Follow this advice for 10 days after the person they had contact with symptoms started. Further information is available in the guidance for people with symptoms of a respiratory infection including COVID-19.

If your child develops symptoms of COVID 19 follow the advice in the next section. If you are worried about your child, take a look at the red/amber/green symptom guide above and if required, contact NHS 111 or your GP for urgent advice, or 999 in an emergency.

• The most common signs of COVID-19 are cough and temperature
• Other possible symptoms include loss of taste or smell, shortness of breath, tiredness, loss of appetite, muscle ache, sore throat, headache, runny nose, diarrhoea, feeling sick and vomiting.
• Here you can find the guidance for households with possible or confirmed coronavirus (COVID-19) infection. 
• Children and young people who are unwell and have a high temperature should stay at home and avoid contact with other people, where they can. They can resume normal activities when they no longer have a high temperature and they are well enough.
• It is not recommended that children and young people are tested for COVID-19 unless directed to by a health professional.
• If a child or young person has a positive COVID-19 test result they should try to stay at home and avoid contact with other people for 3 days after they took the test. After 3 days, if they feel well and do not have a high temperature, the risk of passing the infection on to others is much lower. This is because children and young people tend to be infectious to other people for less time than adults.
• All children and young people with respiratory symptoms should be encouraged to cover their mouth and nose with a disposable tissue 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) while they 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

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 it 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. 

For more information about Covid 19 vaccinations:

https://www.nhs.uk/conditions/coronavirus-covid-19/coronavirus-vaccination/

https://www.rcpch.ac.uk/resources/covid-19-vaccination-children-young-people

https://vk.ovg.ox.ac.uk/vk/covid-19-vaccines

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 gov.uk.