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British Society of Paediatric Gastroenterology, Hepatology and Nutrition

Clinically extremely vulnerable (CEV) children are those who are considered to be at the highest risk of severe disease due to SARS-CoV-2 infection.

Currently , the government and public health agencies have not issued guidance that people who are CEV are advised by to ‘shield’.

The evidence base around the impact of SARS-CoV-2 infection on children and young people with comorbidities has been developing over time. RCPCH is working with paediatric specialties to review this evidence and advise on which children and young people are at the highest risk of severe disease due to SARS-CoV-2 infection because they are ‘clinically extremely vulnerable’ (CEV). This includes the following:

  • Research evidence summaries
  • Service evaluation and audit on the care needs of children admitted to hospital (England)
  • Systematic review of evidence about milder outcomes in children
  • CEV children will be determined on individual basis, in discussions between the clinician, the child and their family. Of note, the majority of children shielded before, are not CEV.

CEV Young people’s transition to adult services Government advice on who is clinically extremely vulnerable is differs for adults and children. Risk of complications from SARS-CoV-2 infection is increasingly recognised as being primarily age related. As some patient’s transition, they may have new discussions with their adult clinicians around their clinical vulnerability. Paediatricians who are treating young people who are CEV and transitioning to adult care should discuss the risk of SARS-CoV-2 infection as a patient moves between services, using the specialty guidance which will be updated.

Children who are CEV to SARS-CoV-2 infection and attending school

While there may be other clinical reasons that prevent a child with underlying health conditions from attending school, while coronavirus shielding advice is paused, the small group of children who are considered to be CEV can attend school.

Governments may reintroduce shielding advice at a local or national level. If this happens, CYP who are advised to shield because they are CEV will receive a letter from the government. This may include advice not to attend school. Parents should contact their child’s specialist or GP if their child receives a letter telling them they are clinically extremely vulnerable, and they should shield that they did not expect.

Families are understandably worried. The College will continue to update current evidence on COVID-19 and children, and members are encouraged to use this when advising families.

The full guidance from the RCPCH will be released soon.

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