COVID-19 information for parents/carers

What parents need to know about COVID-19

COVID-19 appears to generally cause mild illness in children. This includes the new strains that we’ve started seeing since December 2020; even though some of them transmit more easily (in children and adults),  none of them appear to cause more severe disease.

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. 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.

The Royal College of Paediatrics and Child Health also has up to date resources for parents:

https://www.rcpch.ac.uk/resources/covid-19-resources-parents-carers 

Reassuringly, COVID-19 seems to infect children far less frequently than it does adults. And if children are infected, they generally experience mild illness.

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 announced that vaccination should be considered first for children aged 12-15 years with these conditions.

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 which is rarely seen. 

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.

Symptom specific advice can also be found below:

FEVER

COUGH AND COLD

DIFFICULTY BREATHING

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 - to 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 3 months 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

Symptom specific advice can be found below:

FEVER

COUGH AND COLD

DIFFICULTY BREATHING

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 for 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.
  • 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

Please ring your GP surgery or out of hours contact NHS 111 for advice – dial 111 or for children aged 5 years and above visit 111.nhs.uk

Symptom specific advice can be found below:

FEVER

COUGH AND COLD

DIFFICULTY BREATHING

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
  • 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, contact your GP or out of hours NHS 111 – dial 111 or for children aged 5 years and above visit 111.nhs.uk

 

Symptom specific advice can be found below:

FEVER

COUGH AND COLD

DIFFICULTY BREATHING

  • The most common signs of COVID-19 are cough and fever.
  • If your child has a fever, cough and/or loss of taste or smell they will need to have a PCR test. A lateral flow test is not sufficient if they have symptoms. They will need to isolate under the result of the test. 

    https://www.gov.uk/get-coronavirus-test 

  • 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.
  • Below is a flow chart to help you navigate returning to school or nursery and when you can stop isolating. PDF version available 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.

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.

Symptom specific advice can be found below to help you decide who to seek help from whether it is your GP or A&E/999:

FEVER

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 next 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?

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.

The most updated advice on what groups of children are more at risk and may need to shield is below. 

https://www.rcpch.ac.uk/sites/default/files/generated-pdf/document/COVID-19---guidance-on-clinically-extremely-vulnerable-children-and-young-people.pdf 

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.

As of 4/8/21, COVID-19 vaccination is recommended in all children aged 16 years and over. From 13/9/21 this was expanded to all 12-15 year olds. 

At present, there are no COVID-19 vaccines licenced for children below 12 years of age in the UK.

For more information about UK COVID-19 vaccine recommendations in children and the relevant risks and benefits, click here.

The rules about people being made to wear face masks / face covering on public transport and in shops applied to children aged 11 years of age and older. With for younger children, it was up to the parent/carer as to whether they wear a face mask or not. This now applies to all ages as the restrictions have been removed atlhough some venues may ask you to wear a mask as a recommendation. 

However, face masks should NOT be used for babies and children under 2

Wearing a face mask in this age group can out 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.

 

1) 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) 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.

 

As of 4/8/21, COVID-19 vaccination was  recommended in all children aged 16 years and over followed on the 3/9/21 by children aged 12-15 with certain underlying conditions or being household contacts of persons (adults or children) who are immunosuppressed with a comprehensive guide here

From 13/9/21 this was expanded to all 12-15 year olds with a comprehensive guide here

At present, there are no COVID-19 vaccines licenced for children below 12 years of age in the UK.

For more information about UK COVID-19 vaccine recommendations in children and the relevant risks and benefits, click here.

  • 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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