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  • Children and adolescents

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).


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National and local infection control measures

The third step of the plan for a gradual reopening of society applies.

Municipalities can introduce stricter measures locally according to the infection situation. Check your municipality's website for information on local measures.

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
  • Measures to limit contact.

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 variants 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 contributes only to a small extent in the spread of COVID-19 in the society.

Adolescents are infected and 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 pose a risk of transmission.

During the pandemic, children and young people have been affected by strict infection control measures 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.

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. 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 here. Most of the studies are small and deal primarily with children and young people who have been admitted to hospital. 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.

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

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/ Pfizer and Moderna vaccines, which are approved for children and adolescents from the age of 12 years with a high risk of severe disease course.

It is not currently open for vaccination of healthy children and adolescents who are close contacts to people in the risk groups.

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 whine more than usual, or that they do not want to eat. This is called poor general condition. Some children may also have symptoms from the stomach and intestines, 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. 

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. 

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

Respiratory tract infections are most easily transmitted early in the course of the disease. Coronavirus is most contagious in the first few days, so it is especially important to stay home with the first symptoms of a cold or illness. Children who have become ill or developed cold symptoms in the last 24 hours (newly arisen) should be at home. They should be tested, in consultation with parents. For less discomfort, the sample can be taken towards the front part of the nostrils or from the throat.

Some children in childcare 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 or be tested.

If COVID-19 is detected, children must be isolated in accordance with regulations, otherwise the assessment of when the child can return to school and childcare will be the same as for other respiratory tract infections before the coronavirus pandemic. After undergoing a respiratory tract infection, children can go to childcare / school when they are back in their normal form and are fever-free. This applies even though the child still has residual symptoms such as a runny nose (regardless of the colour and consistency of the mucus) or a slight cough. These symptoms are common in the time after a respiratory tract infection in young children.

If the child is not tested and there is no strong suspicion of COVID-19 (for example, no other people around the child have tested positive for COVID-19), the same recommendations apply as for other respiratory tract infections - i.e., the child should be kept at home until they are back to normal, as described in the section above.

Symptoms of COVID-19 can be difficult to distinguish from allergies. If you are in doubt about whether the symptoms are due to a recent respiratory tract infection or allergy, testing is recommended. Children with known allergies where the symptoms are recognised as allergy problems may attend childcare / school. See also:

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, 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 for a COVID-19 test. This also applies to adolescents with mild symptoms.

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

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. It is recommended that the health station and school health services maintain normal activity with 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.

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 see:

The main principles for infection prevention are that sick people stay at home, that there are contact-reducing measures between people, as well as good hand hygiene and cough etiquette and thorough cleaning.

Contact-reducing measures in the infection control guides for schools and childcare centres are adapted to the teaching and care situation and are based on the infectivity of children and adolescents, their right to education and social needs.

The advice is graded at three different levels - green, yellow and red level measures - so that operations can be best adapted to the current infection situation and the different levels of education. The health authorities decide which level schools and childcare centres should use. This is based on the infection situation locally and nationally.

Graduations and other events in school and childcare centres

Closing ceremonies and social gatherings for childcare departments or school classes are normally considered a private gathering in a public place. 

Parent meetings and other events organised by the school will most often be considered a public event.

Teachers or guardians can be organisers and should familiarise themselves with the current advice for events. There may be stricter rules locally, and it is important to check what applies in each municipality.

  • The event can be held outdoors where possible.
  • Ensure the availability of good hand hygiene facilities and thorough cleaning, with a focus on frequent contact points, such as food service and toilets.

Play and social contact

The risk of transmission is lower outdoors than indoors, and when playing in small groups. 

Children who play together do not have to keep a distance. Children can have friends for sleepovers if everyone is well.

The general infection control measures referred to at the top of the article apply when children, adolescents and adults are together in leisure time:  

Adolescents can also have a few friends / contacts that they do not need to keep their distance from. They should be the same over time. 

Birthday parties and other celebrations

For birthdays and other celebrations in or outside the home, limit the number according to the current advice and guidelines for events. 

Guardians should keep a safe distance from other children and adults and follow normal infection control advice. Those who are protected do not have to keep their distance from others, but should pay special attention to the unprotected in risk groups.

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. Therefore, leisure activities should be maintained within the limits of current infection control measures, even where there is a need for strict local measures

Activities of longer duration

For more information and recommendations regarding activities of longer duration for children and adolescents, such as summer schools, summer camps etc., see: 

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

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.