Gov’t Advice: Majority of children no longer need to shield

The majority of children currently considered extremely clinical vulnerable to coronavirus (COVID-19) will be able to be removed from the shielded patient list, according to Government advice published on 6 July 2020.

  • Evidence from paediatric clinicians shows COVID-19 poses a low risk to children and young people
  • Majority of children currently shielding to be told by their doctor they will not need to do so in the future
  • Only a small group of children with certain medical conditions are likely to be advised to shield if shielding needs to be reintroduced in the future

The majority of children currently considered extremely clinical vulnerable to COVID-19 will be able to be removed from the shielded patient list, the government has confirmed in the latest shielding guidance today.

Independent evidence from the Royal College of Paediatrics and Child Health (RCPCH), working with specialists in paediatric medicine, shows the risk of serious illness for children and young people is low and only those with the most severe conditions should now be considered clinically extremely vulnerable.

Children will only be removed from the shielded patient list by their GP or specialist doctor following consultation with the child and their family. Specialists and GPs will be asked to contact children and their families to discuss this over the summer, so families do not need to take any immediate action.

The latest guidance for families is in line with the recommendations from the RCPCH and is as follows:

  • a small group of children who receive specialist care in hospitals may need to carry on shielding following a consultation with their doctor. This includes those receiving cancer care or those at risk of severe infection due to an immunodeficiency
  • most other children who were initially identified as being clinically extremely vulnerable will no longer be considered at highest risk. In particular, children and young people who are cared for just by their GP are very unlikely to need to continue to shield in the long term. This includes children with conditions such as asthma, diabetes, epilepsy and kidney disease

Deputy Chief Medical Officer, Dr Jenny Harries, said:

I do not underestimate the difficulty of children having to stay indoors and to only have limited contact with family and friends for such a long time.

As our understanding of this novel virus has developed, evidence shows most children and young people are at low risk of serious illness and will no longer be advised to shield after July.

Families who are uncertain about whether shielding is right for their child in the future will want to discuss this with their doctor, who will be best placed to determine the most appropriate care. These discussions will take place over the summer.

The Royal College of Paediatrics and Child Health has worked with specialists to define who needs to carry on shielding and continues to provide paediatricians with advice and guidance on who is clinically extremely vulnerable.

Senior clinicians, including the Deputy Chief Medical Officer, have welcomed the college’s advice.

As part of the initial response to the pandemic, several thousand children and young people were advised to shield because their pre-existing conditions were considered likely to increase their risks of clinical vulnerability to COVID-19, based on our understanding of the virus at the time.

The shielding list was dynamic to allow GPs and specialist clinicians to add and remove people based on their clinical expertise, always with discussion with the young person and their family or carer.

As our understanding of the disease has developed, the latest research and evidence suggests that the majority of children, including many of those with underlying health conditions, are at significantly lower risk of serious illness from coronavirus than adults. This has been done in partnership with specialists in paediatric medicine.

Dr Mike Linney, Registrar at the Royal College of Paediatrics and Child Health (RCPCH), said:

Lockdown has been tough on children generally, but especially for those who have been shielding. It’s been a long haul for thousands of families, and we hope this announcement brings some relief.

Fortunately children are less affected by COVID-19. This appears to be the case not just in the UK but world-wide. However, they have suffered from the social effects of lock down, isolation, and school closures.

We know that many families who have been shielding will have concerns. The important point of this guidance is that paediatricians and specialist doctors now have better information to discuss shielding with patients and their families. Children under the sole care of a GP are very unlikely to need to continue shielding, but if you are worried, seek reassurance.

Should we face a second wave, this guidance will allow us to make better decisions about who needs to shield. It was right to be cautious when we knew so little about the virus, but we now have a lot of evidence to guide us. We can be confident that the vast majority of children and young people don’t need to shield.

The new information on the risk in children comes at the same time as broader shielding advice is relaxed from today, advising those shielding that they may now, if they wish, gather in groups of up to 6 outdoors and form support bubbles with another household if they live on their own or are a single parent. Children and young people should continue to shield until 31 July.

From Saturday 1 August, the guidance will then be paused so clinically extremely vulnerable people of all ages will no longer be advised to shield.

We expect most children and young people will be removed from the shielded patient list following consultations with specialist clinicians and GPs over the summer. Individuals who are removed will not be advised to shield again if government guidance on shielding is changed in the future.

Background information

See the latest shielding guidance.

Children and young people should continue to shield until 31 July when shielding is paused for everyone in England. Specialists and GPs will be asked to contact children and families to discuss the new evidence over the summer.

Children who remain on the shielded patients list are advised they should not return to school or nursery before the 31 July.

If patients are transitioning to adult services during the shielding period, they should have a discussion with their current and future specialist, or GP, on the risks and benefits of shielding.

Guidance on supporting children and young people’s mental health and wellbeing is available.

Those on the shielding list and living in an area where a local lockdown is in place should follow shielding guidance set out locally for that area during any time of increased local community transmission.