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Wider collateral damage to children in the UK because of the social distancing measures designed to reduce the impact of COVID-19 in adults
  1. Esther Crawley1,
  2. Maria Loades1,2,
  3. Gene Feder3,
  4. Stuart Logan4,
  5. Sabi Redwood5,
  6. John Macleod2,5
  1. 1 Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
  2. 2 Department of Psychology, University of Bath, Bath, UK
  3. 3 Academic Primary Care, University of Bristol Faculty of Health Sciences, Bristol, UK
  4. 4 Child Health, University of Exeter Medical School, Exeter, UK
  5. 5 Applied Research Collaborative (ARC) West, University of Bristol, Bristol, UK
  1. Correspondence to Professor Esther Crawley; esther.crawley{at}

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In the UK, paediatricians are increasingly concerned that parental worries over visiting healthcare centres are leading to a drop in vaccination rates and the late presentation of serious illness in children. This is likely to cause avoidable deaths and illness in the short and long term, a form of collateral damage from the COVID-19 emergency. In Italy, hospital statistics show a substantial decrease in paediatric emergency visits compared with the same time in 2018 and 2019 of between 73% and 78%.1 In April 2020, both the Clinical Commissioning Groups and the Royal College of Paediatrics and Child Health provided guidance for general practitioners and paediatricians in England that the threshold for face-to-face assessment hospital referrals in children should not change because of the COVID-19 pandemic.2 This intervention is welcome; however, we remain concerned about wider, perhaps less immediately visible collateral damage of strategies used against COVID-19 on vulnerable children.

The Cambridge dictionary defines collateral damage as the ‘unintentional deaths and injuries of people who are not soldiers, and damage that is caused to their homes, hospitals, schools, etc’. In the fight against coronavirus, children are being put at risk, in order to reduce the spread of a disease that mainly causes direct harm to adults.

One of the unique characteristics of the COVID-19 pandemic is the low hospitalisation and mortality rate (<0.2% for teenagers).3 However, children are experiencing additional harm due to social isolation, lack of protective school placements, increased anxiety and a drop in service provision from both the National Health Service (NHS), education and social services. This is particularly true for the most vulnerable children (see Box 1).

Box 1

Definitions of vulnerable children

Definitions of vulnerability, taken from the children’s commissioner technical paper 2 which defines seven groups of children as vulnerable.19

  • Formal categories of children in care of the state whether in care, or living in other forms of state provision such as offender institutions, residential special …

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