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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).


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

  • Sick people should stay at home or go home if they get symptoms and get tested
  • Good hand hygiene and cough etiquette

About COVID-19 among children and adolescents

Children and adolescents usually have a mild course of the disease, and very few children become seriously ill from COVID-19. This also applies to children with chronic illnesses.

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

Unvaccinated adolescents get more symptoms of COVID-19 than children and are more contagious. In addition, adolescents 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. In order to safeguard children's development, learning and mental health, it is important to ensure the most normal everyday life possible for children.

We are expecting a winter wave with increasing infection in the population, also among children and young people. This is because the trasmission rate of the omicron variant is much greater than earlier variants.

The knowledge so far indicates that the omicron variant leads to milder disease and less frequent hospitalization in children compared with the delta variant.

Knowledge base

For the entire population, we expect a major epidemic in January and February because the transmissibility of the omicron variant is much higher than previous variants. At the same time, omicron has lower virulence, and a smaller proportion of infected people will need admission to hospital and intensive care units. The decisive factor is the balance between higher transmissibility and lower virulence, i.e. the overall burden of disease. It is expected that the latest wave with the omicron variant will cause significantly increasing infection also among children and adolescents.

Disease burden among children and adolescents

The individual risk of a severe disease course among children and adolescents is very low.
To date (as of 4 January 2021), there have been 126,507 children and adolescents aged 0-17 diagnosed with COVID-19. There are probably significant numbers of detected cases, and earlier in the pandemic it is estimated that approximately 60% of cases of infection were detected. Meanwhile, there have been just under 200 admissions among children and adolescents aged 0-17. This means that 99.7% of those infected have not been admitted to hospital due to COVID-19, and the proportion of hospital admissions among infected people has decreased through the pandemic.

Among children and adolescents in Norway who are diagnosed with COVID-19, the risk of being admitted to hospital has so far been 2.5 per 1000. The median admission time for acute COVID-19 is 1 day.

Although many children and adolescents have been infected this autumn, this has not led to an increase in hospital admissions of children. The proportion who develop multi-inflammatory syndrome (MIS-C) has also decreased, without us knowing why.

In comparison, in the autumn of 2021 (week 30-51) there were 2507 admissions for RS virus aged 0-4 years and 76 aged 5-17 years (compared to 1000-2000 admissions in a normal season). In a normal influenza season, there are normally approximately 500 admissions aged 0-17 years.

Preliminary information indicates that the omicron variant leads to hospital admission for children less often compared to the delta variant. There is still limited knowledge about omicron in children, and currently there is only one published study on this but, combined with surveillance data and credible media reports from different countries, this indicates that omicron does not cause a more severe disease course among children than other variants.

According to the latest technical briefing published by the UK (31.12.21), there is a lower risk of hospital admission among children aged 5-17 years with omicron compared to delta (Risk 42% compared to the delta variant, HR 0.42, 95% CI 0.28-0.63).

A study (preprint) from the USA compared outcomes among SARS-CoV-2 infected people during a period where the delta variant was dominant and a period when the omicron variant was about to take over (15-24 December). The results show fewer outpatient consultations and admissions for children and adolescents in all age groups (0-17 years) infected in the “omicron period” compared with the “delta period”. The researchers did not investigate which variant the patients in the two groups were infected with. In the "omicron period", in reality, only between a quarter and a half of patients in the United States were infected with the omicron variant. This indicates that the risk reductions may be even greater than reported.

It is difficult to assess the information from countries that report admissions among children where they do not differentiate between admissions due to COVID-19 or where the coronavirus is detected randomly, e.g. by screening inpatients. In addition, the health of children in other countries and access to health services are not directly comparable with Norway.

Transmission in schools

There is transmission in schools and childcare centres and it has previously been shown that the probability of further spread is low for each individual case. The main pattern is that infection is diffusely spread in the child population, with small clusters of infection rather than large outbreaks.

