22 March 2022

Since the start of the COVID-19 pandemic, parents and carers have felt reassured by the knowledge that children have represented only a small proportion of cases worldwide. However, the arrival of the Omicron strains has resulted in more infections in children and young people. The good news is that evidence and our experience suggest severe illness from COVID-19 in children is still rare. That said, the world is still learning how to live with COVID-19, and it’s important that we don’t let our guard down. Here’s a breakdown of the current facts and advice about COVID-19, the vaccination and what it all means for children and young people to get you through the next leg of the COVID journey.

How at risk are children and young people from COVID-19?

Internationally, the data has consistently reported the lowest rates of COVID-19 infection in children. Pre-school and primary school age children appear less likely to acquire the infection and make up less than 5 per cent of reported cases in Australia and elsewhere.

“Importantly, the published data also suggests that children tend to have less severe cases of COVID-19 than adults,” says Children’s Health Queensland’s Director of Infectious Diseases Julia Clark. “In most cases the virus causes mild or moderate symptoms, which can include fever, cough and tummy upsets but also milder cases of pneumonia sometimes requiring hospitalisation.”

“Severe complications in children are uncommon,” Dr Clark adds. ‘Indeed, the data on Omicron suggests the variant causes less severe disease in both children and adults resulting in a lower proportion requiring admission to hospital. The most recent data estimates that 2 per cent of children with the Omicron variants require admission to hospital. However, the sheer number of infections in the community do mean we are seeing more children in hospital than previously.”

Serious illness remains extremely rare in children. While there are reports of higher rates of child deaths in some countries, a population-based analysis of 12 million children in the United Kingdom in 2020 found 1 in 50,000 children experienced a critical illness, and the rate of death related to COVID-19 was 2 per million children. In comparison, about one half of all adults with critical illness (predominantly elderly people with chronic conditions) have died.

What about the Omicron variant?

We’re still learning more about Omicron every day. It is clearly more contagious (or ‘transmissible’) than the previous variants of the virus, including the Delta strain. The available data suggest it results in a milder illness in children and adults. Severe infections in children requiring intensive care unit admission or leading to death remain uncommon. Omicron has only been on the radar since November/December 2021 and has spread rapidly in Queensland and Australia. It’s fast becoming the dominant strain here and in many parts of the world.

It’s important for families to remember that most transmission still occurs in households and  the highest infection rates are now in teenagers and young adults – age groups who socialise the most!

Are babies more at risk?

The latest published data suggests infants are at an increased risk of developing severe cases of COVID-19 compared to young children, but with a similar risk to adolescents. During the Delta wave, approximately 10 per cent of babies needed admission to hospital to receive oxygen, in a similar way to other winter viruses – although with Omicron, babies and infants are half as likely to be admitted to hospital. These are important and serious infections, but these babies almost all recover without needing support from intensive care. This is very different to the experience in the elderly, particularly those with existing health problems.

What about children with complex and chronic conditions?

Internationally, data continues to show that children are affected less commonly and less severely than adults by COVID-19.  “Even children with serious underlying conditions will usually only experience a mild illness with COVID-19. This is reinforced by data from liver transplant units and from children’s cancer centres,” Dr Clark said.

However, most children who have experienced severe cases of COVID-19 to date also had underlying chronic conditions with chronic pulmonary disease, obesity, neurological and developmental conditions, and cardiovascular conditions the most frequently reported internationally.

“It’s important to note that most children who are infected with COVID-19 have become infected via a family member. It is therefore crucial for every family member to take the recommended infection prevention precautions and ensure eligible family members are vaccinated to reduce the risk to a child with a complex and/or chronic condition getting the disease. Children over the age of 5 years are now able to be vaccinated which will both decrease their chances of getting disease and also help to decrease overall virus circulation,” Dr Clark said.

Parents and carers should contact their child’s specialist care team for tailored advice and information about their specific condition.

Learn more about children with complex and chronic conditions.

What about children who are immunocompromised?

Children whose immune systems have been compromised due to medical treatment (such as chemotherapy, organ transplants, current use of immunosuppressive medications, etc.) are more at risk from the common cold, the flu and other infections, and are more at risk of developing a serious infection from COVID-19. Most children with cancer experience mild illness and do well if they get COVID-19 but more severe illness can occur, so close observation is needed

It’s always important to take precautions to prevent the spread of infections for immunocompromised children (including basic hand and respiratory hygiene practices, and social distancing). Having vaccinated carers and other close contacts is also essential. If you have concerns about your child, we recommend discussing their current level of immunosuppression with their specialist to form the best plan for your child.

Learn more children who are  immunocompromised or immunosuppressed.

What about the multi-inflammatory syndrome?

One of the most severe presentations of COVID-19 is a complex multi-system inflammatory condition terms Paediatric Inflammatory Multisystem Syndrome – Temporally Associated with SARS-CoV-2 (or PIMS-TS). It has some features that are similar to other rare auto-inflammation diseases, such as Kawasaki disease. Doctors from around the world don’t know why a very small number of children develop this condition when most other children are not affected. This is an extremely uncommon disease and most children who have developed the condition, including critically ill children, have all made a good recovery.

Are children ‘super-spreaders’ of the coronavirus?

While we all know kids, especially younger ones, are not great at keeping their hands and bodily fluids to themselves at the best of times, there is so far no evidence to suggest they are so-called super-spreaders of coronavirus (COVID-19). Infection rates in children, including in schools, appear to mirror community rates of transmission rather than driving them. Outbreaks within schools and children’s camps increased with the Delta variant, but the vast majority of infections in children still occur in the household (this also seems to occur with Omicron).

