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Shielding and support for you

We're here for you if you want to talk

0808 2080 888

[email protected]

Shielding guidance for children

This page explains the various guidelines available about coronavirus and children with blood cancer.

Pausing shielding in England, Scotland and Northern Ireland from 1 August 2020

In England, Scotland and Northern Ireland, governments have announced that if infection rates remain low, shielding for adults and children could be 'paused' from 1 August.

We are aware these announcements may worry people shielding across the UK.

It's important to remember:

For more information about the pause to shielding, your work rights and financial support after 1 August, see our page about what happens after shielding is paused.

Making sense of guidelines

As we move through the pandemic, guidelines are changing, becoming less consistent across the UK, and may even be conflicting with what your clinical team are saying.

This can make it difficult to think through it all and decide what’s best for your child.

It’s important to remember that these are guidelines. They are intended to be informative, and to guide parents and clinical teams, but not to dictate what should happen in individual situations.

The guidelines look at which children may be more at risk from coronavirus, and for which children ‘shielding’ is currently recommended. This can help you understand your child’s risk to some extent. But all children with blood cancer are different. Your healthcare team can give you the most personalised advice about your child’s risk and sensible precautions.

In addition, if you do decide to ‘shield’ your child, what this means is also a personal decision. Speak to your clinical team about any questions you have.

We hope the guidelines we share here are helpful, but always talk to your child’s clinical team for the best advice.

Is my child at high risk from coronavirus (COVID-19)?

When we talk about ‘risk’ we are talking about the chance of something happening.

With coronavirus, there are two key risks:

  • the risk of catching coronavirus
  • the risk of becoming seriously ill if you do get coronavirus.

There are certain things that can increase or decrease the chances of these things happening, but we can never know exactly what will happen to an individual.

The risk of catching coronavirus in the first place can be reduced by regular hand cleaning, not touching your face with your hands, maintaining a 2 metre distance from other people, and avoiding crowded places. The fewer people you come into close contact with, the less likely it is that you’ll come into contact with an infected person. You’re also less likely to catch the virus outside than in indoor spaces. The risk of catching coronavirus also reduces for all of us as the rate of transmission across the country reduces, because less people are infected at any one time. This is why there are guidelines on social distancing for people in England, Scotland, Wales and Northern Ireland.

For those people who do catch coronavirus, most will have a mild to moderate illness and recover without needing special treatment. But some people are more likely to develop serious illness. These include older people and people with certain health conditions, including cancer. This is why there are stricter guidelines about shielding for these groups of people – because catching coronavirus for these people could be more serious.

Whilst children with blood cancer have a higher risk of becoming seriously ill with coronavirus than children without blood cancer, this does not mean that they will become seriously ill.

National guidelines about who is at high risk and should shield

Last updated: 6 July

As coronavirus is a new virus, the guidelines published in March about who is at higher risk and should shield were based on prior knowledge about how other respiratory viruses have tended to affect people with these conditions in the past, and on prior knowledge about how certain conditions and treatments affect the immune system, which plays a key part in recovering from a virus. The NHS worked with the government to produce a list of people thought to be at the highest risk of complications from coronavirus (clinically extremely vulnerable), who they would advise to ‘shield’. This list includes:

  • adults and children who currently have any type of blood cancer
  • adults and children who’ve had an autologous transplant (using your own stem cells) in the last year
  • adults and children who’ve had an allogeneic transplant (using donor stem cells) in the last two years
  • adults and children on immunosuppression medication after a transplant, who have GvHD, or who have ongoing immunodeficiency after a transplant.

These guidelines are intended to apply to both adults and children, although the data used to come up with the criteria was adult data.

Changes to guidance in England and Scotland

In England and Scotland, the Royal College of Paediatrics and Child Health (RCPCH) has published a new list of clinically extremely vulnerable children, which has replaced the list above.

This means that many children who were previously advised to shield in England and Scotland will not be advised to shield in the future. This new guidance has been adopted because since the start of the outbreak, we have learned that coronavirus usually affects children much less severely than adults. Data also suggests that some children who were thought to be clinically extremely vulnerable have not been impacted by coronavirus as significantly as previously thought.

The new list of clinically extremely vulnerable children in England and Scotland includes children who:

In England, these children should continue to shield until 31 July, when shielding will pause. They may be advised to shield again if government guidance on shielding changes in the future.

If your child has been shielding in England for a condition that's not listed above, they should also continue to shield until 31 July, but it's very unlikely that they will need to shield in the future. This is because the latest evidence suggests that they are not at high risk of becoming seriously ill if they get coronavirus. If this is the case for your child, their GP or specialist doctor will contact you over the summer to discuss this with you.

In Scotland, letters will be sent to everyone under the age of 18 who is shielding, explaining these changes and what they mean for your child. Your child should continue to shield until their specialist doctor has discussed this with you.

As of 6 July, the following are the government guidelines in each country.

From 6 July until 31 July, adults and children shielding in all parts of England except Leicester and certain surrounding areas are advised:

  • You no longer need to observe social distancing with other members of your household.
  • You can spend time outdoors in a group of up to 6 people from different households, whilst maintaining strict social distancing.
  • If you live alone or are a single parent with children under 18, you can create a ‘support bubble’ with one other household of any size – this means you can go inside each other’s homes, stay over, and you do not need to keep 2 metres apart. You can only do this with one other household, and they must not ‘bubble’ with any other households.
  • If you don’t live alone, you can create a ‘support bubble’ but only with someone else who does live alone – this means you can go inside each other’s homes, stay over, and you do not need to keep 2 metres apart. You can only do this with one other person, and they must not ‘bubble’ with any other households.
  • You must follow social distancing advice strictly whilst outside - for example, keeping a 2 metre distance from other people.
  • You should not go to school , work, shops or pharmacies.
  • You should not go to other people's homes, or have visitors.
  • You should go to any medical appointments your healthcare team ask you to.

If you live in Leicester or certain surrounding areas, you should follow the stricter guidance below, until the localised lockdown ends:

  • If you live with other people, you can go outside with them, once a day.
  • If you live alone, you can meet one person from another household outside, once day (ideally you should keep meeting the same person, not different people on different days).
  • You must follow social distancing advice strictly whilst outside - for example, keeping a 2 metre distance from other people.
  • You should not go to school, work, shops or pharmacies.
  • You should not go to other people's homes, or have visitors.
  • Avoid close contact with other people inside the home.
  • You should go to any medical appointments your healthcare team ask you to.

From 1 August:

From 1 August, the government has announced that shielding advice will be paused in England. Instead, you’ll be advised to follow the same guidance as the rest of the population, and to follow social distancing measures as strictly as possible.

This means that children can go back to school in September if shielding advice is still relaxed at that time.

At this stage, government support such as food parcels and Statutory Sick Pay for those shielding will also end.

It’s important to know that you’ll still be able to access practical support in the following ways:

We’re currently seeking clarity from the government on what other forms of support will be available from 1 August.

More information: Shielding in England.

Until 31 July, people shielding are advised:

  • You should stay at home as much as you can.
  • You should avoid close contact with other people inside the home.
  • You can go outside for unlimited exercise.
  • You can take part in non-contact outdoor activities such as golf, hiking, outdoor swimming.
  • You can meet outdoors with people from 1 other household, in a group of no more than 8 in total, once a day.
  • You should not enter indoor areas or meet other people inside.
  • You should avoid busy places and follow strict social distancing outside (staying 2 metres away from others).
  • You should always keep your hands clean and wash them thoroughly when you return from being outside.
  • You should not go to school, work, shops or pharmacies.
  • You should not go to other people's homes, or have visitors.
  • You should go to any medical appointments your healthcare team ask you to.

From 1 August:

From 1 August, shielding advice in Scotland will be paused, if infection rates remain low. Instead, you’ll be advised to follow the same guidance as the rest of the population, and to follow social distancing measures as strictly as possible.

At this stage, government support such as food parcels and Statutory Sick Pay for those shielding will also end.

It’s important to know that you’ll still be able to access practical support in the following ways:

We’re currently seeking clarity from the government on what other forms of support will be available from 1 August.

More information: Shielding in Scotland.

Until 16 August, adults and children shielding are advised:

  • You can go outside for unlimited exercise.
  • You can meet people from another household, but only outside.
  • You must maintain good hygiene (frequent hand cleaning) and social distancing (keeping 2 metres away from other people).
  • You should not go to school, work, shops or pharmacies.
  • You should not go to other people's homes, or have visitors.
  • You should avoid close contact with other people inside the home.
  • You should go to any medical appointments your healthcare team ask you to.

A letter is being sent to everyone in Wales who is shielding to tell them this new advice, and that they should follow it until 16 August. There will be another letter later, advising what to do after 16 August.

More information: Shielding in Wales.

