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Advice and information for children and adolescents

Published Updated

Advice and information on issues affecting children and adolescents in connection with coronavirus (COVID-19).

Advice and information on issues affecting children and adolescents in connection with coronavirus (COVID-19).


Children seem less likely to become infected or ill

The Norwegian Institute of Public Health monitors knowledge about the role of children in the spread of COVID-19. In December 2020, the European Centre for Disease Control (ECDC) published a summary and assessment of available knowledge:

The combined knowledge indicates that: 

  • Children of primary school age and younger are less likely to become sick from coronavirus. When they become ill, they usually have milder symptoms and a mild disease course.
  • Children can be infected and have symptoms, but to a lesser degree than adults. Since they have fewer symptoms than adults, it is assumed that they are less contagious.
  • It is rare that they infect other children or adults outside their household. This is supported by findings from the Norwegian Corona Child Study.
  • Transmission in schools and childcare centres contributes only to a small extent in the spread of COVID-19 in the society. The start of the school year in August does not appear to be the cause of the second wave of COVID-19 seen from October 2020. 

Adolescents (teenagers) are probably more contagious than children because they get more symptoms when infected with COVID-19. Adolescents may also have a lifestyle that increases the risk of transmission, such as a larger and more geographically dispersed network of contacts, the need for close contact with peers, as well as pandemic fatigue. Their ability to infect others appears to increase gradually until adulthood. 

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. The NIPH has been notified about 5-10 children in Norway with this condition (January 2021). When treated for this syndrome the prognosis is good.

For more information on COVID-19 symptoms in children and adolescents, see Facts about the virus and COVID-19 disease.

In December 2020, a new variant of the coronavirus was detected in the United Kingdom. Initially, questions were raised as to whether children and young people had a greater role in the spread of the English virus variant. Recent reports show, however, that the gender and age distribution of the new variant appears to be similar to other variants. Public Health England have reported that there seems to be a lower transmission among children than adults, about half as contagious in the age group under 10 years compared to adults.

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

Based on current knowledge, there appears to be a very low risk of severe COVID-19 disease among children and adolescents in general, but also among children and adolescents with chronic diseases or conditions. For more information about these groups, see:

Should children and adolescents be vaccinated with coronavirus vaccines?

The vaccines that are now available are approved for use from 18 years and older, with the exception of the BioNTech and Pfizer vaccine that is approved from 16 years.

For children and adolescents, the risk of severe COVID-19 disease is low, even with chronic underlying disease. However, vaccination of adolescents is possible with the BioNTech and Pfizer vaccine, which is approved from the age of 16 and can be used in adolescents with a high risk of serious illness.

If you are worried about your sick child or adolescent

In most cases, children / adolescents who are sick do not have COVID-19, but have another infection or condition that requires assessment and treatment. If you are worried about your child or adolescent, contact the health service to see if they should be assessed by a doctor. Do not delay seeking medical attention due to concerns about being infected with COVID-19.

In general, 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 0–6 months. Other reasons to contact a doctor are when the child/ adolescent has: 

  • poor general condition (the child / adolescent is lethargic and feeling unwell)
  • difficulty breathing and / or breathing faster than usual when resting
  • fever combined with respiratory tract symptoms and / or poor general condition

When shall children with respiratory tract symptoms stay at home?

Children who have had symptoms of a respiratory tract infection in the last 24 hours should stay at home, especially if the child has several symptoms at the same time and is not feeling well. If the child only has a runny nose and is otherwise in a good general condition, there is no need for the child to stay at home.

If the child has mild respiratory tract symptoms without fever, observe the child at home for up to 48 hours. With rapid recovery, the child can return to childcare / school without being tested for coronavirus. If the child is not recovering after 48 hours, contact a doctor or out-of-hours medical service by phone to assess whether the child needs a medical examination and / or COVID-19 test.

When can the child return to childcare or school?

The child's general health condition determines when they can return to childcare/ school after recovery from a respiratory tract infection. This applies even if the child still has some residual symptoms such as a runny nose (regardless of the colour and consistency of the mucus/ snot) or a cough. Such symptoms are common after a respiratory tract infection.

If the child has been tested for COVID-19, the test result must be available before the child can return to childcare / school. For everyone who is diagnosed with COVID-19 must be in isolation and follow-up and will be followed up by the healthcare service.

The child can return to childcare / school even if other family members have respiratory tract symptoms. However, if other family members have been diagnosed with COVID-19, the child must be in quarantine and will be followed up by the healthcare service.

When should adolescents with respiratory tract symptoms stay at home?

For adolescents with COVID-19 the symptoms resemble those in adults, especially for older adolescents. Adolescents who have developed symptoms of respiratory tract infection in the past 24 hours should stay home from school and contact the local testing centre to be tested for COVID-19. This also applies to adolescents with mild symptoms.

Children staying in several homes

Many children have several homes. Most often, these are children with guardians who have two different households after a break-up, but they can also be children and adolescents who have different forms of relief families or have part-time stays in care homes.

The main rule is that planned meetings can be maintained as agreed. This also applies where the UK virus variant has been detected in the local community. 

