Source: Royal College of Physicians of Ireland
Please note: This guidance has been developed by Consultant Paediatricians across a variety of Specialities to provide guidance and reassurance for parents and healthcare professionals caring for medically vulnerable children and is subject to change with emerging evidence.
Introduction:
Medically Vulnerable Children during the Coronavirus (COVID-19) Pandemic
Many children have underlying health problems which may make them prone to more severe illness with any infection, so the question arises as to whether these children should be cocooned from SARS CoV 2 infection. Typically, these children and their families already exercise extra caution around avoiding exposure to colds and flus etc. and they receive the annual seasonal flu vaccine.
It is clear now that fortunately the vast majority of children who get SARS-CoV 2 infection do not develop severe COVID-19 illness. This also appears to be the case for children with underlying health problems, these children may get an infection with very few symptoms at all or they may experience an illness like, but usually no worse than, the seasonal flu. Children who are immunocompromised, or taking immune medications for inflammatory conditions such as arthritis or inflammatory bowel disease, also do not appear to have an increased risk from COVID-19.
It should be noted that the widely reported but very rare multisystem inflammatory response (Kawasaki- like syndrome, also called PIMS, Paediatric Inflammatory Multisystem disorder) possibly linked to COVID-19 occurs in children who are otherwise well without pre-existing medical conditions, and as such it is unpredictable as to who will get it.
Given current knowledge about COVID-19 disease in children it is now difficult to justify cocooning in most children with underlying conditions. Long-term cocooning of children with complex medical needs is likely to adversely affect them and may outweigh the potential risk of infection.
Recommendations
- We advise that for children with profound immunodeficiency (e.g. a very recent transplant) it is best that individual risk (including the possible necessity of avoiding school) should be discussed with your specialist team.
- For all other children, care should be taken to reduce transmission through the measures promoted by the HPSC (https://www2.hse.ie/conditions/coronavirus/protect-yourself-and-others.html) including hand washing and social distancing by all household members etc.
- Schools will reopen when community transmission risk is low and when preventive measures are in place. Excluding a child from school for prolonged periods is not in their best interest but please discuss this with your doctor if concerned.
- If a child with pre-existing health condition acquires COVID-19-parents should make contact early with their GP and specialist as recommended with other infectious illnesses.
- We also wish to highlight that all efforts are being made in GP surgeries and in hospitals to reduce the risk of infection to anyone attending, so be reassured that your child can continue to access medical services as needed during this pandemic.
- Children can develop illnesses, specifically non COVID related illnesses at any time, and as such, if unwell, should attend the GP or ED, as appropriate.
- Please avail of vaccinations as recommended and don’t forget to get the flu vaccine for yourself and your children early in the autumn – it is available to all medically vulnerable children and is now also available free of charge to all children aged 2-12 years.
Conclusion
We make the recommendations above (1-7) in the best interests of all children and of medically vulnerable children, in particular. Knowledge of COVID-19 disease in children continues to expand and as information comes to light, this guidance will be updated. For the most up to date information and guidance on national restrictions and recommendations please consult https://www2.hse.ie/coronavirus/
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