From 6 July until 31 July, adults and children shielding are advised:

  • You no longer need to observe social distancing with other members of your household.
  • You can spend time outdoors in a group of up to 6 people from different households, whilst maintaining strict social distancing.
  • If you live alone or are a single parent with children under 18, you can create a ‘support bubble’ with one other household of any size – this means you can go inside each other’s homes, stay over, and you do not need to keep 2 metres apart. You can only do this with one other household, and they must not ‘bubble’ with any other households.
  • If you don’t live alone, you can create a ‘support bubble’ but only with someone else who does live alone – this means you can go inside each other’s homes, stay over, and you do not need to keep 2 metres apart. You can only do this with one other person, and they must not ‘bubble’ with any other households.
  • You must follow social distancing advice strictly whilst outside – for example, keeping a 2 metre distance from other people.
  • You should not go to school, work, shops or pharmacies.
  • You should not go to other people's homes, or have visitors.
  • You should go to any medical appointments your healthcare team ask you to.

From 1 August:

From 1 August, the government has announced that shielding advice will be paused in Northern Ireland.

Instead, you’ll be advised to follow the same guidance as the rest of the population, and to follow social distancing measures as strictly as possible.

At this stage, government support such as food parcels and Sick Pay for those shielding will also end.

It’s important to know that you’ll still be able to access practical support in the following ways:

We’re currently seeking clarity from the government on what other forms of support will be available from 1 August.

More information: Shielding in Northern Ireland.

What we’ve learned so far about children

Since the first national guidelines were published, we have learned more about how coronavirus affects different people. For example, we’ve learned that coronavirus usually affects children much less severely than it does adults (and older adults in particular).

So for children with blood cancer, having blood cancer does increase their risk of becoming seriously ill from coronavirus, but at the same time, the fact that they are a child could reduce this risk, but we don’t know by how much.

We also now have data available about children with cancer who've had coronavirus in the UK. Although a small data set, it seems to suggest that the increased risk of coronavirus in children with cancer is not as significant as previously thought.

New data and guidance about children with cancer

Last updated: 23 June 2020

We now have some data from within the UK about children with cancer who’ve had coronavirus.

After looking at this data, and considering what they know about childhood cancer and treatment, the Children’s Cancer and Leukaemia Group (CCLG) now thinks that only some children with blood cancer need to carry on shielding. They have written some new, more detailed guidance about the risk to children with cancer. The CCLG is continuing to update this guidance - it was last updated on 17 June 2020.

The CCLG is a credible organisation and they have developed these guidelines based on children’s data, working with experts who specialise in childhood and teenage cancer. This guidance has also informed the guidance above from the Royal College of Paediatrics and Child Health, which has been adopted in England and Scotland.

This data suggests that the increased risk of coronavirus in children with cancer is not as significant as previously thought. This is consistent with data being gathered in other countries about children with cancer.

It’s important to note that the data is only based on a small number of cases (52 as of 16 June 2020), but that is because there are only a small number of confirmed cases of COVID-19 in children with cancer.

This guidance groups children with cancer into three different risk levels, with different advice about shielding and school. The guidance is intended for children and young people up to the age of 18.

This group includes children and young people who:

This group should:

  • follow shielding advice
  • not go to school or work
  • other people they live with should also avoid going to school or work if possible
  • everyone else in the household should follow guidance to shield the vulnerable child as far as is possible – how to do this is explained in the government’s information on ‘Living with other people

This group includes children and young people who:

This group:

  • do not need to shield
  • can go to school or work
  • should strictly follow the general advice on social distancing for people in England, Scotland, Wales and Northern Ireland.
  • other people they live with should also follow the same guidance as the rest of the population on social distancing, as strictly as possible.

Although not completely free of risk, the data available suggests it is safe for children in this group to return to school, as long as the school can ensure good hygiene and social distancing measures.

Most children and young people who completed chemotherapy or radiotherapy more than 6 months ago are not in the vulnerable groups. They should follow the general advice on social distancing for people in England, Scotland, Wales and Northern Ireland.

For more information about these guidelines, see the CCLG COVID-19 guidance for children and young people with cancer.

Summary

The three sets of guidelines above differ in which children they recommend should shield. This could change again as we learn more about the impact of coronavirus on children with cancer.

You may also have questions about how strictly you need to shield your child - what's OK and what to avoid.

Guidelines are there to guide clinicians and parents through decisions about shielding, but ultimately, it's up to parents to decide what's best for their child. Your healthcare team are there to support you to think through these guidelines and any questions you have.