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  • Children and adolescents

Advice and information for children and adolescents

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).


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

  • Sick people should stay at home or go home if they get symptoms and have a low threshold for being tested
  • Good hand hygiene and cough etiquette

About COVID-19 among children and adolescents

The Norwegian Institute of Public Health monitors knowledge about the role of children in the spread of the disease. 

The combined knowledge about the virus indicates that children can be infected and develop symptoms, but to a lesser degree that unvaccinated adults. If they become ill, they usually have a milder disease course.

Since they have fewer symptoms than adults, they are less contagious. However, they can infect others, most commonly in their household.

Transmission in schools and childcare centres has contributed to a small extent in the spread of COVID-19 in society.

Adolescents get more symptoms of COVID-19 than children and are more contagious. In addition, many are naturally more social and have a larger network of contacts, and this normal lifestyle will involve the possibility of transmission.

During the pandemic, children and young people have been affected by strict infection control measures which have been introduced mainly to protect adults. Once a major part of the adult population is protected, outbreaks in childcare centres and schools will have fewer consequences and can be handled with less extensive measures. 

In July, the European Centre for Disease Prevention and Control published an updated risk assessment of COVID-19 among children and the school's role in the transmission, focusing on the increasing incidence of the Delta variant. ECDC points out that in areas where adults are mainly vaccinated, it is expected that an increasing proportion of all cases will occur among the child population. As children very rarely become seriously ill from COVID-19, ECDC points out that it is important to have infection control measures that are proportionate and adapted to the infection situation, and that it is important to maintain good preparedness in the school system for handling infection in the school year 2021/2022.

A large British study shows equally good effect on limiting infection by testing as with quarantine, including for the Delta variant. The risk of further transmission in school was very low, below 2 %. This is supported by unpublished Norwegian data.

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. In most cases, children and adolescents who are ill will not have COVID-19, but other infections or conditions.

Examples of respiratory tract symptoms can be cough, sore throat, nasal congestion and runny nose. 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 getting sick when they do not want to join in with play or normal activity,  whine more than usual, or do not want to eat as much as normal. Some children may also have gastrointestinal symptoms, with abdominal pain, decreased appetite or diarrhoea.

When should you contact a doctor?

If you are worried about your child or adolescent, contact the health service. Medical consultation should not be delayed because of concerns for COVID-19 transmission.

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 under 6 months. 

When should children with respiratory tract symptoms stay at home and when can they return to school?

Now that the vast majority of the adult population has been vaccinated, and an increasing proportion of adolescents are vaccinated, strict measures are no longer necessary in society, and coronavirus infection can increasingly be treated like other respiratory tract infections.

It is up to the parents to decide whether the child should be tested for COVID-19. Children with respiratory symptoms do not necessarily need to be tested, unless a doctor has deemed it necessary. Some children, particularly in childcare age, may have a continuously runny nose. If they are otherwise in good form with no other signs of a recent respiratory tract infection, they do not need to stay home. If the symptoms get worse or more pronounced, the child should go home.

However, respiratory tract infections are most easily transmitted early in the course of the disease, so it is especially important that children with newly-arisen symptoms or who feel unwell stay at home. If symptoms are mild and disappear completely after one day, the child can return to childcare / school.

Otherwise, children can go to childcare / school when symptoms improve, their general condition is good, and have been fever-free for at least 24 hours without the use of antipyretics. The child can return even though he/she still has residual symptoms such as a runny nose, snot (regardless of the colour and consistency of the mucus), hoarseness or a slight cough. 

Children with known allergies where the symptoms are recognised as allergy problems may attend childcare / school as normal.

If you are concerned about your child, or if symptoms persist, consult a doctor.

Testing of children of primary school age and younger

Testing children can be difficult, and one must consider how important the test is seen in connection with how the child experiences being tested. It is important to ensure that children does not experience that the testing involves force, or is performed in a way that is perceived as traumatic for the child.

A low threshold for testing is still recommended with newly-arisen symptoms, but parents can consider whether their children should be tested or wait. Testing is recommended if  symptoms arise after close contact with a confirmed case of COVID-19 (last ten days).

If the child is a household member of someone who is infected, a 7 day testing regime is recommended, starting the day the infected person is isolated. If it is difficult to test the child, it is better to take a few tests than no tests and it is recommended that you try to carry out testing of children who are going to childcare or school. It is not necessary to test infants or toddlers who are not going to childcare and who are primarily with their closest caregivers. See Close contacts and isolation.

Both self-testing with rapid antigen tests at home or testing at a test centre can be used. With a positive self-test result, it is recommended to take a confirmatory sample at the test centre, and go into isolation.

Illustration: NIPH
Illustration: NIPH

When should adolescents with respiratory tract symptoms stay at home?

For adolescents with COVID-19 the symptoms resemble those in adults. Adolescents who have developed newly-arisen symptoms of respiratory tract infection should stay home from school and take a self-test or contact the local testing centre for a COVID-19 test. This also applies to adolescents with vague/mild symptoms.

Adolescents with known allergies where symptoms are recognised as allergy problems can go to school as normal.

Should children and adolescents be vaccinated with coronavirus vaccines?

The vaccines from BioNTech/ Pfizer and Moderna are approved for use for children from 12 years.

For children and adolescents, the risk of severe COVID-19 is low, even with underlying conditions. Vaccination will nevertheless help to protect the few who can become seriously ill if they become infected, in addition to reducing transmission in society.

The Government has decided that children and adolescents in the age groups 12-15 years and 16-17 years will be offered coronavirus vaccination based on advice from the NIPH.

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 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. 

Care for children when several people in the household are ill

It is important that the child /adolescent's need for care is taken care of, even if their 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, school health service and other health services

The municipalities should ensure that health services offered to children and adolescents are adequate. The health station and school health services should run as normal, with basic infection control measures.

Childcare centres, schools and after-school programmes

Daily life, events, leisure activities and other gatherings in schools and childcare centres in most municipalities can take place as normal.

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

05.10.2021: 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.