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  • Children and adolescents

Article

Advice and information for children and adolescents

Children and adolescents usually have a mild course of the disease, and very few children become seriously ill from COVID-19. This also applies to children with chronic illnesses.

Children and adolescents usually have a mild course of the disease, and very few children become seriously ill from COVID-19. This also applies to children with chronic illnesses.


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General advice that applies to everyone, including children and adolescents:

  • Sick people should stay at home or go home if they get symptoms and get tested
  • Good hand hygiene and cough etiquette
  • In families with newborn babies and infants, visits from adults and children with respiratory tract infections should be limited or avoided.

Symptoms of COVID-19 in children

Children who get COVID-19 usually have a mild disease course. The symptoms are usually mild and short-lived, and can be difficult to distinguish from other respiratory tract infections. 

Examples of respiratory tract symptoms can be cough, sore throat, nasal congestion and runny nose. False croup with barking cough, hoarseness and / or difficulty breathing also occurs. In addition, children may experience gastrointestinal symptoms with abdominal pain, decreased appetite or diarrhoea. Children with COVID-19 may not have a fever and cough. The youngest children often do not complain about sore throats and body aches, but it is often noticed that they are becoming sick when they do not want to join in with play or normal activity,  whine more than usual, or have a poor appetite. 

FHI
FHI

(Click on the picture to enlarge it)

When should you contact a doctor?

If you are worried about your child or adolescent, contact the health service. 

The younger the child is, the lower the threshold should be for contacting a doctor. As a general rule, this applies to children who are 2 years and younger, especially children aged under 6 months. 

Vaccination of children and adolescents

Children and adolescents very rarely get severe COVID-19 disease course, but some may need to be admitted to hospital. Vaccination can reduce this risk. Immunity through infection, with or without a single dose of vaccine, can provide broad and lasting protection in children and adolescents. Having had COVID-19 can affect the number of vaccine doses required.

More information

Children with chronic diseases have a low risk of severe COVID-19

The risk of severe COVID-19 disease course is very low, both among children and adolescents in general, but also among children and adolescents with serious and chronic diseases or conditions. In consultation with the Norwegian Paediatric Association, the Norwegian Institute of Public Health considers that the vast majority of children and young people with chronic diseases and conditions can go to childcare and school as normal.

Multi-inflammatory syndrome in children, MIS-C 

Some countries have reported an inflammatory condition after COVID-19 among children and adolescents, known as MIS-C (multi-inflammatory syndrome in children) or PIMS (paediatric inflammatory multisystem syndrome temporarily associated with COVID-19). The condition is rare, but serious. In Norway the condition has occurred in less than 1 in 1,000 children and adolescents who have been diagnosed with COVID-19. When treated for this syndrome the prognosis is good.

Long-term effects of COVID-19 in children

So far, studies show that there is little risk of long-term effects of mild COVID-19 among children and adolescents, even though there is still a lack of knowledge. Studies of children and adolescents that include control groups have shown that both those who are diagnosed with COVID-19 and those who are not diagnosed with COVID-19 may have symptoms after a mild infection. Norwegian registry data show that for mild COVID-19 in children and adolescents, few need contact with the health service after undergoing infection. The analyses included all tested children and adolescents under the age of 18 in Norway, who were compared with randomly selected controls, approximately 700,000 people in total. Danish registry data show similar findings.

Children / adolescents and COVID-19 certificates

The NIPH recommends that everyone who plans to travel should check the rules for entry at their destination.

Read more here: 

 

Knowledge base (as of February 2022)

The omicron variant has a much higher transmission rate than previous variants. At the same time, omicron has lower virulence, and a smaller proportion of infected people will need admission to hospital and intensive care units. The decisive factor is the balance between higher transmissibility and lower virulence, i.e. the overall burden of disease. It is expected that the latest wave with the omicron variant will cause significantly increasing infection also among children and adolescents.

