On June 10th, 2020, The Royal College of Paediatrics and Child Health (RCPCH) published guidance for clinicians about the shielding of clinically vulnerable children and young people.
According to this new guidance, the majority of children with conditions including asthma, diabetes and epilepsy do not need to continue to shield and can return to school. However, Dr Liz Whittaker, Consultant in Paediatric Infectious Diseases and Immunology and co-author of the guidance, said: “There is a group of children who are very clinically vulnerable and they should continue to shield. There is a second group who are currently shielding but may not need to do so. It’s important for parents and carers to have a conversation with their specialist to determine the best course of action. These conversations will be informed by knowledge of the severity of the disease, intensity of the treatment, and for some, their home situation.”
Thousands of children across the UK suffer from chronic conditions and diseases that are not immediately obvious. These conditions are known as ‘invisible illnesses’ and include cystic fibrosis, lung disease, primary ciliary dyskinesia (PCD), severe asthma, autoimmune diseases and transplant recipients. Children with invisible conditions are at greater risk if they contract Covid-19 but many are keen to return to school.
What can primary schools do to ensure they are protected and supported by teachers and that all children have an understanding of invisible illnesses?
Increasing awareness
To begin to comprehend how chronic invisible illness affects people, children need help to understand that not all illnesses can be seen, and that unseen conditions can be life-changing and debilitating. Over 90,000 children were asked to shield in March 2020. It is especially difficult for children to understand what this means. Similarly, it can be confusing for children when one of their friends has prolonged periods of time absent from school when they look well.
Raising awareness for invisible illnesses has never been more important. We must also remember that many of these children with health conditions are not just at risk from Covid-19. Winter is always an especially tough time for those with health conditions; the ‘flu and other seasonal viruses often lead to children with invisible illnesses having prolonged periods of time off school and in some cases having significant stays in hospital.
Talking to children about invisible conditions should not be a taboo subject. Many children live with these illnesses every day and they should not feel embarrassed or experience a lack of opportunities to talk about their conditions in a caring, sensitive and supportive environment. Gently encouraging children and their families to talk about their invisible illnesses and how they manage them will lead to a better understanding from their peers and teachers.
What information do schools need to know?
Schools will normally be made aware by parents, or their child’s health care team, if they have a condition that needs to be monitored. If this has not been done it is important that parents are given the opportunity to contact staff within the school to discuss their child’s health condition.
Parents will need to feel reassured about the care their child will receive when they are at school and, most importantly, children need to feel safe and confident to return to school. This will only happen if there has been sufficient time given to the discussion and the child’s routines and activities in school have been thoroughly prepared for.
Nina Peters, from community interest company (CIC) ShieldUs, works with families who have had to shield due to a variety of hidden health conditions. The organisation has been working to try and relieve anxiety and raise awareness for those at risk in society. She is concerned that schools’ risk assessments need to be more robust to support children with invisible illnesses and explains: “The mental health impact is huge for children and their families returning to school. We feel it is important that children with chronic health conditions can access the support and understanding they need at school. Having spoken to many children and families who have had to shield, the overwhelming feeling is that schools need to have more robust risk assessments in place to protect any at risk children.”
Expecting children to fully grasp the gravity of a pandemic is impossible. Teachers and staff will be aware that there is a delicate balancing act between ensuring children realise the risks, stick to hygiene rules and social distancing, whilst not increasing their anxiety and stress. For at-risk children this is more pronounced, and it’s important that managers and teaching staff work together to offer these children the support and understanding they need.
Positive ways to identify children who are shielding
The key is not to single out children who have health conditions. They need to feel included and understood. Using positive language and images is hugely important. For instance, ShieldUs advocates naming anyone who has had to shield because of an invisible illness as a ‘Shielded Superhero’. Inspired by Clark Kent, whose work colleagues don’t know he is also Superman, they suggest that children who are Shielded Superheroes have a special superpower which keeps their illness completely invisible. This is very appealing to young children.
In addition, it is vital to positively involve all children, and ShieldUs has created the concept of ‘Protector Heroes’ who are those who look out for Shielded Superheroes. Working together, Shielded Superheroes and Protector Heroes can make the world safer and more compassionate; what better lesson to teach our young children?
With some creative thinking there are lots of ways to help children develop their understanding about others around them who have invisible illnesses. ShieldUs has produced a free e-book available for staff to use with children. The e-book explains shielding to children in a simple and accessible way, and it can be printed and used for posters and displays. For more information visit: www.facebook.com/ShieldUs2020 or www.shieldus.company.site
For children needing to shield, the return to school can still be a safe, exciting and enjoyable time, with careful preparation. Primary school managers can provide significant support in terms of risk assessment, maintaining healthy routines and working with class teachers to ensure all children have an understanding of invisible illnesses and shielding.
Practical advice
- To curb the spread of infection special attention needs to be paid when children are using toilet facilities and moving around the school site. How about getting children to design and create their own posters for displays in school? This helps everyone feel involved and is a great way to raise children’s understanding.
- Children with certain lung conditions often have a persistent cough. Everyone needs to be aware of this so that they are not repeatedly sent home. Children who cough frequently are likely to be concerned that their friends will treat them differently now due to Covid-19.
- It is not just about ensuring people are kept safe during this pandemic, but also from other bugs that make thousands of vulnerable children seriously ill every winter. This is an opportunity to raise awareness of an ongoing situation for at-risk children. Schools must always have policies in place for every at-risk child.
Dr Helen Edwards, is co-founder of Tapestry and The Foundation Stage Forum, and a former Ofsted inspector. For more information about invisible illnesses and shielding listen to the Tapestry/FSF podcast interview with Nina at https://fsfpodcasts.simplecast.com/
