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GPs should not examine children’s throats ‘unless absolutely necessary’

GPs and other doctors should not examine children’s throats unless it is ‘essential’, due to the risk of transmission of coronavirus (Covid-19), the Royal College of Paediatrics and Child Health has said.

The college said there was ‘growing concern’ about asymptomatic children spreading the infection and that ear, nose and throat specialists had warned about possible transmission from the upper airway.

It noted that viral replication had been shown to take place in both the upper airway and lower airway.

As a result, clinicians should only look at the oropharynx of children if essential, in which case personal protective equipment – comprising a fluid resistant surgical face mask, plastic apron and gloves – should be worn.

The RCPCH said: ‘Our priority is to keep ourselves and our colleagues safe whilst maintaining a pragmatic approach, and being mindful that PPE [personal protective equipment] is potentially in limited supply.’

The college emphasised that GPs and doctors seeing child patients with suspected tonsillitis based on clinical history should ‘not examine the throat unless absolutely necessary’.

It recommended that if clinicians are using the feverpain scoring system to decide about the use of antibiotics for suspected tonsillitis – in children over the age of three – then a score of 2 should be automatically given to start with if an examination has not taken place.

For those children who score 4 or 5 overall under the feverpain system, the college recommends clinicians consider antibiotics.

The RCPCH said that while this may result in in a temporary increase in antibiotic prescribing, ‘we feel that this is preferable to healthcare staff being unnecessarily exposed to Covid-19’.

It reiterated that use of antibiotics in children under the age of three for tonsillitis is rarely beneficial and should only be prescribed in exceptional circumstances or if a diagnosis of scarlet fever is strongly considered.

The RCPCH statement, dated 27 March, said: ‘Whilst the Covid-19 narrative has focused predominantly on adults, there is growing concern about the role played by asymptomatic children in the spread of infection.’

It added: ‘We recommend that the oropharynx of children should only be examined if essential.

‘If the throat needs to be examined, personal protective equipment (fluid resistant surgical face mask, plastic apron and gloves) should be worn, irrespective of whether the child has symptoms consistent with Covid-19 or not.’

Referring to tonsillitis cases, the statement reiterated: ‘During the Covid-19 pandemic, if a diagnosis of tonsillitis is suspected based on clinical history, the default becomes not examining the throat unless absolutely necessary.’


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