Disease burden among children and adolescents

  • The individual risk of a severe disease course among children and adolescents is very low. The omicron variant is less virulent and more often leads to upper respiratory tract symptoms than earlier variants.
  • To date (as of 2 February 2022), there have been 276,938 children and adolescents aged 0-17 diagnosed with COVID-19. Among these, 125,615 are in the age group 5-11 and 89,253 in the age group 12-15. This means that about 33% of children ages 5-11 and 35% of adolescents aged 12-15 have been diagnosed with COVID-19. There are probably significant numbers of undetected cases, and earlier in the pandemic it is estimated that approximately 60% of cases of infection were detected. The share of undetected cases is probably even higher today. 89% (n=111,417) of transmission among ages 5-11 and 91% (n=80,958) of transmissions among ages 12-15 has happened in the period from week 33/2021 till start of week 5/2022. At the same time there has only been under 200 hospital admissions among children and adolescents aged 0-17 throughout the whole pandemic. That means that at least 99.9% of the infected have not been admitted to hospital because of COVID-19, and the share of infected people admitted has dropped. The median admission time for acute COVID-19 is 1 day.
  • Although there were many children and adolescents infected in autumn 2021, this did not led to an increase in hospital admissions of children. The proportion who develop multi-inflammatory syndrome (MIS-C) has also decreased, without us knowing why.
  • In comparison, in the autumn of 2021 (week 30-51) there were 2507 admissions for RS virus aged 0-4 years and 76 aged 5-17 years (compared to 1000-2000 admissions in a normal season). In a normal influenza season, there are normally approximately 500 admissions aged 0-17 years.
  • Preliminary information indicates that the omicron variant leads to hospital admission for children less often compared to the delta variant. There is still limited knowledge about omicron in children, and currently there is only one published study on this but, combined with surveillance data and credible media reports from different countries, this indicates that omicron does not cause a more severe disease course among children than other variants.
  • According to the latest technical briefing published by the UK (31.12.21), there is a lower risk of hospital admission among children aged 5-17 years with omicron compared to delta (Risk 42% compared to the delta variant, HR 0.42, 95% CI 0.28-0.63).
  • A study (preprint) from the USA compared outcomes among SARS-CoV-2 infected people during a period where the delta variant was dominant and a period when the omicron variant was about to take over (15-24 December). The results show fewer outpatient consultations and admissions for children and adolescents in all age groups (0-17 years) infected in the “omicron period” compared with the “delta period”. The researchers did not investigate which variant the patients in the two groups were infected with. In the "omicron period", in reality, only between a quarter and a half of patients in the United States were infected with the omicron variant. This indicates that the risk reductions may be even greater than reported. Another study from the same group of scientists (preprint) concluded that children under 5 years old, who were infected for the first time while the Omicron variant dominated (prevalence > 92%), had significantly reduced risk of serious illness compared with children infected for the first time when the Delta variant dominated.
  • It is difficult to assess the information from countries that report admissions among children where they do not differentiate between admissions due to COVID-19 or where the coronavirus is detected randomly, e.g. by screening inpatients. In addition, the health of children in other countries and access to health services are not directly comparable with Norway.

Transmission in schools

There is transmission in schools and childcare centres and it has previously been shown that the probability of further spread is low for each individual case. The main pattern is that infection is diffusely spread in the child population, with small clusters of infection rather than large outbreaks.

  • Data from NIPH's registers (Beredt-C19) up to and including the autumn semester 2021 show that the majority of COVID-19 cases in childcare centres and primary schools are included in infection clusters in 1-2 cases and that infection clusters with more than 10 cases are rare. In lower secondary schools, the majority have also belonged to infection clusters of 1-2 cases in most weeks, but in weeks with a higher incidence of infection, the majority are included in infection clusters of 3 or more, and it has been more common with infection clusters of 10-20 people or more in lower secondary schools (wuhan, alpha and delta variant).
  • The Corona Child Study (for the wuhan and alpha variants) showed that when a child was an index case, 1.4% of close contacts in schools and childcare centres were infected.
  • A study (preprint) based on NIPH's registers (Beredt-C19) identified children or employees who tested positive and calculated the number of secondary cases among children and employees at the same school within 14 days. Secondary infection, from child to child, and from child to employee, was only found in 0.3% of cases. The analyses were made during the wuhan and alpha periods, but were updated for the delta variant this autumn. These data are not yet published, but show that secondary infection increased 1% between children, while it remained at 0.3% from children to employees. We do not yet have similar data for the omicron variant.
  • The risk of transmission has previously been shown to be significantly higher in households. This has been shown both in registry studies (the wuhan variant) and in the contact tracing study Corona-house (the wuhan and alpha variant). Secondary infection occurred in 50% of households, with 78% for the alpha variant and 43% for variants that are not of concern (non VOC).
  • During the ongoing omicron wave, with high transmission rates in sociatey, the monitoring of cases in schools will have lesser value. When there are this many transmission introductions happening, it is impossible to estimate the share of transmission happening in schools.

Links

References

1. Gudbjartsson DF, Helgason A, Jonsson H, Magnusson OT, Melsted P, Norddahl GL, et al. Spread of SARS-CoV-2 in the Icelandic Population. The New England Journal of Medicine. 2020.

2. Folkhälsomyndigheten, Sverige. Bekräftade fall i Sverige

3. Statens Serum Institut, Danmark. Epidemiologisk overvåkingsrapport. 

4. Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020.

5. Balduzzi, Adriana and Brivio, Erica and Rovelli, Attilio and Rizzari, Carmelo and Gasperini, Serena and Melzi, Maria Luisa and Conter, Valentino and Biondi, Andrea. Lessons After the Early Management of the COVID-19 Outbreak in a Pediatric Transplant and Hemato-Oncology Center Embedded within a COVID-19 Dedicated Hospital in Lombardia, Italy. Estote Parati. (Be Ready.) (3/19/2020). Available at SSRN. Sammendrag på engelsk. DOI: dx.doi.org/10.2139/ssrn.3559560

6. D'Antiga L. Coronaviruses and immunosuppressed patients. The facts during the third epidemic. Liver Transpl. 2020. 

7. Lu et al. NEJM. 2020. DOI: 10.1056/NEJMc2005073.

8. Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020 (CDC) 

History

23.06.2022: Minor changes and updates. Update to paragraph about COVID-19 certificate.

08.04.2022: Removed the section «About covid-19 in children and adolescents» and «When should children and schoolchildren with respiratory symptoms be at home?». Added flow chart and links to "Do you have newly arisen respiratory tract symptoms" under the section "Symptoms of covid-19 in children." Removed the section "Care for children and young people with illness", "Children who stay in several homes", "Follow-up at public health clinics, school health services and other health services »and« Childcare centres, schools and after-school programmes » Minor text changes in the section «Vaccination of children and adolescents».

07.04.2022: Removed text about testing.

24.02.2022: Added information about testing. Added information about COVID-19 certificate.

22.02.2022: Text changes in the sections General infection control advice, Knowledge base and Symptoms of COVID-19 in children.

03.02.2022: Updates after press conference 01.02.2022. Updated paragraphs Knowledge base, Testing of children, Children and adolescents in isolation, and Vaccines for children and adolescents.

02.02.2022: Flowchart updates.

24.01.2022: Flowchart update.

17.01.2022: Updated sections about testing and child/adolescent in isolation

13.01.2022: Added knowledge base section as per Norwegian version.

23.12.2021: Updated section "Testing of children primary school age and younger".

17.12.2021: Updated flowchart

09.12.2021: Edited text in section « About COVID-19 among children and adolescents». Updated sections «When should children with respiratory tract symptoms stay at home and when can they return to school?», «Testing of children of primary school age and younger», «Children and coronavirus vaccination» and «Childcare centres, schools and after-school programmes». Changed the name of the section "Should children and young people be vaccinated with the coronavirus vaccine?" to «Children and coronavirus vaccination».

20.11.2021: updated flow chart

05.10.2021: Minor clarification in advice to parents regarding testing of children.

04.10.2021: Rearranged the order of subchapters. Added clarifications regarding testing for children and when children with respiratory tract symptom can stay home and when they can return to school/childcare. Corrected figures for MIS-C cases. Updated advice for schools and child care. Added link to information about COVID-19 vaccination for youth ages 12-15 in different languages.

25.09.2021: • Updated in accordance with normal daily life with increased preparedness. • Updated advice on when children should be at home and when they can return to childcare/ school. • Updated advice on testing children. • New flow chart. • Updated and simplified information about schools / childcare.

07.09.2021: Updated section about vaccination

06.09.2021: Added link to news article about mild disease and few long-term health consequences

03.09.2021: Revised text and merged chapters "When should children with respiratory symptoms be home from childcare / school?" and "When should children return to childcare / school"

19.08.2021: Revised several paragraphs as per the Norwegian version. New section about long-term effects of COVID-19. Some adjustments to text.

17.08.2021: Added link to news article about testing

20.06.2021: Updated according to the Government's reopening plan.

16.06.2021: Updated flow chart Children with symptoms.

11.06.2021: Added section about symptoms in children, revised section «About covid-19 in children and adolescents». Revised section on MIS-C. General shortening of text and language changes. Changes in the order of paragraphs.

08.06.2021: Added paragraph about closing ceremonies in schools and childcare centres

02.06.2021: Updated with age for vaccination for children - changed from 16 to 12

25.03.2021: Added updated test recommendations for children and adjusted the section on when children can attend kindergarten / school

05.03.2021: Removed flowcharts for when children and adolescents should be home - pending new versions.

03.02.2021: Updated information - vaccination, play and social contact , importance of leisure activities, removed film

26.01.2021: New paragraph under "When should adolescents with respiratory tract symptoms stay at home?" about children staying in several homes. New paragraph regarding a new variant of the coronavirus that was detected in the United Kingdom.

19.01.2021: Updated according to the Government's recommendations

14.01.2021 Clarification about visits from children and adolescents until 19 January.

06.01.2021: Updated according to the Government's recommendations about limiting social contact from 04.01 for two weeks

05.11.2020: Emphasised that adolescents should have the same close contacts over time.

09.10.2020 New paragraph under Play and Social contact, about private vs public events and outdoors vs indoors.

05.10.2020 Minor revisions to English version - added paragraphs under "play and social contact."

01.10.2020 Updated according to Norwegian version

12.06.2020
Removed "of longer duration" in paragraph title "Events and summer activities of longer duration for children and adolescents". Removed heading "Transport"

08.06.2020: 
Emphasised that the 1 metre rule does not allow in all circumstances for children, as per Norwegian version.

29.05.2020:
Added link to page about sport and organised leisure activities.

20.05.2020: 
General changes as per Norwegian version. 

08.05.2020
General changes as per Norwegian version. 

30.04.2020

Added sentence about children who are back at school or nursery.

22.04.2020
Added references

21.04.2020
Updated with revised text, as per Norwegian version.

23.03.2020
Article created. Content transferred from a joint article about information to pregnant women, children and adolescents, as per Norwegian version.