Care for children when several people in the household are ill

It is important that the child's need for care is taken care of, even if the guardian has COVID-19. Similarly, if the child has COVID-19, they must receive adequate care and attention from parents or others, even though this may mean that it is not possible to keep a distance. If caregivers are ill and unable to care for children for whom they are responsible, the municipal health services must be informed to implement relief from child welfare or others, as in other situations where caregivers are ill.

Follow-up at public health clinics and school health service

The municipalities should ensure that health services offered to children and adolescents are adequate. It is recommended that the health station and school health services maintain normal activity in line with national professional guidelines and necessary infection control measures.

For more information about the public health clinics and school health services, see the Norwegian Directorate of Health's website Helsestasjon, svangerskapsomsorg og skolehelsetjeneste and your municipality's website or contact the municipality for updated information.

Childcare centres, schools and after-school programmes

The Norwegian Institute of Public Health and the Directorate of Education and Training have prepared infection control guidelines for childcare centres, schools and after-school programmes. The guidelines describe measures to reduce transmission and provide advice and support to ensure good infection control for staff, children and adolescents.

For information about infection control measures in childcare centres and schools, as well as advice on end-of-term activities and events, see:

Play, social contact and events

Limit the number of guests that are present at the same time. This applies to both indoor and outdoor gatherings for both children and adults. The risk of transmission is lower outdoors than indoors, and when playing in small groups. 

The general infection control measures apply when children, adolescents and adults are together in leisure time:  

  1. Sick people should stay at home, or go home if they develop symptoms
  2. Good hand hygiene and cough etiquette 
  3. Limit contact between individuals that do not live in the same household 

The current recommendations and guidelines for the number of people who can gather in private gatherings and at public events (for example when the school arranges a gathering) can be found on NIPH's page about Events, gatherings and activities. The municipalities can also introduce stricter measures locally due to the infection situation both for private gatherings and for events. See your municipality's website for information on local measures.

Children:

Play and social contact in their leisure time should first and foremost be with children who are in the same group in childcare centres / school / organised leisure activities.  Outside these groups, children can also play with a few close friends, preferably from the same local environment.

  • Children who play together do not have to keep a distance. This applies to children who are already together at school and in sports, or others who are considered the child's close friends.
  • Children should keep their distance from other children who are not in these groups.
  • Adults who accompany children to activities and play should keep their distance from other children and adults.
  • If an adult is responsible for a child outside their own household, the recommendation to keep a distance must be weighed up against whether the child needs to be comforted or helped.
  • Children can have friends for sleepovers if everyone is well and the guests are among the same close contacts as in school and leisure time. Other members of the family should try to keep a distance from the guests.

Adolescents:

Adolescents can also have a few friends / contacts that they do not need to keep their distance from, and who are considered to be their close contacts. They should be the same over time. They should keep at least one metre away from others who are not close contacts.

Birthday parties and other celebrations

For birthdays and other celebrations in or outside the home, limit the number according to th current advice and guidelines for events. Both children and adults are included. It may be necessary to split a class in two to ensure that not too many children and adults are  present at the same time.

If possible, guardians of invited children should not go inside. If this is necessary for some children, the guardian should keep a safe distance from other children and adults and follow normal infection control advice.

Remember clean hands for everyone, especially when food is served.  

Organised leisure activities and importance for children and adolescents

Leisure activities are important for the physical and mental well-being of children and adolescents. The outbreak has lasted for a long time and it is uncertain how long it is necessary to have strict infection control measures. It is therefore of great importance that children and adolescents can engage in leisure activities in a safe way that will reduce the risk of infection.

Where there is a need for strict infection control measures, try to maintain some activity as long as possible.

For many children and adolescents, participation in leisure activities can be of great importance, because the setting is a safe and familiar arena that can be an important point in a difficult everyday life. It is especially important to be aware of vulnerable children and adolescents, including those who under normal circumstances would not have been exposed, but who have become so as a consequence of the pandemic.

The pandemic may have changed participation in leisure activities. Instructors / leaders should be aware of dropouts from organised leisure activities, and if there are some children who have not participated in the activity for a while, the association can contact parents to look at possible solutions for participation.

Events and activities of longer duration

For more information and recommendations regarding events such as summer schools, camps etc., please see Events, gatherings and summer activities

 

Information for the general public

For general advice about coronavirus: our topic page and helsenorge.no 

Information helpline for questions about coronavirus: 815 55 015 (weekdays 08-15.30)

The Norwegian Directorate of Immigration has answers to many frequently asked questions about travelling to Norway, and a helpline 23351600 that is open on weekdays from 10:00-14:00. 

The Ministry of Foreign Affairs also has answers to many frequently asked questions.

If you need acute medical attention, contact your doctor. If you cannot reach your doctor, contact the emergency out-of-hours clinic on 116117. If life is in danger, call 113.

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

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.

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Facts

Coronavirus

SARS-CoV-2 is the name of the virus that is causing the outbreak of COVID-19 disease.

The virus is related to another coronavirus that caused the SARS outbreak in 2002/2003 but is not the same virus.