Worldwide, relatively few children have been reported with COVID-19, the disease caused by the novel coronavirus. RIVMNational Institute for Public Health and the Environment is conducting research on the role of children in the spread of the virus.

The novel coronavirus is mainly spread between adults and from adult family members to children. The spread of COVID-19 among children or from children to adults is less common. In general, the younger the children, the less significant the role they play in spreading the virus.

Distance among children

The 1.5-metre measure is less strict for young children:

  • Children up to and including 12 years of age do not have to stay 1.5 metres apart from each other or from adults. This also applies to childcare and primary education.
  • Young people aged 13 until 18 years old (i.e. 17 years old and younger) do not have to stay 1.5 metres apart from each other, but they do need to keep their distance from adults. This applies to all pupils in secondary schools, regardless of their age. 
  • In secondary vocational education (MBO) and higher education, all students should stay 1.5 metres apart, regardless of their age. For the exception concerning vocational education, see government.nl.

Source and contact tracing, testing and staying home

RIVMNational Institute for Public Health and the Environment has drafted a Guidance document (in Dutch) for source and contact tracing for children. It contains examples of situations involving infections in childcare and schools.

For children in childcare or primary education*:

  • If children have cold symptoms (such as a runny nose, nasal cold, sneezing or sore throat), or symptoms that are known to be hay fever, they may attend childcare or primary school. These children do not need to be tested for COVID-19.  This does not apply if the children have been in close contact with someone who has COVID-19, or if the children live with someone who has a fever or shortness of breath.  In that case, the children must stay home.
  • If these children have other symptoms that could indicate COVID-19, such as fever, shortness of breath or coughing (more than occasionally), they should stay at home until the symptoms have been gone for 24 hours. The children do not need to be tested for COVID-19, unless they are seriously ill. In that case, please contact your family doctor (GP).
  • In addition to the cold symptoms, do the children also have a fever and/or shortness of breath? Then everyone in the household stays home.
  • If one person in the household tests positive for COVID-19, everyone in the household must stay home. If the children develop symptoms, then make an appointment to get tested.
  • If the children are returning from an area that has an orange or red travel advisory because of the coronavirus or you receive a notification with the Coronamelder app, then the above advice applies to children up to and including 12 years of age. They are allowed to go to school or childcare. Anyone over 12 years of age must stay home for 10 days (quarantine) after returning from an orange or red area or after a notification from the Coronamelder app. For orange or red areas due to COVID-19, see NetherlandsWorldwide

For children in secondary education, vocational school (MBO) or higher education:

  • Do children have cold symptoms (such as a runny nose, nasal cold, sneezing or sore throat), as well as fever, shortness of breath or coughing (more than occasionally)? Have the child tested* and stay home until you get the results of the test.  
  • In addition to the cold symptoms, do the children also have a fever and/or shortness of breath? Then everyone in the household stays home.
  • If one person in the household tests positive for COVID-19, everyone in the household must stay home. If anyone develops symptoms, they must get tested.
  • If the children are returning from an area that has an orange or red travel advisory because of the coronavirus, or your child receives a notification with the Coronamelder app, then they must stay home for 10 days (quarantine).  You can find more information about the travel advisories at NetherlandsWorldwide.

More information can be found at government.nl.

* Please note: the current testing policy has been updated. Children up to 12 years old do not need to be tested. This is a temporary exception.

Younger children with cold symptoms are allowed to attend childcare and primary school

Children aged 0 to 4 years old with cold symptoms (runny nose, nasal cold, sneezing and sore throat) are allowed to go to the childcare centre or host parent, as long as they do not have a fever or other symptoms that could indicate COVID-19. This also applies to children who are in group 1 or 2 of primary school, who are allowed to go to school or to the after-school care centre if they only have cold symptoms (such as runny nose, nasal cold, sneezing or sore throat).

All children of primary school age who only have cold symptoms (such as a runny nose, nasal cold, sneezing or sore throat) can attend school; this is a temporary measure.

Staying at home and testing* is necessary if the children:

  • have been in contact with someone infected with the novel coronavirus
  • are part of an outbreak investigation
  • are seriously ill

* Please note: the current testing policy has been updated. Children up to 12 years old do not need to be tested. This is a temporary exception.

