Table 2

BSPGHAN NIFWG framework for considering individualised lockdown exit strategy for children receiving HPN

Group BGroup C
Most vulnerable patients to consider whether they may continue to re-enact shielding when appropriate8 38No return to ‘shielding’ but consider ‘other enhanced social distancing’Enact social distancing as per local population measures
Circumstances that may recommend MDTs and families to re-enact shielding when appropriate*
  • Children at risk of severe infection due to immunodeficiency induced by their disease or drug therapy

  • Other significant conditions or other organ involvement (renal, haematology, cardiac, GI, respiratory, diabetes mellitus, severe metabolic disease, children with severe neurological disease, severe lung disease requiring continuous or overnight supplementary home oxygen

  • Decompensated liver disease. Receiving post-transplant immunosuppression or on transplant waiting-list

  • Social cofactors (eg, heavily reliant on support from healthcare professionals/carers)

Circumstances to consider group other enhanced social distancing measures†
  • Any of first column factors not severe enough to merit ‘shielding’

  • 7/7 PN

  • Under 1 year of age

  • Difficult contingency arrangements for prime carer illness

  • High output ileostomy

  • Parental anxiety

  • BAME ethnicity

Circumstances that would recommend patients to act with general population‡
  • No immunosuppression

  • <7 nights PN

  • Normal neurodevelopment

  • Easy contingency arrangements for prime carer illness

  • *No children or young people with chronic gastrointestinal conditions automatically fulfil highest risk 'Group A' by revised RCPCH criteria.8 However a proportion of HPN patients may have severe multiple risk factors that may give consideration to enacting as 'Group A'. These families will represent a small minority of the total PN population and likely most risk factors will emerge from other organ dysfunction. However, it maybe that cardiorespiratory or neurodisability in combination with IF may lead to a decision of ‘continue shielding’ with less severe disease than would indicate shielding in isolation, and discussion with relevant other specialist team may assist with decision-making.

  • †Potential strategies are the following: (1) Transition to local social distancing protocol with other age group peers; (2) temporal transition to local social distancing protocol, such as 2 weeks behind age group peers; (3) remain a ‘step’ behind age group peers; (4) remain in lockdown but not ‘shielding’.

  • ‡If an MDT considers that the mental health risks to the individual or family OR if the potential safeguarding risks for the child are significantly high enough, they may wish, in conjunction with the families or social services, to make a case for ongoing nursery or school placement even with lockdown resumption. However, we recommend some form of peer review for this extraordinary decision.

  • BAME, Black Asian and minority ethnicity; BSPGHAN, British Society for Paediatric Gastroenterology Hepatology and Nutrition; GI, gastrointestinal; HPN, home parenteral nutrition; IF, intestinal failure; MDT, multidisciplinary team; NIFWG, Nutrition and Intestinal Failure Working Group; PN, parenteral nutrition.