Covid-19 and children with spinal cord injury
We have worked collaboratively with Dr Allison Graham, Consultant Physician in spinal cord injury (with specialist interest in paediatric injury) to produce the following specific information on Covid-19 and children with spinal cord injury. Throughout this piece we link to the NHS, the Centres for Disease Control and Prevention, and the Royal College of Paediatrics and Child Health.
This page was last updated November 2020
There is much more still to learn about how Covid-19 impacts children, but the guidance below provides information on children with spinal cord injury, shielding and school.
According to the Royal College of Paediatrics and Child Health there are two groups who are advised to shield:
1. Group A – those with poor immunity
2. Group B – covers conditions that require discussion between the clinician, child and family but do not necessarily mean a child is clinically extremely vulnerable (CEV) and required to shield. Some children with a spinal cord injury will be impacted.
Spinal cord injury does not automatically mean a child will need to shield.
A child may need to shield if they have a spinal cord injury and have:
• Significant difficulty with swallowing
• Significant risk of decompensation during infection – a child who is unable to cough effectively. In children with spinal cord injury, this will be a very high spinal cord injury (high level tetraplegia).
More advice is available from the British Paediatric Neurology Association.
Special consideration should also be given to children who have had an admission to intensive care (Paediatric Intensive Care Unit or High Dependency Unit) within the last 6 months and have:
• Significant impairment in ability to cough and to clear airway secretions due to level of injury
• Require a cough assist device to help with clearance of airway secretions
• Life-dependent on long term ventilation, both invasive (via tracheostomy) and non-invasive (CPAP and BiPAP).
Before this recent guidance, we used assisted breathing needs (such as requiring ventilation with machines) as a risk factor to shield. This should continue to be considered however the guidance is that it should not automatically mean that a child needs to shield. If your child has a spinal cord injury and any of the conditions listed above, speak with your child’s clinician to seek further advice on whether they need to shield.
Children who are clinically extremely vulnerable (CEV) to Covid-19 and attending school
The criteria above are a means of identifying those children and young people who are clinically extremely vulnerable (CEV). They do not directly determine whether a child or young person should attend school. This will be determined on individual basis, in discussions between the clinician, the child and their family.
The government feels school is important for development and children should go to school unless they are in above group.
Covid-19 symptoms in children
Symptoms may present slightly differently in children. Do seek medical advice if needed – the symptoms experienced with Covid-19 are often symptoms of other illnesses as well. Although there is a lot of coverage about how busy the NHS currently is, we would still encourage you to seek medical help if required through calling NHS 111 if in England, Scotland or Northern Ireland or through their website, and if in Wales use either NHS 111 if available in your area or call Wales Direct on 0845 4647. Call 999 if an emergency. Ensure you have up to date information about your child’s normal situation and medication use.
The National Spinal Injury Centre at Stoke Mandeville or your local unit can be contacted for further help and advice. Although they currently have a reduced service with outpatient appointments, they are still doing routine appointments by video, phone and email where possible and can support with any concerns you may have.
Information about health services
It is vital to remember that the health service is still open – it is just taking on a different form. If you have any concern about your child’s health that is not related to Covid-19 then contact your GP practice or the spinal units who can all offer advice and appointments by telephone.
What happens if you do need to be seen at a spinal centre or hospital?
If you do need to be seen then there are guidelines that will be explained and temperatures are taken of anyone who goes in. Most advice is that one adult only should accompany the child. Hospitals are currently working with green and red zones to keep areas where potentially positive patients are separate form those with other conditions.
It will take a long time for “normal service” to resume but it’s really important not to wait and worry at home. Seek medical advice when you need it.
Hyperacute inflammatory presentation
The hyperacute inflammatory presentation is very rare. Any parent who sees their child become seriously unwell quickly need to seek urgent medical advice. There are a variety of possible signs which include any unusual rash on the mouth, hands and feet, and needs to be reviewed medically. Acute services are open and can safely see children. We do not yet know why some children respond this way.
Covid-19 vaccine information
For children with a spinal cord injury
Currently the vaccine is only licensed for children aged 16 and over.
Children aged 16 and 17 with spinal cord injury will either be in group four or six, depending on level of injury. Do speak to your child’s clinician if you have any questions or concerns about this. Spinal Injuries Association have also produced a template letter for GPs, advocating that those with tetraplegia and high-level paraplegia should be prioritised in group four.
For parents of children with a spinal cord injury
The JCVI (Joint Committee on Vaccination and Immunisation) has included unpaid carers on the vaccination priority list (UK wide) in group six. You may be in a group higher up the list due to your age if you are over 65. You can find the list of groups here.
Carers are shown to be prioritised for the vaccine as part of the ‘Persons with underlying health conditions’ group.
If you are based in England, this template letter from Carers UK may be helpful for contacting your GP.