COVID-19 appears to generally cause mild illness in children. This includes the Omicron variant that we’ve started seeing since December 2021. Even though it transmits more easily (in children and adults) compared to previous variants , it does not appear to cause more severe disease in adults or children.
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.
There is no evidence to suggest that the Delta or Omicron variants are more likely to infect children compared to previous strains. And even if children are infected, they generally experience mild illness. There have been relatively 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 underlying chest problems - even when they have been infected with COVID, they have generally experienced mild infection.
Hospital admission rates in the week ending 5 December 2021.
There are still little data available about the severity of the Omicron variant but there is no suggestion so far that this will lead to severe infection in children, including those who are unvaccinated (such as children under 12 years of age).
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).
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.
The COVID-19 vaccination is now recommended for all children aged 5 years and over. However, for children aged 5-11 years, the vaccine is initially being prioritised for children at higher risk of severe COVID-19 infection. Once the vaccine has been offered to this group, it will then be offered to all other 5-11 year olds.
Children should receive their 2nd COVID vaccine 12 weeks after their 1st dose (although a second dose can be given after 8 weeks in children at higher risk of severe COVID-19 infection). Click here to book it now.
Although the risk of severe COVID-infection in children remains extremely low, the main reason for vaccinating children is to offer protection against a future strain that could potentially be more severe. In addition, it has also been shown that the risk of COVID-19 associated inflammatory syndrome (PIMS) is lower in children who have been vaccinated. Most young people are extremely keen to be vaccinated. Some concerns have been raised about the risk of young people developing inflammation of the heart (myocarditis or pericarditis) following the COVID-vaccine. However, we now have a far better understanding of this because many countries have been vaccinating children aged 5 years and over for many months. The risk of myocarditis and pericarditis is low (approximately 1 in 100,000 risk) and is usually very effectively treated with simply treatment such as non-steroidal anti-inflammatory drugs such as ibuprofen. It is slightly more common in boys than in girls and is more likely to occur after the 2nd dose of the vaccine rather than the 1st. Very few cases have been reported in children below 12 years of age. The image below weighs up the benefits and risk of children being vaccinated (thanks to BBC news):
The COVID vaccine has been offered to vulnerable children aged 5-11 years from the start of February 2022. It will then be made available to all other 5-11 year olds after that. It is important that parents have clear information about why the COVID vaccine is being offered to these children; here are some questions commonly asked by parents:
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 you child is unwell, look at the red/amber/green section below for information about what you should do. They can goback to school when they no longer have a high temperature and they are well enough to attend. They do not require a COVID test unless specifically instructed by a healthcare professional.
If your child has none of the symptoms above but is poorly with headache, muscle aches, fatigue, abdominal pain, diarrhoea and/or vomiting or lethargy, they should remain at home until they feel better (click here for more information). If they have diarrhoea or vomiting they should not return to school until 48 hours after last having diarrhoea or vomiting. If you are worried that your child is unwell, look at the red/amber/green section below for information about what you should do.
If your child has a runny nose, sore throat or occasional cough but none of the symptoms above, they can go to school.
Click here for information on self-isolation and for info for other household members.
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.
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 the 2-4 weeks following infection with COVID, some children develop an inflammatory syndrome that can affect their heart muscle (myocarditis) their 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. Fortunately, there are readily available treatments that are highly effective to treat this.
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 have conducted studies to provide information about how best to treat children with PIMS.
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?
Based on data collected across the UK, the risk of developing PIMS-TS following COVID is about 0.05% (of ten thousand children who are infected with COVID, only about 5 will develop PIMS-TS). Almost all of these have been successfully treated.
Have any children died from PIMS?
A very small number of children have died from PIMS in the UK. Most children make a full recovery. In the UK, many more children die of other infections such as flu or even chicken pox every year, compared to PIMS. All children with PIMS will receive a medical follow up.
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.
