A perfect storm of health issues could be facing children in the UK this winter.
While UK children went fully back to in-person schooling in 2021, after covid-19 lockdowns in 2020, the country is approaching its first winter in years where people of all ages can mix freely, with no restrictions, enforced isolation or official encouragement to work from home.
Covid-19 is usually mild in children. However, waning immunity combined with huddling indoors amid the cold weather means that rates of the infection are set to rise across all age groups.
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And covid-19 isn鈥檛 the only infection that the UK is set to contend with. Rates of flu and respiratory syncytial virus (RSV) are also expected to soar, with children being both among the worst affected and the biggest drivers of viral transmission.
In addition, , mumps and rubella (MMR) has fallen in England.
The emotional toll of the pandemic on children may also be聽coming to light, while the UK鈥檚 cost-of-living crisis could already be affecting some children鈥檚 physical and mental health.
All things considered, children鈥檚聽health may be a particular concern this winter, but聽how big an issue could it be?
According to at University College London, both children and adults will have lower immunity to seasonal flu this winter, compared with pre-pandemic immunity levels.
While children rarely become seriously ill with flu, . During the height of the pandemic鈥檚 restrictions, flu rates聽dropped dramatically as聽lockdowns limited social interaction.
In 2019, the year before the SARS-CoV-2 coronavirus arrived in聽the UK, . In 2021, when covid-19 restrictions were broadly in place, seven people aged 0 to 19 died from flu.
With covid-19 being more transmissible than flu, social distancing protected against both聽infections. 鈥淸Now,] children聽are mixing normally again,鈥� says Bedford.
Australia鈥檚 winter flu season is usually a good indicator of how flu will play out in the UK, says Bedford. Pre-pandemic, flu cases would start rising in June in Australia. This year, , probably due to lower levels of immunity in the population.
In England, , compared with other age groups, at the end of October. Similarly, in early November. Figures aren鈥檛 available for the rest of the UK, and聽nor are figures for flu-related deaths in children.
at Alder Hey Children鈥檚 Hospital in Liverpool, UK, says he has seen an increase in the number of children with flu-related chest infections and pneumonia this autumn, compared with previous years. 鈥淲e normally come across kids like this now and again, but more often than not these days, we鈥檙e referred a child with pneumonia that鈥檚 been quite complicated to resolve.鈥�
RSV is another concern, says at Evelina London Children鈥檚 Hospital. Although usually mild, the virus is a leading cause of pneumonia in babies and can cause severe chest infections in聽children, especially among those with underlying health conditions.
鈥淲e鈥檙e expecting a big RSV wave,鈥� says Absoud. As with flu, any immunity that children built up in pre-pandemic years will have聽declined amid the prolonged period of restrictions. By 2聽years old, most children have usually caught RSV and therefore have some immunity.
According to Absoud, a key issue聽is that the surges in these seasonal infections will hit the National Health Service (NHS) at the聽same time, alongside measles, which is also a rising threat due to聽falling vaccination rates.
From the start of 2021 to September 2022, . This is down slightly from 86.6 per cent the previous year and consistently below the World Health Organization鈥檚 target of at least 95聽per cent.
Although usually mild, measles聽can cause serious complications if聽it spreads to the聽lungs or brain. It is also . Each person with measles generally infects another聽15 people, says Bedford.
Overall, covid-19 is less of a concern for children鈥檚 health than聽flu, RSV and measles, says Absoud. Rates of covid-19-related hospital admissions for children are relatively low throughout the聽UK. In the week ending 6聽November, .
鈥淭he risk is not zero, but we鈥檙e聽more worried about flu聽and聽RSV,鈥� says Absoud.
The UK鈥檚 cost-of-living crisis is also expected to affect children鈥檚 health聽this winter, says Sinha.
The high cost of energy may discourage people from heating their homes, leading to damp, says Sinha. Damp exposure is linked to a higher risk of developing asthma and having asthma attacks.
Cold and damp homes are also聽more likely to have mould, which can cause fungal infections. 鈥淚f a child with a compromised immune system is living in a house surrounded by fungal spores, that can lead to chest infections,鈥� says Sinha.
The financial worries that many聽families are facing may affect some children鈥檚 mental health, too.
鈥淐hildren are hugely affected by the health and well-being and functioning of the adults in their lives,鈥� says Elaine Lockhart at the Royal College of Psychiatrists, UK. 鈥淧arents may be struggling with their own mental health or may be stressed about having to work more hours. It becomes a really vicious cycle.鈥�
The mental health impact of the pandemic and its aftermath on children may also be becoming more apparent.
NHS Digital figures show that from July 2021 to July 2022, 鈥� an聽11聽per cent increase on the previous year. While other factors could be at play, many people at least partly blame the pandemic.
Speaking anecdotally, Lockhart says that since the pandemic began, she has seen an increase in聽the severity of mental health issues that some children are experiencing. Those with less urgent symptoms may therefore have to wait longer for treatment. Conditions such as mild anxiety and mild depression can often be eased relatively quickly if a person is treated early, says Lockhart.
鈥淐hild mental health colleagues聽are completely stretched,鈥� says Absoud.
All the heightened issues that聽children in the UK may face聽this winter will probably be聽exacerbated if they come from聽a deprived socioeconomic background. These children may live in crowded housing, which could raise their risk of respiratory infections, says Sinha. They may also be more affected by the cost-of-living crisis, both physically and聽mentally, says Absoud.
鈥淚鈥檝e been in the NHS 22 years,鈥� he says. 鈥淣ever have I seen social inequalities impact health so visibly on the ground.鈥�
