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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 number of children among confirmed cases has so far been low. This could indicate that children either have milder symptoms or are infected to a lesser degree. People are most contagious when they have symptoms and children have little symptoms, and children seem to contribute less to transmission than do adults. When people with COVID-19 have been followed up in Norway, children appear to infect others to a small extent.

In previous outbreaks with other coronaviruses (MERS and SARS), infections were also rarely reported among children.

Knowledge of COVID-19 infection among children and adolescents

In April 2020, the Norwegian Institute of Public Health updated a systematic review about the role of children in the transmission of COVID-19.

The report concluded that children and adolescents appear to be infected to a lesser extent than adults are, they had milder symptoms and very few of the children and adolescents with COVID-19 had a severe disease course.

Worldwide, fewer than 10 children under the age of 10 are reported to have died (as of 15thApril 2020).

In Iceland, childcare centres and schools have been open during the ongoing outbreak. Researchers in Iceland tested 848 children under the age of 10 years for COVID-19 at the end of March / April 2020 (1). Participants either had no symptoms of disease or had mild cold symptoms. None of the children tested positive for COVID-19, compared with 0.8 per cent among participants older than 10 years. 546 children with symptoms of respiratory tract infections were tested. Only 6.7 per cent of children under 10 years tested positive for COVID-19, while 13.7 per cent of the adults had COVID-19.

Sweden, like Iceland, has kept childcare centres and schools open. As of 8th May 2020, the Swedish Public Health Agency reported that of the 24 623 people who tested positive for COVID-19, 118 were children aged under 10 years and 282 were aged between 10 and 19 years (2). Two children under the age of 10 have needed intensive care and one died. No outbreaks have been reported in childcare centres or schools.

In Denmark, 10 083 people had tested positive for COVID-19 by 8th May 2020 (3). Of these, 187 were children under 10 years and 398 were aged between 10 and 19 years. Very few of them needed to be admitted to hospital.

Among the 8 034 laboratory-confirmed cases in Norway by 8th May 2020, 131 were children under 10 years and 426 were aged between 10 and 19 years. Six children under 10 years and 7 adolescents in the age range 10-19 have been admitted to intensive care.

 

COVID-19 among children with chronic conditions

Based on current knowledge, the risk of severe COVID-19 disease appears to be very low both in children in general and in children with chronic conditions and / or impaired immune systems.

In a study from Italy with 1591 patients admitted to the intensive care unit, there were no children under 14 years and 4 people aged 14-19 years (4). Three of the four had chronic conditions that were not described in detail. Another Italian hospital, dedicated to children with cancer and children receiving organ transplants, observed no cases of COVID-19 among the chronically ill children (5).

COVID-19 was reported among five children with cancer from Bergamo and Emilia-Romagna (6). All children had a mild and self-limiting course of the disease. Three children with liver transplants who had laboratory-confirmed COVID-19 did not have pulmonary symptoms.

In an article including 171 children admitted to hospital in Wuhan, China (7), three were admitted to intensive care. These children had underlying conditions (hydronephrosis, leukaemia and intussusception). The child with intussusception died. 

In a report from the Centers for Disease Control, USA, (8) there were 2 572 children under the age of 18 registered with COVID-19. For 745 of them, there was information about admission to hospital: 147 children and adolescents were admitted to hospital, and 15 were in intensive care. Six of these had underlying conditions (the underlying condition and hospital admission were only known for 295 cases). It is likely to be an over-reporting of severe disease in this report because children with mild symptoms were not tested to the same degree.

Childcare centres, schools and after-school programmes

On the 12th March 2020, the government decided to close childcare centres and schools. On the 7th April 2020, they announced a gradual re-opening of childcare centres and schools, and from 11th May, all schools re-opened. 

The Norwegian Institute of Public Health and the Norwegian Directorate for Education and Training have prepared infection control guidelines for childcare centres, schools and after school programmes in order to facilitate the re-opening of schools and childcare centres.

Social contact during leisure time

Even though childcare centres and schools are gradually re-opening, it is important to maintain general infection control measures in the population, such as:

  1. Sick people should stay at home
  2. Practise good hand hygiene and cough etiquette and increase cleaning
  3. Reduced contact between individuals

Limit the number of close contacts

To limit the spread of infection, the overarching goal is to avoid having many contacts. Social interaction between children in leisure time, such as play dates, birthday parties, gathering at playgrounds or when walking to school etc., should include the same children as those in the child’s group in the childcare centre, school or after-school programme. Interaction with children outside these groups should be limited to a few, and should primarily involve children from the same local community.  

Advice:

  • Keep children and adolescents with symptoms of respiratory tract infection at home. They should not meet with other children/ adolescents outside their family. This also applies for mild symptoms. Other recommendations apply to people in home isolation or home quarantine
  • If someone in the household has symptoms of respiratory tract infection, but is not diagnosed with COVID-19, children in the household may play with others as usual. However, if the child develops symptoms of COVID-19, he/ she should go home.
  • Wash hands frequently; before and after play, when the hands are visibly dirty, after toilet visits, after contact with airway secretions (e.g. coughing/sneezing in the hands) and before meals.
  • Try to cough/sneeze in a paper towel (and throw it away), or in the crook of the elbow. Try to keep at least 1 metre distance from others.
  • Play and socialise outdoors where possible.
  • Avoid unnecessary physical contact such as shaking hands and hugging as far as possible.
  • It is important to remember that adults should also keep a safe distance and limit their number of close contacts.

Hand washing with soap and water is effective in preventing infection. If this is not available, alcohol-based disinfectants are a good option. However, alcohol-based disinfectants are not effective when the hands are wet or visibly dirty.  

Birthday parties

It is possible to have birthday celebrations as long as the infection control recommendations specified under Social contact during leisure time are followed: 

  • Maintain good hand hygiene. Hand washing or disinfectants should be easily accessible. Clean hands on arrival, before eating and when the visit is over.
  • Guests should preferably be from the same groups as the birthday child in the school / childcare centre. The purpose of this is to limit the number of contacts.
  • Guardians / other participants should not attend the party. If this is necessary for some children, the guardian should maintain safe distance from other children and adults, and adhere to normal infection control advice.
  • When possible, the celebration should preferably take place outdoors. For indoor celebrations, make sure that there is enough space for everyone to keep the recommended distance.
  • Parents of the birthday child / organiser should try to keep a distance from the other children they are otherwise not in close contact with.
  • Food should be served in portions, including cake. 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 can 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 community. It is sensible to limit number of activities if that implies engaging in many different groups.

Guardians should avoid staying in common areas around the activity, except for delivery and collection of children. They should also keep at least 1 metre distance from children and adults who are not from their same household.

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.

Transport

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

Events and summer activities of longer duration for children

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

As the healthcare service is now in a challenging situation, there may be temporary changes in the services offered by the public health clinics and school health service. See 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).

 

References

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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.