[updated 20th May 2020]
The main sources of information for this page are:
- "COVID-19 - 'shielding' guidance for children and young people" by the Royal College of Paediatrics and Child Health
- “COVID-19 - talking to children and families about returning to school: guiding principles” by the Royal College of Paediatrics and Child Health
- parent and carer leaflet (PDF) developed by the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN)
what are the risks of COVID-19 to children?
National and international data shows that the numbers of children requiring hospital admission as a direct consequence of COVID-19 infection is low, and those needing PICU (paediatric intensive care unit) admission is lower still. It appears children still have infection but in the vast majority it is much milder than that seen in adults.
Recently issued NICE guidance for health professionals and care staff has been recently summarized in the British Medical Journal. The article says doctors should reassure parents and carers of children who are immunocompromised that immunosuppression does not seem to increase the risk of severe covid-19.
“Covid-19 usually causes a mild, self-limiting illness in children and young people, even in those who are immunocompromised,” NICE says.
Children and teenagers who are immunocompromised and their carers may be feeling particularly anxious and fearful about covid-19, so it is important they are involved in decision making as much as possible, NICE advises. Doctors should also support patients’ and carers’ mental wellbeing through communication and by signposting to charities and support groups.
It is also important to recognise that during this current pandemic, children who are unwell remain more likely to be unwell due to a non-COVID-19 condition than to COVID-19 itself; this includes those with the conditions described in this guidance. ESPGHAN has a useful checklist for all symptoms where parents are recommended to immediately seek medical advice.
However, some children may remain more at risk of COVID-19 related disease, and these children should be protected as far as is possible from infection by 'shielding'.
'Shielding’ means to strictly avoid contact with someone who is displaying symptoms of coronavirus infection and for your child not to leave your home, therefore not going out for shopping, leisure or travel. Government guidance for shielded patients to minimise all non-essential contact with other members of their household/family might not be possible in young children. It is however advisable to keep the number of carers who look after ‘shielded’ children to a minimum and for those carers to stringently follow ‘social distancing’.
which children need 'shielding'?
Public Health England's list of conditions for adults and children to which they advise 'shielding' is important. How best to apply this to children and young people in the UK is complex. Although in adults these co-morbidities (additional health conditions) are associated with an increased mortality risk, the evidence for this among children and young people is very limited.
The current consensus on paediatric patient groups where 'shielding' is recommended is likely to be updated in due course to minimise the burden of 'shielding' for those who do not need it.
Some children with the diagnoses listed below will have less severe disease and 'shielding' might be considered unnecessary.
Therefore, parents should discuss with the clinicians most closely involved in the care of your child and family, to balance the risks. If they agree shielding is not needed, 'social distancing' should be strongly adhered to. Public Health England has guidance on social distancing for vulnerable people and isolation advice when living with children.
what is the specific advice for children with inflammatory bowel disease?
The RCPCH (professional association for child health specialists) in conjunction with BSPGHAN (professional association for paediatric IBD specialists) have updated their guidance on which children are clinically extremely vulnerable and need to be shielded. For gastroenterology this includes:
- PIBD (paediatric inflammatory bowel disease) patients with significant co-morbidity (respiratory, cardiac, hypertension or diabetes mellitus) and are on any 'moderate risk' therapy for IBD and / or have moderate to severely active disease (discuss with specialist)
- PIBD patients regardless of comorbidity and who meet one or more of the following criteria:
- Intravenous or oral steroids ≥20mg prednisolone (or >0.5mg/kg)^ or equivalent per day (only while on this dose)
- Commencement of biologic plus immunomodulatory or systemic steroids with previous six weeks
- Moderate to severely active disease not controlled by 'moderate risk' treatments
- Short gut syndrome requiring nutritional support
- Requirement for parenteral nutrition
- Intestinal failure on home parenteral nutrition
- Immune suppression for organ transplant or auto immune hepatitis
If you have received a shielding letter for your child but their condition or treatment is not covered in the list above, or you would have expected to receive a shielding letter but haven’t, we recommend you contact your IBD team and ask for their advice.
Children with IBD who do not require shielding are advised to stringently follow social distancing, particularly if taking the following medicines:
- One immunomodulatory drug (e.g. azathioprine, methotrexate) or
- One biologic (e.g. adalimumab, infliximab, ustekinumab or vedolizumab) or
- A combination of an immunomodulatory drug with a biologic without signs of active IBD.
For children with IBD who are unwell with signs of active IBD and/or:
- require high doses of systemic steroids (e.g. prednisolone; threshold varies according to body weight and will be guided by your IBD Team) or
- are within 6 weeks of starting treatment with biologics (e.g. infliximab, adalimumab, ustekinumab or vedolizumab).
Crohn's and Colitis UK have developed a decision tree for the risk in children (opens PDF) to understand whether your child should be shielded.
should my child go back to school?
The government advice on returning to school varies by nation, with Scotland and Wales not focussing on 1 June as a key date, and Northern Ireland not expecting a return to school until September. We will update our advice for these nations when new guidance is issued.
In England, the government has issued guidance for parents and carers on opening schools and educational settings to more pupils from 1 June.
There are two categories that are likely to apply to children with IBD – those considered ‘clinically extremely vulnerable’ and those considered ‘clinically vulnerable’. The advice varies depending on which of these categories applies to a child and some children with IBD will not be in either category.
Expert advice is that clinically extremely vulnerable children should remain shielded and not to return to school, even if their year group has. The list above will be updated as evidence becomes available from both national data collection and published studies, which will minimise the burden of 'shielding' for those who do not need it.
Clinically vulnerable children who are only under the care of primary care (GPs) are overwhelmingly likely to benefit from returning to school when their year group does.
Clinically vulnerable children, who are under secondary or specialist care for an underlying health condition are, on the balance of probabilities, more likely to benefit from returning to school when their year group does so. These families may need a conversation with their treating teams to balance the potential risks and any anxiety. Your child’s IBD team will be balancing clinical risk with the consequences of your child missing out on attending school and can discuss with you what is best for your child.
Crohn's and Colitis UK provides advice for children who live with someone who is high risk (extremely clinically vulnerable) or someone who is moderate risk (clinically vulnerable)
should children with IBD continue to take their medication?
There have been many enquiries regarding IBD medications. There is emerging evidence that children are safe to continue their medicines during the coronavirus pandemic and that stopping medicines put children at risk of disease relapse. Experts therefore strongly advise for your child to continue with their current medicines. Your IBD Team will be working closely with your general practitioner to ensure you get the medicines and care you need at this difficult time. Request prescriptions with plenty of time to spare as it might take longer than usual to provide prescriptions.
You will find that most face to face appointments will be cancelled and changed to telephone appointments, to minimise travel and social contact and to keep your child safe. If you are required to attend the hospital for investigations or treatment, please do so as planned whilst adhering to social distancing measures.
Please remember, the NHS is still open for you if your child is unwell. Please get help if your child is ill.
what should I do if I suspect my child has COVID-19?
If your child has symptoms of coronavirus infection, or has had contact with someone who has coronavirus symptoms, please follow the advice as outlined on the NHS website and contact your IBD team before attending for any planned infusions, admissions or investigations.
Please contact your IBD team by telephone if your child is taking an immunomodulatory drug, a biologic medicine or steroid medication and they have a fever over 37.8, as they may need review by the clinical team.
other useful sources of information include:
We have resources, tips and advice on coping with social distancing and isolation for families, children and young people. We are here for you please do get in touch, we want to help.