Worldwide, relatively few children have been reported with COVID-19, the disease caused by the coronavirus SARS-CoV-2.

Contagiousness increases with age. In general, the younger the children, the less significant the role they play in spreading the virus. Read more about the spread of the virus.

Children become less seriously ill and almost never need to be hospitalised because of the coronavirus SARS-CoV-2. See the overview of the COVID-19 epidemiological situation in the Netherlands.

Contagiousness increases with age

In the period following the 2020 summer holidays, the number of COVID-19 infections increased in all age groups, including children. The number of infections among young people aged 13 to 17 years increased particularly fast in that period. Yet younger children play a minor role in spreading the COVID-19 compared to older children and adults. With the emergence of more contagious virus variants, it is likely that children are also more contagious. Because the number of infections in children and how contagious they are do increase as they get older, it is and remains important to follow the basic recommendations as well as possible, at school and at home. That includes the hygiene rules and the guidelines for testing and staying home that apply to children.

Spread of the virus at school and outside of school 

The number of SARS-CoV-2 infections in the Netherlands is high, which caused the number of infections in schools to increase as well, in the period leading up to the Christmas holidays. Infections increased among children and teachers alike. A rapid increase was observed in that period, especially among older children in secondary school. Clusters emerged at school and outside of school. This mainly happened among children who had frequent contact amongst themselves. What we were seeing was that children mainly infect each other in small groups. The same applied to teachers.  

If a pupil, student or employee is infected, the Municipal Public Health Service (GGD) and the schools check who needs to be quarantined and get tested. International studies show a lower rate of transmission by children at primary school ages than by older children and teenagers in secondary school. This is also reflected in the cluster investigations by the GGDs. Employees in secondary and higher education are slightly more likely to be part of a cluster than employees in primary education and childcare.

Schools reopened

Children and adolescents in primary school, secondary school and vocational education (MBO) are being taught at school again (for part of the time). Schools are adopting additional measures to make this possible. The service document for childcare and primary education and the service document for secundary education (in Dutch) describe what the schools are doing to reduce the risk of the virus spreading among children and staff. These measures are based on advice from RIVMNational Institute for Public Health and the Environment .

For more information on specific rules for young children and schoolchildren, distancing, testing and staying home, see Government.nl.

Hygiene in childcare facilities and schools

Good hygiene and hand hygiene help prevent COVID-19 from spreading. There are hygiene guidelines for childcare facilities, kindergartens and after-school childcare, and for primary schools. Secondary schools should follow the general hygiene guidelines. 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.

See also Hygiene and COVID-19.

Ventilation and airing in childcare facilities and schools

Ventilation is important for a comfortable and 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. This should be done at times when the indoor spaces are not occupied by multiple people. Air out the indoor spaces for 10 to 15 minutes by, for example, opening windows and doors across from each other during the break. This quickly refreshes the air inside the room. Read more about properly ventilating classrooms in the ‘Protocol on education at school during corona’ (in Dutch) and the ‘ventilation guidelines’ (in Dutch).  It is also important to follow the basic recommendations.  For example, wash your hands regularly and stay home if you have symptoms.

For more information:

More information for schools

The website of the Dutch Government offers more information on the coronavirus SARS-CoV-2 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:

  • Childcare
  • Primary education and special education
  • Secondary education
  • Secondary vocational education (MBO)
  • Universities of applied sciences and research universities
  • Rules for distancing

RIVM.nl also has more information for pregnant workers 

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 SARS-CoV-2:

  • RIVM is conducting a detailed study on the reports and outbreaks of COVID-19 infections 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 conducted research among Dutch COVID-19 patients and their family contacts
  • RIVM will shortly begin investigating COVID-19 infections in primary schools.
  • 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)

In nearly all age groups, the number of newly reported infections was slightly lower in the past week compared to the week before. The largest increase in the number of reported positve tests was in the age group of 0-12 years. This age group also showed the largest increase in the number of tests taken. This is most likely related to the reopening of primary schools and childcare centres, in combination with the stricter testing policy: these children must stay home and can get tested even if their symptoms are mild.