Data from NIPH's registers (Beredt-C19) up to and including the autumn semester 2021 show that the majority of COVID-19 cases in childcare centres and primary schools are included in infection clusters in 1-2 cases and that infection clusters with more than 10 cases are rare. In lower secondary schools, the majority have also belonged to infection clusters of 1-2 cases in most weeks, but in weeks with a higher incidence of infection, the majority are included in infection clusters of 3 or more, and it has been more common with infection clusters of 10-20 people or more in lower secondary schools.

The Corona Child Study (for the wuhan and alpha variants) showed that when a child was an index case, 1.4% of close contacts in schools and childcare centres were infected.

A study (preprint) based on NIPH's registers (Beredt-C19) identified children or employees who tested positive and calculated the number of secondary cases among children and employees at the same school within 14 days. Secondary infection, from child to child, and from child to employee, was only found in 0.3% of cases. The analyses were made during the wuhan and alpha periods, but were updated for the delta variant this autumn. These data are not yet published, but show that secondary infection increased 1% between children, while it remained at 0.3% from children to employees. We do not yet have similar data for the omicron variant.

The risk of transmission has previously been shown to be significantly higher in households. This has been shown both in registry studies (the wuhan variant) and in the contact tracing study Corona-house (the wuhan and alpha variant). Secondary infection occurred in 50% of households, with 78% for the alpha variant and 43% for variants that are not of concern (non VOC).

Links

 

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?

If they are otherwise in good form with no other signs of a recent respiratory tract infection, children do not need to stay home if they have a runny nose. If the symptoms get worse or more pronounced, the child should go home.

However, as is the case for other respiratory tract infections, COVID-19 is 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.

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. Other rules apply if the child is in quarantine or isolation, see When you are a close contact and When you are in isolation

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.

2021-12-15 Engelsk flowchart symptoms.JPG
Flowchart.

Testing of children 

For many children, testing will be uncomfortable and they will want to avoid it. If they are resassured, however, a child will often co-operate with testing. It is important to ensure that the testing is not perceived as forced, or performed in a way that is perceived as traumatic. Children who resist testing should not be tested, and no one should be tested by force for infection control purposes. Parents know their child best and can assess whether testing can be carried out. If necessary, parents can test themselves instead. 

It is explicitly stated in the COVID-19 regulations that children under the age of 16 years in infection quarantine should not be tested if it is disproportionately demanding to have the child tested.

  • Children under school age who are considered as "other close contacts", should only be tested with symptoms.
  • Children who are in quarantine because they are household members can be tested out of quarantine in accordance with current rules if they do not resist testing.
  • Children and young people who take part in regular testing do not need to be tested further as "other close contacts".
  • For children who are not close contacts, with symptoms of respiratory tract infection, see flow chart above.

Children and adolescents in isolation and quarantine

The child and adolescent who are diagnosed with COVID-19 disease must be in isolation. However, it is important that the need for care for children and adolescents is taken care of, even if this means not being able to keep a distance. This applies whether it is the child or guardian who is in isolation. It can also mean that siblings in the same household can interact as normal.

Children and young people in isolation or quarantine can also be outdoors as long as they are not in contact with anyone other than household members.

Children and coronavirus vaccination

In Norway, only the Comirnaty mRNA vaccine from Pfizer-BioNTech is administered to children and adolescents under 18 years of age. For children from 5 to 11 years of age the approved dose of Comirnaty is lower (“child dose”). Children and adolescents from the age of 12 receive an "adult dose".

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 some children in the age group 5-11 years with severe underlying illness, as well as 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 follow national and local recommendations and measures.

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

17.01.2022: Updated sections about testing and child/adolescent in isolation

13.01.2022: Added knowledge base section as per Norwegian version.

23.12.2021: Updated section "Testing of children primary school age and younger".

17.12.2021: Updated flowchart

09.12.2021: Edited text in section « About COVID-19 among children and adolescents». Updated sections «When should children with respiratory tract symptoms stay at home and when can they return to school?», «Testing of children of primary school age and younger», «Children and coronavirus vaccination» and «Childcare centres, schools and after-school programmes». Changed the name of the section "Should children and young people be vaccinated with the coronavirus vaccine?" to «Children and coronavirus vaccination».

20.11.2021: updated flow chart

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.