All the evidence that we have seen so far suggests that children with mild or asymptomatic (showing no signs or symptoms) infections are not very effective spreaders of the virus. However, the Omicron variant is highly transmissible, and we are yet to see the impact of this on children, particularly unvaccinated children. Of course, this risk can be reduced even further with careful attention to hand hygiene and cleaning, particularly in children who may have symptoms.

Is the COVID 19 vaccine safe for children?

Comirnaty (Pfizer) and Spikevax (Moderna) are the only two COVID-19 vaccines approved for use in Australian children and adolescents less than 18 years of age. The Comirnaty (Pfizer) is  available from 5 years of age and the Spikevax (Moderna) is available for from 6 years of age. Real world data from many millions of doses of both these vaccines has shown that they are safe and effective (produce strong levels of protection).

The majority of the side effects seen in children after the COVID-19 vaccine are expected effects that signal their immune response is building protection. These may include pain, redness and swelling at the injection site, or more generalised symptoms such as muscle pain, chills, fever and tiredness. Myocarditis and pericarditis (inflammation of the heart muscle) is a rare side effect associated with mRNA COVID-19 vaccines. Young males (particularly 12-17 years of age) appear to be most at risk however, local and international data does not suggest younger children (less than 12 years) are at risk of this condition. As is the case for all vaccines, the safety of our COVID-19 vaccines continue to be closely monitored by expert health professionals.

The Pfizer and Moderna vaccines  include only one active ingredient, mRNA, and a small number of inactive ingredients commonly found in other vaccines and even usual household products such as cosmetics, soaps and shampoos. These include lipids, salts, sucrose and water in the vaccine in a precise formulation. They do not contain any potentially harmful chemical or heavy metals.

Find out more about getting your child vaccinated.

Why vaccinate children if they don’t get very sick?

COVID-19 is a serious illness that can affect everyone in our community. While most children tend to experience only a mild illness when compared to adults, severe illness and rare long-term complications of COVID-19 (such as
PIMS-TS
/MIS-C) have still been reported in Australia and internationally. Risk factors for severe COVID-19 disease in children include obesity, severe neuromuscular disease,  immunosuppressive conditions, heart and lung diseases, diabetes, trisomy 21 (Down Syndrome) and other complex chronic illnesses. Aboriginal and Torres Strait Islander children and individuals from remote communities may also be at an elevated risk from COVID-19 infection. By having your child vaccinated against COVID-19 you are protecting them from getting seriously ill if they were to get infected with the virus.

Vaccination of children will also have a positive impact on general child health and wellbeing by helping reduce disruption to their education and learning, access to usual health care needs, lessening the pandemic’s impact on sports and other extra-curricular activities, and opportunities for socialising.

Finally, a vaccinated your child is also less likely to transmit the virus to other family members, friends, and members of the community who are at risk of becoming very unwell.

How can I help prevent my child getting COVID-19?

Vaccination is the single most effective tool available to prevent infection in children and adults. Young children who cannot receive a vaccine are protected by the vaccination of adults and older children around them.

Additionally, physical distancing, good hand and respiratory hygiene are all important preventative actions we can take to prevent COVID-19 infection. Avoid crowded places, poorly ventilated, indoor locations and avoid prolonged contact with others. Spend more time outdoors than indoors. Ventilation is also important: Open windows when indoors to increase the amount of outdoor air.

Teach your children to:

  • Wash their hands with soap and water often and thoroughly (for at least 20 seconds) to prevent viruses entering their body. This includes after being out in public, before eating, and after going to the toilet.
  • Cough or sneeze into a tissue or their elbow (and wash their hands and put the tissue in the bin afterwards).
  • Try not to touch their face.
  • Try to stay at least 1.5 metres away from people who are coughing or sneezing.

Don’t let fear put your child’s health at risk

If your child is feeling unwell and you think they need to be seen by a doctor, especially in an emergency, there is no need to be concerned about the risk of them picking up COVID-19 in a hospital, practice or other healthcare facility. Strict infection control measures (including personal protective equipment like masks and gowns, intensive cleaning routines and isolation procedures) are in place to protect everyone – children, families and staff. If your child requires urgent care or has an important procedure or treatment due, do not delay bringing them to hospital. Similarly, if your child is on prescribed medication as part of their treatment or homecare, it is important that they continue taking their medication.

Be assured, the paediatric medical community is working tirelessly to ensure that all children with acute and/or chronic conditions are treated effectively and safely.

What should I do if my child develops symptoms of COVID-19?

If your child develops any COVID-19 symptoms, particularly fever, cough, sore throat or shortness of breath, loss of smell or taste, they should be tested.

Children may also experience other symptoms, such as runny nose, headache, loss of smell, loss of taste, nausea or vomiting, muscle pain, joint pain, fatigue, diarrhoea or a loss of appetite. Symptoms can vary depending on each case.

If your child has any symptoms, you can visit your nearest COVID-19 testing centre or ‘fever clinic’.

If you are unsure, or if your child has a sudden onset of any COVID-19 symptoms, you should contact your local doctor or call 13 HEALTH (13 43 25 84) for health advice.

You should also keep your child isolated until their symptoms have cleared up.

If you think they need to see a doctor, you should go to the GP or local emergency department. Remember to phone ahead so the practice or emergency department can make appropriate safety preparations and protect other patients.

It’s important that you don’t delay taking your child to hospital if they are sick.

Should children receive the Influenza (flu) vaccine?

Annual influenza vaccination is the most important measure to prevent influenza and its complications, and is recommended for all people aged 6 months and over. A free influenza vaccine is available for children aged from 6 months to 5 years and all Aboriginal and Torres Strait Islander children from mid-April.

The influenza vaccine can be co-administered (i.e. on the same day) with the COVID-19 vaccine.