[updated 7th July 2020]
The main source of information for this page is "COVID-19 - 'shielding' guidance for children and young people" by the Royal College of Paediatrics and Child Health
Until 31st July 2020
The Government has said restrictions for those shielding are reduced from 6th July 2020. However, there will still be special shielding advice you need to follow during this period. Check the latest advice on gov.uk and the RCPCH website.
1st August 2020 onwards
The Government expects to stop recommending strict shielding measures for vulnerable groups after 1st August 2020. This would mean that, from this date, you and your child could choose to follow the same national guidance as everyone else. However, you should still be very careful to follow precautions to avoid infection, including strict social distancing.
We know this may be worrying and you may feel that you should keep protecting your child. We need to protect those who may be extremely clinically vulnerable to the virus, but we also know that children have a much milder symptoms of COVID-19 and that unnecessary shielding can have a negative impact on their health and wellbeing. If you’re advised that you can stop strict shielding measures, you should feel comfortable doing so.
If you’ve received conflicting advice or are unsure about following guidance, we recommend you speak to your clinical team.
what are the risks of COVID-19 to children?
As part of the initial response to the pandemic several thousand children and young people were advised to shield because their pre-existing conditions meant they were felt to be at the highest risk of severe illness from COVID-19. Expert understanding of the impact of COVID-19 infection on children and young people has been developing over time. New evidence and research findings have led to an update of the advice about which children are at the highest risk of severe infection because they are ‘clinically extremely vulnerable’.
COVID-19 disease has been reported in children and young people of all ages, including shortly after birth. However, there have been far fewer confirmed cases of COVID-19 disease in children than adults (children consistently make up <2% of total case numbers in reports). Infection with SARS-CoV-2 appears to take a milder course in children than in adults: most infected children present with mild symptoms or are asymptomatic, and very few develop severe or life threatening disease.
Deaths in children due to COVID-19 have been extremely rare: mortality seems to be consistent at around 0.01% (similar to the incidence seen every year with seasonal influenza).
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 with inflammatory bowel disease need 'shielding'?
The RCPCH guidance on which children need shielding has changed so there is a smaller, very specific, group of children who should automatically be shielded. This group does not include children with IBD unless they are also affected by one of the conditions listed in the RCPCH guidance.
This information on risk is only about IBD. If your child has another health condition their risk may be higher. If you’re unsure or worried about your child’s risk, speak to their healthcare team.
If a child has any of the following, speak to your child’s healthcare team about whether they should be shielding. Your child may have higher risk of severe illness from COVID-19 and may need to follow the government’s advice on shielding. Your child’s healthcare team will make this decision based on your child’s individual condition. If your child is advised not to shield, they must follow strict social distancing.
- Your child’s IBDU, Crohn's or Colitis is active – e.g. they’re in a flare
- Currently taking oral or intravenous steroids (except budesonide / beclomethasone) equivalent to 20mg or more prednisolone per day (weigh more than 40kg), or 0.5mg/kg prednisolone per day (weigh less than 40kg)
- Started a new biologic medicine within the last 6 weeks in combination with another immunosuppressant or steroids (except budesonide or beclomethasone)
- Takes parenteral nutrition or has short gut syndrome which requires nutritional support
All other children with IBD have no additional risk of severe illness from COVID-19. They should follow the government's advice on social distancing.
Crohn's and Colitis UK have developed a decision tree for the risk in children (opens PDF) to understand if you need to discuss with your child’s healthcare team whether your child should be shielded.
why isn't there a moderate risk group for children?
The risks of serious harm are very low for children and cases of children with IBD being admitted to hospital with COVID-19 are extremely rare - and they have all recovered. Based on this evidence, children with IBD who were previously in the moderate risk group are no longer considered to have an increased risk of serious illness from COVID-19. Therefore, there is no need for a moderate group.
Children who were previously in the shielding group are likely to still be considered high risk and should continue shielding.
IBD is a fluctuating condition so it's possible that your child's risk may change over time. If you're worried about a change to your child's risk you should speak their IBD team.
This guidance is under constant review as new evidence becomes available.
should my child go back to school?
Expert advice is that only clinically extremely vulnerable children (those that have been told to shield as per above) should remain shielded and not to return to school, even if their year group has.
All other children with IBD can return to school when their school reopens for their peer group.
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:
Government guidance on clinically extremely vulnerable children and young people
OFFICIAL COVID19 NHS WEBSITE
Crohn's and Colitis UK advice page
Public Health England FAQ
World Health Organisation (WHO) daily updates
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.