Children up to and including 12 years of age who have a fever, shortness of breath or are coughing (more than occasionally) must stay home until the symptoms have been gone for at least 24 hours. Contact your GP if your child has severe symptoms. In those cases, children can of course be tested.

Children who have tested negative for COVID-19 can go back to school, regardless of whether they have any symptoms. They must stay home during the quarantine period if a household member has tested positive, or if a household member has a fever or shortness of breath.

Preventing the virus from spreading in childcare facilities and schools

Hygiene

Good hygiene (and hand hygiene) help prevent the novel coronavirus from spreading. There are hygiene guidelines for childcare facilities, kindergartens and after-school childcare (in Dutch) and primary schools (in Dutch). For secondary schools, the general hygiene guidelines (in Dutch) are being followed. In addition, pay extra attention to cleaning frequent touch points, such as door handles, toilet controls, light switches and banisters. Also regularly clean electronic devices, such as computers and tablets, for example with a dry microfibre cloth.

Ensure good personal hygiene:

  • Wash your hands frequently with soap and water, for example when you arrive at school, before eating and after using the toilet.
  • Cough and sneeze into your elbow
  • Use paper tissues to blow your nose. Discard the tissue after use and then wash your hands.

See also Hygiene and COVID-19

Ventilation and airing out indoor spaces

Ventilation is important for a healthy indoor climate in childcare facilities and schools. Ventilating refreshes the indoor air with outside air. Good ventilation also helps to limit transmission of respiratory infections, such as COVID-19. For that reason, it is important to properly ventilate homes, businesses and other buildings, such as schools. This can be done by leaving windows open at a tilt, by opening ventilation grilles or gaps, or by using mechanical ventilation systems. Indoor spaces where multiple people will be spending time, such as classrooms, should also be aired out for 10 to 15 minutes by, for example, opening windows and doors across from each other. This quickly refreshes the air inside the room. Air out the indoor spaces at times when they are not occupied by multiple people, for example during the break. For more information:

More information for schools

The website of the Dutch Government offers more information on the novel coronavirus in the context of various types of childcare and education. The site also provides detailed information for schools, such as protocols to minimise the spread of the coronavirus:

More information can be found at government.nl.

Researching the role of children in the spread of the virus

RIVM is conducting various studies on the role of children in the spread of the novel coronavirus:

  • RIVM is conducting a detailed study on the reports of COVID-19 patients received from the Municipal Public Health Services (GGDs) in the Netherlands.
  • RIVM is working closely with the monitoring stations operated by the Netherlands Institute for Health Services Research (NIVEL) to investigate the registrations provided by GPs on patients with flu-like symptoms who are tested for COVID-19.
  • RIVM is conducting research among Dutch COVID-19 patients and their family contacts
  • RIVM has taken blood samples to test for antibodies against COVID-19 in the PIENTER Corona study.
  • RIVM is keeping track of relevant literature on children and COVID-19. This also includes studies that have been conducted in other countries.

Data from Municipal Public Health Services (GGDs)

Based on reports from Municipal Public Health Services (GGDs), children aged 0-17 years only represent 7.3% of all patients with COVID-19 reported since 1 June 2020, although they comprise 20.7% of the population. That 7.3% consists mainly of 12 to 17-year-olds, i.e. 5.2%, compared to 0.3% of 0 to 3-year-olds and 1.7% of 4 to 11-year-olds. Only 2.9% of the hospitalisations reported since 1 June involved children under the age of 18. Most of these hospitalisations (2.0%) were 0 to 3-year-olds, compared to 0.4% of 4 to 11-year-olds and 0.6% of 12 to 17-year-olds. There are no reports of children who have died from COVID-19.