Since 3 February 2021, source and contact tracing at schools and in childcare follows the same procedures as source and contact tracing for adults. For children aged 4-12 years who attend primary school, the policy on staying home and getting tested has been changed since 8 February, and is now the same as the policy for older children in secondary school and for adults. If they have any symptoms that could indicate COVID-19, they must stay home and get tested.

The chart on reported positive tests by age can be used to look at the number of reported positive tests per 100,000 inhabitants by week, and whether this is increasing or decreasing. It is also possible to compare the reported positive tests for the different ages from 0 to 19 years per 100,000 inhabitants. This chart provides further specification for the chart based on age groups (see other tab). The chart based on age groups can be used to compare different age groups, such as reported positive tests in children compared to adults.

The testing policy for children up to group 8 (the final year of primary school) was updated on 6 January 2021. This will help us see more clearly how the virus is spreading among children, including the spread of new variants. As a result, it is possible that the number of tested children and newly reported infections in these age groups may increase slightly again in the upcoming period. The testing policy for children in secondary school (aged 13 years and up) has not changed, so changes in the number of tests and reported infections in children aged 13 years and up will provide a better overview of changes in the number of COVID-19 infections.

The figure below shows the number of people who tested positive and were reported to the GGDs. The corresponding percentages are also displayed. Although children aged 0 to 17 years old comprise 20.7% of the population, they represent a lower percentage of the people who tested positive for COVID-19.  
 

Taartdiagram Percentage positieve testen bij kinderen lager dan bij volwassenen 20210217

 

The figure below is based on data from the GGD test lanes and shows the number of tests that took place and the percentage of positive test results by age category from 1 June 2020 on. The figure shows that the percentage of positive tests in children aged 4-11 and 12-17 is higher than in adults after 18 September. Due to new policy on source and contact tracing and the reopening of the daycare facilities and primary schools, there was an increase in the number of young children tested last week, and also in the number of reports of positive test results. Now that the secondary schools and vocational schools have reopened, these numbers may continue to rise in all the younger age groups in the coming weeks.

Grafiek positief geteste personen die bij de GGD zijn gemeld 20210217

Employees working in schools and childcare facilities 

From 31 August 2020 to 10 January 2021, over 390,000 people working in education or childcare were tested. 9% of those tests were positive. This percentage is lower than the total of 14% of the over 3.7 million adults tested in the test lanes in the same period.  

Hospital admissions

The table below shows hospitalisations as reported to the GGDs. It is not mandatory to report hospital admissions due to COVID-19, so these numbers are lower than the number of people actually admitted to hospital due to COVID-19. 

1 June to 17 September 2020     18 September 2020 to 28 February 2021  
Age group Number of hospital admissions Percentage Number of hospital admissions Percentage
0 to 3 14 2.0% 138 1.2%
4 to 11 3 0.4% 25 0.2%
12 to 17 4 0.6% 29 0.2%
Adults 677 97.0% 11,615 98.4%
Total 698   11,807  

Two children have died of COVID-19 in the Netherlands.  These cases concerned children with serious underlying disorders. 

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

When reporting a person who has COVID-19, it is also possible to report which other person with COVID-19 is a probable source of the infection. This data shows that the virus is primarily spread between people who are about the same age. The figure below shows data (up to 5 January 2021) on 188,496 paired people with COVID-19, displaying the ages of both the source and the person 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). 

Overzicht van verspreiding van het virus tussen leeftijdgenoten

Infected contacts according to the age of the source patient

Municipal Public Health Services (GGDs) conduct source and contact tracing for a person who has COVID-19. They monitor the contacts of a source person 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 person. Nearly half of the contacts had a source in the age group of 18-29 years, while 7.7% had a source under the age of 18 years.
 

grafiek met absolute aantallen (wel/niet geïnfecteerd of niet getest) van contacten naar leeftijd van de bronpatiënt

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

Taartdiagram met de leeftijdverdeling van de bronpatiënt

Infected children 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 the coronavirus SARS-CoV-2. A COVID-19 infection was detected in four of the 222 patients under the age of 18 who were tested (1.8%). Of the 1303 adults who were tested, 107 tested positive (8.2%). This is based on data from February 2020 to 28 February 2021.