Children and teenagers may be experiencing long term symptoms or problems from COVID-19. Symptoms may include fatigue, brain fog, pain, breathing difficulties, headaches, anxiety, low mood and sleep disturbances. You may see the effect of this in different ways including poor school attendance, difficulty maintaining usual activity levels and increased anxiety.
Whilst most children / teenagers will get better without any specialist help, if symptoms are persisting for more than 12 weeks and these is having a significant impact on how they are able to function, help should be sought from your GP who can assess your child and refer them to a Long Covid service if appropriate. Your local long COVID service is likely to include a multidisciplinary specialist team such as a paediatrician, occupational therapist, physiotherapist and psychologist. They will review your child’s symptoms, and meet with them face to face if necessary. The team will work with colleagues to help the child receive the right help, therapy and support that they need. They will also provide signposting to self-help / community resources.
Resources:
https://www.yourcovidrecovery.nhs.uk/
Sleep hygiene information and downloadable leaflet
Fatigue management
Instructions for completing daily fatigue diary
Energy Measure Instructions
If your child lives in Hampshire or the Isle of Wight, click here for more information about the long COVID service.
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; extremely few children children have died. he vast majority of children who get infected with COVID have very mild symptoms or no symptoms at all.
Deaths from COVID registered in the week ending 26 November 2021.
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 rules about people being made to wear face masks / face covering on public transport and in most indoor places applies to children aged 11 years of age and older - click here for more information. 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:
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. 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:
Remember: if the answer to any of the questions above it "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.
All children between 2 and 15 years of age (year 11) 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
COVID-19 vaccines are recommended in pregnancy. Vaccination is the best way to protect against the known risks of COVID-19 in pregnancy for both women and babies, including admission of the woman to intensive care and premature birth of the baby
Studies from the UK show that although pregnant women are no more likely to get COVID-19 than other healthy adults, they are at increased risk of becoming severely unwell compared to non-pregnant women, particularly in the third trimester.
In pregnant women with symptoms of COVID-19, it is twice as likely that their baby will be born early, exposing the baby to the risk of prematurity. A recent study has also found that pregnant women who tested positive for COVID-19 at the time of birth were more likely to develop pre-eclampsia, more likely to need an emergency caesarean and their risk of stillbirth was twice as high, although the actual number of stillbirths remains low.
Please click here for further information
COVID-19 vaccines are recommended in pregnancy. All pregnant women and girls in the UK aged 16 and over have now been offered a COVID-19 vaccine.
On 16 April 2021, the Joint Committee on Vaccination and Immunisation advised that all pregnant women should be offered the COVID-19 vaccine at the same time as the rest of the population, in line with the age group roll out. Previously their advice was that pregnant women at high risk of exposure to the virus or with high risk medical conditions should consider having a COVID-19 vaccine in pregnancy.
Vaccination is the best way to protect against the known risks of COVID-19 in pregnancy for both women and babies, including admission to intensive care and premature birth.
The decision whether to have the vaccination in pregnancy is your choice. Make sure you understand as much as you can about COVID-19 and about the vaccine and you may want to discuss your options with a trusted source like your doctor or midwife.
COVID-19 vaccines are recommended to breastfeeding women. There is no plausible mechanism by which any vaccine ingredient could pass to your baby through breast milk. You should therefore not stop breastfeeding in order to be vaccinated against COVID-19.
Please click here for more information.
To book your COVID-19 vaccine click here
Yes. There is a wealth of evidence that breastfeeding reduces the risk of babies developing infectious diseases. There are numerous live constituents in human milk, including immunoglobulins, antiviral factors, cytokines and leucocytes that help to destroy harmful pathogens and boost the baby’s immune system. There is currently no evidence that Covid-19 can be passed to the baby through breastfeeding. There is also evidence that mothers with Covid-19 pass their antibodies to their baby through breastmilk, thereby giving protection to their baby.
You may wish to consider the following precautions
(Source: https://www.unicef.org.uk/babyfriendly/covid-19/ )
