Key points

  • Visits to A&E for children and young people (defined as people younger than 20 years of age in this analysis) have seen a 62% reduction. This is far greater than the 45% reduction seen for the whole population.
  • A&E visits for illness by children and young people during the pandemic were 62% lower than the same period in 2019 – twice the reduction seen for adults.
  • The severe social distancing induced by the closure of schools, colleges and nurseries is a likely explanation for the dramatic reductions in illness visits to A&E for children and young people as with less contact they are exposed to less infectious disease.
  • As schools and colleges resume, we should expect to see changes in the prevalence of infections among children and young people, and a subsequent increase in visits to A&E.
  • A&E visits for injuries by those aged 5–19 (school and college age) during the pandemic were 67% lower than the same period in 2019. For all other age groups this was 42%.
  • The reduction in injury visits may be because children and young people are having fewer minor injuries; it may also indicate the threshold for making the decision to attend A&E has risen, both for parents and guardians, and for other services such as NHS 111.
  • The NHS should respond to this reduction by providing guidance to parents and guardians on when to seek emergency care for their child and when it is safer and more appropriate for care to take place at home.

Introduction

The pandemic is having an unequal impact on people of different ages. While people aged 65 years or older are experiencing the majority of COVID-19 deaths, the wider health impacts are being felt across generations.

Access to appropriate health care at all ages, both for COVID-19 and other conditions, is crucial for maintaining good health. A&E departments, like many other services, have seen dramatic reductions in the number of visits, but these reductions have varied considerably across age groups.

Understanding what has driven the reduction is important in helping the NHS plan for what might happen next. We would expect A&E visits to rise as people start to go back to work and school, but this may be moderated by new practices adopted over the past few months.

For which age groups have visits to A&E reduced the most?

Table 1: Proportion of A&E visits for the most common illness types, across major A&Es for the first 20 weeks of 2019, by age.

  Proportion of total illness visits to A&E
Illness 0–19 years All ages
Respiratory conditions 36% 20%
Gastrointestinal problems 18% 17%
Ear, nose and throat 11% 5%
Total 65% 42%

Source: National Commissioning Data Repository (NCDR), Emergency Care Data Set (ECDS) feeds. Sample is a subset of major A&Es in England (0-19 years, n=41 / all ages, n=39).

In all three groups, we see significant initial reductions in attendances, starting just prior to lockdown and continuing two weeks into lockdown. Although visits for ear, nose and throat and gastrointestinal problems are slowly recovering (though still 40–60% below normal), visits for respiratory conditions remain at 80% below normal. In all cases the reductions are greater than in the whole population.

Table 2: Proportion of A&E visits for the most common injury types, across major A&Es for the first 20 weeks of 2019, by age.

  Proportion of total injury visits to A&E
Injury 0–19 years All ages
Dislocations / fractures 18% 18%
Contusions / abrasions 21% 17%
Lacerations 13% 13%
Sprains / ligament injuries 19% 17%
Head injuries 9% 8%
Total 80% 73%

Source: National Commissioning Data Repository (NCDR), Emergency Care Data Set (ECDS) feeds. Sample is a subset of major A&Es in England (0-19 years, n=41 / all ages, n=39).

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