COVID-19 in Dutch households

In spring 2020, RIVMNational Institute for Public Health and the Environment conducted a study to find out more about people infected with COVID-19 and their family contacts. In cooperation with the Municipal Public Health Services (GGDs), various families took part in this study. A total of 55 households took part in the first part of the study until the end of May 2020, involving 242 participants, including 187 household members. The results of this study are now known. In this family-based study, there were no indications found in any of the 55 participating families that a child younger than 12 years old was the source of COVID-19 within the family, and only one family in which it was an older child (aged 12-17 years).

Younger children seem to spread the virus less easily to each other and to adults, compared to older children and adults. To learn more about that, RIVM is working with the UMC on a second family study, focusing on households where the child was the first infected person in the family. More information about the second part of the study will follow shortly.

Frequently Asked Questions

Do children pass on the UK variant of the virus more easily? 

Studies done so far show that the UK variant of the virus is more contagious than the variant that was most common in the Netherlands. This applies to all age categories – including children. Research in the municipality of Lansingerland showed that children can become infected with the UK variant, although less frequently than adults. They are likely to develop symptoms somewhat more often than with the old variant. However, these symptoms are generally milder in children than in adults. Infected children can pass on the virus within a household and also at school. It is not yet clear whether primary school children also present a lower transmission risk for the virus variants compared to adults, as is the case for the ‘old’ variant. 

If someone in the class has tested positive for COVID-19, why does the whole class or group have to be quarantined?

Because of the high number of infections and the more contagious variants of the virus, a stricter policy on source and contact tracing has been implemented. That includes children. This stricter policy ensures that people get tested sooner and that contacts are advised to go into quarantine more often. That includes classmates and children at the childcare centre who (cumulatively) have a lot of contact with each other. This ensures that the virus has fewer opportunities to spread. It also helps us see where the virus is spreading. 

If the number of contacts per child or employee is limited, for example by working with fixed groups or letting the same children play with each other, then the Municipal Public Health Service (GGD) does not consider the other classmates as close contacts. In that case, they do not need to be quarantined. They are still advised to get tested, but do not have to stay home. 

My child has symptoms. Can my child attend childcare, primary school or secondary school?

Information on when to keep your child home from childcare or primary school can be found at Government.nl. Children and adolescents in vocational education (MBO) or higher education are subject to the basic rules for staying home that apply to everyone.

Should I stay home because my child has symptoms?

Household members of children and adolescents in secondary school, vocational education (MBO) or higher education are subject to the basic rules for staying home that apply to everyone. For household members of children in childcare or primary school, see Government.nl.

Can I have my child tested?

Can I have my child tested? Yes, that is possible. Information about testing children is available on Government.nl

My child belongs to a risk group. Can my child go to school, childcare and after-school care?

Children with underlying medical problems do not appear to have a higher risk of severe illness from COVID-19 than healthy children. If you are unsure, please consult your child’s doctor or paediatrician and the school management. If a family member belongs to a risk group, consult with the doctor and the school management.

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

There are reports from other countries about a number of children who have had a severe inflammatory reaction, which has been linked to COVID-19. These kids developed a fever, skin rash and inflammation around the heart. The symptoms are similar to Kawasaki’s disease. Further research is needed to determine whether there is a link with COVID-19. For now, that link has not been confirmed. 

What about the vaccinations for my child in the National Immunisation Programme and the coronavirus SARS-CoV-2?

It is very important for your child to receive the usual vaccinations from the National Immunisation Programme. If, for example, you postpone the 14-month shots, there is a risk that your child will contract diseases such as measles and meningococcal meningitis. These are highly contagious diseases that still occur in the Netherlands. If you or your child has cold symptoms or a fever, or if someone in the family has a fever, please contact the well-baby clinic.

Would you like to know more about vaccinations and the coronavirus SARS-CoV-2? Go to the frequently asked questions on the site of the National Immunisation Programme (in Dutch).