COVID-19 and IBD

Back to School

Parents have had to make difficult decisions as to whether or not to send their children with IBD back to school. Balancing the educational needs of your child with potential health risks is extremely difficult, and you may have decided on an online learning environment, and that is okay! You may already be considering switching to in-person next semester, and that's okay too! There are several things to consider; these guidelines are intended to help you make the decisions that are best for your child and your family. 

This guidance and should not replace the recommendations of your national public health agency or your doctor. If you are unsure and/or have any concerns, please talk to your doctor.

This page contains information on:

Guidance for Children and Adolescents
Considerations for Parents 
Guidance for Teachers and Staff

Guidance for Children and adolescents

Children and adolescents who get COVID-19 tend to have very mild symptoms and rarely require hospitalization. The risk of hospitalization and death in children with COVID-19 is not higher than a typical influenza infection. Several registries studying COVID-19 in children and adolescents with IBD have only reported mild COVID-19 disease, even among children using immunosuppressive or biologic medications. 

Recommendations:

If your child with IBD is in remission and otherwise healthy, your child should follow the national public health guidance regarding returning to school. This includes children on immunosuppressives or biologics. In general, children/adolescents who are in remission and feeling well may return to school and follow the bundle of measures to keep children safe at school including physical distancing, cohorting of classes (where possible), hand-hygiene, and wearing masks. We recommend non-cloth masks for all children, regardless of vaccination status. KN95 or N95 masks are preferred to prevent infection with the airborne Omicron variant. At minimum, a 3- or 4-ply surgical mask should be used.

If your child has any symptoms of COVID-19 (similar to a cold or flu), they should remain home from school and should be tested for COVID-19.

There is uncertainty as to the risk of high-dose steroids (more than 0.5 mg/kg/day of prednisone equivalent dose, or more than 20 mg per day), severe active inflammation, and malnutrition in children/adolescents with IBD. Consequently, we recommend a more cautious approach until more data becomes available to help guide decisions.

We recommend that children/adolescents stay home from school if they are:

• Newly diagnosed with IBD, or

• Have severe active inflammation (that is, people who were told by their doctor that the inflammation in their gastro-intestinal tract is severe and not yet under good control), or

• Are taking steroid medications (more than 0.5 mg/kg/day prednisone equivalent dose, or more than 20 mg per day) (excluding steroid enemas/creams or budesonide), or

• Have moderate/severe malnutrition (that is, people who were told by their doctor that they are malnourished, and that malnutrition came as a result of active inflammation that isn’t yet under good control)

If your child was recently diagnosed or had a flare of IBD, but is now in remission and has tapered the dose of steroids to less than 0.5 mg/kg/day and less than 20 mg per day, you may consider resuming attendance at school. Typically, this might take some time after the disease diagnosis or flare. Please speak to your doctor.

If there is an outbreak of COVID-19 at your child's school, or your child has had direct contact with someone with suspected or confirmed COVID-19, your child should stay home from school for at least 14 days and you should speak with your local public health office.

If your child has other illnesses that put him/her at risk of severe COVID-19, you should speak to your doctor about whether it is safe to return to school.

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Considerations for Parents

In addition to the guidance for children above, there are a few additional considerations that parents should weigh prior to deciding what is right for their child and their situation. These may include:

• Access to washrooms at school; will there be limitations? (Note that public washrooms do not pose a large risk for transmission of COVID-19 infection, as long as they are cleaned regularly and your child washes their hands after using the washroom)

• Some school bus routes have become much longer due to driver shortages and could be an issue for children requiring washroom access more frequently.

• Flexibility to move to online class/in-person class depending on changes in your child’s wellness.

Household Guidance:

If your child is newly diagnosed, has severe active inflammation or is taking high-dose steroids, your child should stay home, and be shielded from COVID-19 using the following strategies:

• Wear a mask in public indoor spaces or outdoors with others for a prolonged time. KN95 or N95 masks are preferred. A 3-ply or 4-ply surgical mask should be considered the minimum protection. A cloth mask should not be used

• ​All household members should employ good hand hygiene, and other strategies to reduce transmission of COVID-19.

• Be aware of local information on numbers of people with COVID-19 in your community (consult your provincial/territorial and municipal health websites); consider additional precautions if community cases are increasing or high (e.g. working from home if possible)

• Household members should adhere to public health physical distancing recommendations outside of the home and avoid gatherings where physical distancing is not possible, and places where people are not wearing masks.

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Guidance for teachers and staff

Teachers with IBD are faced with the challenge of returning to school while COVID-19 remains in our communities. The return-to-school scenario can be a challenging decision-point.

The following guidance is meant to offer risk assessment information. These recommendations are general guidance and should not replace the recommendations of your national public health agency or your doctor. If you are unsure and/or have any concerns, please talk to your doctor.

Recommendations:

If you are in remission and are otherwise healthy, you should follow the national public health guidance regarding returning to school. In general, adults who are in remission and feeling well may return to work, including those on immunosuppressive or biologic medications.

There is uncertainty as to the risks posed by high-dose steroids (more than 20 mg of prednisone equivalent dose), severe active inflammation, and malnutrition in adults with IBD. In older adults, it appears that severe active inflammation and prednisone may increase the chances of having severe COVID-19. Consequently, we recommend a more cautious approach until more data becomes available to help guide decisions. 

We recommend that teachers with IBD work virtually (if possible) if they:

• Have severe active inflammation (that is, people who were told by their doctor that the inflammation in their gastro-intestinal tract is severe and not yet under good control), or

• Take steroid medications (more than 20 mg prednisone equivalent dose) (excluding steroid enemas or budesonide), or

• Have moderate/severe malnutrition (that is, people who were told by their doctor that they are malnourished, and that malnutrition came as a result of active inflammation that isn’t yet under good control), or

• Require parenteral nutrition (TPN or intravenous nutrition through a central line), or

• Have other comorbidities that put him/her at risk of severe COVID-19 (as per national public health recommendations).

If you were recently diagnosed or had a flare of IBD but are now feeling well and tapered the dose of steroids to less than 20 mg per day, you may return to school.

General Guidance:

• Teachers with IBD should adhere to national public health guidelines including physical distancing (where possible), and consistently wearing a mask and face-shield.

• Wear a mask in public indoor spaces or outdoors with others for prolonged time. KN95 or N95 masks are preferred. A 3-ply or 4-ply surgical mask should be considered the minimum protection. A cloth mask should not be used.

• Be aware of local information on numbers of people with COVID-19 in your community (consult your provincial/territorial and municipal health websites); consider additional measures if community cases are increasing or high.

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Last Updated: October 7, 2020