Since 1 June 2020, all Dutch people with (mild) symptoms can be tested for the coronavirus. Data from the GGD test lanes show that more than 100,000 tests have been administered to children since 1 June 2020, of which a total of 1.1% were positive. Of this total number of tests administered to children, more than 5,700 tests were carried out on children up to 3 years of age, of which 1.1% were positive. More than 42,000 tests were administered to children between the ages of 4 and 11 years, and 0.8% were positive. More than 56,000 tests were administered to children between the ages of 12 and 17 years, and 1.7% were positive. In the same period, over 44,000 people working in education or childcare were tested. 0.7% of these employees tested positive. This percentage is lower than the total of 2.0% of the over 940,000 adults tested in the test lanes in the same period.

 

Results of childcare and primary education employees from GGD test lanes  

Spread of COVID-19 between people in the same age group

When reporting a COVID-19 patient, it is also possible to report which other patient is a probable source of the infection. This data shows that COVID-19 is primarily spread between people who are about the same age. The figure below shows data (up to 14 September 2020) on 732 paired patients, displaying the ages of both the source patient and the patient that they infected. Transmission of the virus appears to take place mainly between people of about the same age, and less frequently between parents and children (of all ages).

 

Infected contacts according to the age of the source patient

Municipal Public Health Services (GGDs) conduct source and contact research for COVID-19 patients. They monitor the contacts of a source patient and test them if they develop symptoms. In the period from 29 June to 6 September (week 27 to 36), more than 62,000 contacts were monitored within the framework of source and contact tracing. The figure below shows the absolute numbers (infected/non-infected or not tested) of contacts according to the age of the source patient. Nearly half of the contacts had a source patient in the age group of 18-29 years, while 7.7% had a source patient under the age of 18 years.

The chart below shows the age distribution of the source patient. Of the total number of infected contacts, 0.3% (n=14) had a source patient under the age of 4, while 0.7% (n=36) had a source patient aged 4-11 years, and 4.6% had a source patient aged 12-17 years. Of the vast majority of contacts that became infected (94.4%), the source patient was 18 years or older.

One infected child in GP practices

Around 40 GP practices in the Netherlands are registering the number of patients visiting the practice with flu-like symptoms; these are the Nivel monitoring stations. Using a cotton swab, a smear is taken from the nose and throat of some of these patients; the resulting culture is examined in the laboratory to detect viruses, including COVID-19. In one of the 183 patients under the age of 18 that were tested (0.5%), a COVID-19 infection was detected (data from February to early September 2020). The infected patient was 15 years old. Of the 1021 adults tested, 65 were positive (6.4%).

COVID-19 in Dutch households

Within a short time frame, RIVMNational Institute for Public Health and the Environment set up a study to find out more about people infected with COVID-19 and their family contacts. In cooperation with GGD Utrecht, various families took part in this study. A total of 54 households took part up to mid-April, involving 239 participants, including 185 household members. The first results of this study are now known. In this family-based study, there were no indications found in any of the 54 participating families that a child <12 years old was the source of COVID-19 within the family.

 

 

Frequently Asked Questions

My child belongs to a risk group, can my child attend school, childcare and BSO?

Children with underlying health conditions do not seem to run a greater risk of a severe course of COVID-19 than healthy children, with the possible exception of children with severe obesity and or diabetes. In case of doubt, it is wise to consult with the attending physician (or paediatrician) and school management.  If a family member is in a risk group, then also consult with the doctor and the school management.

Can COVID-19 cause a severe inflammatory response in children?

Reports have been received from abroad about some children with a severe inflammatory response, suggesting a possible link to COVID-19.  These children presented with a fever, a skin rash and inflammation around the heart. The symptoms are similar to those seen in Kawasaki disease. Research will show whether there is a link to COVID-19.  As yet, this has not been proven.

What about the vaccinations within the National Immunisation Programme for my child and the novel coronavirus?

It is very important that your child receives the usual vaccinations provided within the National Immunisation Programme (RVP in Dutch). If, for example, you postpone the 14-month vaccinations, there is a risk of diseases such as measles and meningitis caused by meningococcal infections. These are highly contagious diseases that still occur in the Netherlands. If you or your child has a cold or a fever, or if someone in the family has a fever, please contact the well-baby clinic.

Would you like to know more over vaccinations and the novel coronavirus? Go to the frequently asked questions on the site of the National Immunisation Programme (in Dutch).