GPs should not stop medicines for immunocompromised children, says NICE
GPs should contact specialists before stopping any medicines for immunocompromised children who develop Covid-19 symptoms, NICE has said.
A NICE Covid-19 rapid guideline regarding children and young people who are immunocompromised said healthcare professionals should also 'reassure patients and their parents or carers that Covid‑19 usually causes a mild, self-limiting illness in children and young people, even in those who are immunocompromised'.
However, it did add that they may be 'more vulnerable' to the illness.
The guideline said: 'Children and young people often show no or mild symptoms of Covid‑19 and very few will develop severe or life-threatening disease, but those who are immunocompromised may be more vulnerable to Covid‑19.'
Patients, parents and carers should be advised 'not to avoid their usual appointments unless told to, because it could cause harm to the patient'.
NICE urged GPs caring for patients who do develop symptoms to follow a checklist (see box) before stopping any usual treatment, and consult the patient's specialist team.
'If thinking about whether to stop usual treatment when a patient has symptoms of Covid‑19, contact the specialist team for urgent advice before stopping any medicines,' the guideline said.
GPs should also advise patients or their parent or carer that they should contact their specialist team if they do develop Covid-19 symptoms, or in order to receive individual advice if they have been advised to shield.
Experience to date shows that very few children develop severe complications from Covid-19, however NHS England is urgently looking into reports that the virus may very rarely cause a 'multisystem inflammatory state' in children.
Meanwhile, GPs have been reminded to continue to consult children in need of GP care, with the exception of examining their throats.
NICE Covid-19 rapid guideline regarding immunocompromised children and young people
1.2 Reassure patients and their parents or carers that COVID‑19 usually causes a mild, self-limiting illness in children and young people, even in those who are immunocompromised.
1.3 Advise patients and their parents or carers not to avoid their usual appointments unless told to, because it could cause harm to the patient. Tell them about alternative approaches that can be taken to minimise risk.
1.4 Tell patients and their parents or carers to contact their specialist team straight away if they think that the patient may have COVID‑19 or if they have other medical concerns, to ensure any symptoms and underlying conditions are appropriately assessed.
3.1 Be aware that:
- children and young people often show no or mild symptoms of COVID‑19 and very few will develop severe or life-threatening disease, but those who are immunocompromised may be more vulnerable to COVID‑19
- COVID‑19 can be difficult to diagnose and the symptoms can overlap with symptoms of other diseases
- patients taking medicines that affect the immune response might have atypical presentations of COVID‑19, for example, those taking prednisolone may not develop a fever
- COVID‑19 affects children and young people differently to adults so there may be less risk in starting or continuing with medicines that affect the immune system.
3.6 If thinking about whether to stop usual treatment when a patient has symptoms of Covid‑19, contact the specialist team for urgent advice before stopping any medicines. Discuss the risks and benefits with the patient and their parents or carers, and take into account:
- the severity of the underlying condition
- the risks and benefits of stopping or continuing treatment
- the effect of stopping treatment on other conditions
- whether COVID‑19 is confirmed
- the severity of the COVID‑19 symptoms
- other risk factors such as age and comorbidities, for example, diabetes or severe respiratory, cardiac or inflammatory disease.