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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 September 2020, this was summarised here: Barns rolle i spredning av SARS-CoV-2 (COVID 19)

  • 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 are likely to become infected to the same degree as adults, but since they have few or no symptoms, they appear to be less contagious than adults.
  • Sick children can infect others, and it is most common that they infect others in the same household. It is rare that they infect other children or adults outside the household.
  • Transmission in schools and childcare centres contributes only to a small extent in the spread of COVID-19 in the society.

Adolescents 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.

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. 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

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:

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.

Flowchart: NIPH
Flowchart: NIPH

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.

For more information and advice for adolescents (lower secondary and older) with newly arisen respiratory tract symptoms, see:

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 and social contact during leisure time

For private gatherings, try to limit the number of guests so that there are no more than 20 people present. This applies to both indoor and outdoor gatherings, children and adults included. For example, it may be necessary to divide a class in two so that there are not too many children and adults present at the same time. The risk of transmission is lower outdoors than indoors, and when playing in small groups. At public events (for example when the school arranges a gathering), other advice applies and an entire cohort can gather even though it exceeds 20 people.

In order to limit transmission, it is important to maintain the general infection control measures, even when children and adolescents are together in leisure time. The general infection control measures are:  

  1. Sick people should stay at home
  2. Good hand hygiene and cough etiquette 
  3. Reduced contact between individuals that do not live in the same household (or equivalent close contacts)

This advice also applies to adults who are with the child / adolescent.

Sick people should stay at home

Keep children and adolescents with symptoms of respiratory tract infection at home. They should not be with others outside the family. This also applies for mild symptoms. For children and adolescents who are in home isolation or home quarantine, specific advice applies.

If someone in the household has symptoms of a respiratory tract infection, but not confirmed COVID-19, the child may be with others. However, the child should go home if he or she develops symptoms of a respiratory tract infection or does not feel well.

Remember good hand hygiene and cough etiquette

Encourage children to cough / sneeze in a paper tissue (which is thrown away afterwards), or into the crook of the elbow. They should also be reminded to wash or disinfect their hands, for example, before play and socialising, when their hands are visibly dirty, after using the toilet, after contact with mucus, saliva, etc., (for example after coughing / sneezing into the hands) and before meals. Remember that hand washing with soap and water is most effective in preventing infection. If there are no hand washing facilities, alcohol-based hand disinfectants are a good alternative. Be aware that alcohol-based disinfection is ineffective when hands are wet or visibly dirty.

Limit the number of close contacts

It is wise to avoid having many contacts. Play and socialising between children in their free time, for example groups of friends, birthday parties, play in the neighborhood, walk-to-school groups, etc., should first and foremost be with children who are in the same group in childcare centres / school / organised leisure activities. Limit contact and play with other children and young people outside these groups to a few, and preferably to children 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.

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.

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.

Sleepovers

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. The guests should bring their own toiletries, and other members of the family should try to keep a distance from the guests.

Birthday parties and other celebrations

For birthdays and other celebrations in the home, try to limit the number of guests to a maximum of 20 people. This applies to celebrations indoors and outdoors, children and adults included. For example, 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 the celebration takes place in a public place, for example a play centre / rented premises, the rules for events must be followed. This means that everyone, including the children, must be able to keep at least one metre distance from each other during the entire event. This also applies if the children are usually in the same cohort / group (for example, a school class). If there are several groups of children present in the same room, the different groups must also be able to keep their distance from each other.

The celebration should preferably take place outdoors where the risk of transmission is lower. For indoor celebrations, make sure that there is enough space for everyone to keep the recommended distance.

Guardians of invited children should not attend. 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.

Food and cake should be served in portions and avoid bowls of snacks like popcorn or sweets. Remember clean hands for those who serve the food and for those who will eat it.

Organised leisure activities

Leisure activities are important for the physical and mental well-being of children and adolescents. The outbreak may last for a long time. It is therefore of great importance that children can engage in leisure activities in a safe way that will reduce the risk of infection.

Activities should primarily involve children from the same local environment. It is wise to limit the number of activities if the child is in many different groups. For activities with regular participants, it is not necessary for children to keep a distance from each other, in line with the advice given for schools and childcare centres. 

In the age groups that includes lower and upper secondary school, children and adolescents should try to keep a distance of one metre, except when this interferes with performing the activity.

Guardians should avoid staying in common areas around the activity, except for delivering and collecting children. They should also keep at least 1 metre distance to other adults and children.

Children and adolescents should be encouraged not to arrive before the scheduled starting time and to leave straight after the activity to avoid gatherings of several groups. Participants should be encouraged to avoid using public transport, unless necessary. If car-pooling is used, infection control advice should be followed, including not mixing children from different local communities or catchment areas.

For more information about infection control advice for organised activities, see: 

For information related to the coronavirus pandemic with regards to other organised activities, please see the websites of the different organisers/associations.

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

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.

Talking to children

It is important to talk to children / pupils about coronavirus disease to avoid fear and to create security around the situation.

This film is made by the Norwegian Directorate of Health and is intended for children and adolescents. The sound is only in Norwegian but subtitles are available in several languages:

  • Click on the cogwheel symbol at the bottom when you open the film
  • Remove "autoplay" if it shows red
  • Choose "settings" 
  • Click "subtitles"
  • Choose "automatic translation"
  • Choose language

(We cannot guarantee that the autotranslation for some of the languages is completely correct).

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

05.11.2020: 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.