Table 1.

Recommendations for paediatric surgery during the COVID-19 pandemic based on the domains identified including justification

Domain	Recommendations	Justification
Surgical rationing	Consider continuing surgery for paediatric malignancies. Consider adding waiting list length to inform surgical rationing in addition to urgency classifications.	To minimise a precipitous drop in surgical volumes that the service may not recover from
Surgical provision	Consider surgical approaches that minimise length of hospital stay.	To minimise the chance of nosocomial spread
HCW welfare	HCW life insurance cover in the event of death or incapacitation.19 Psychological support.13 Frequent personal protective equipment training and retraining.	To protect HCWs
Guardian policy	Designate a ‘resident/in-hospital guardian’ who lives on hospital grounds and is isolated from outside visitors. Limit in-hospital guardians to one person to prevent overcrowding. Hand hygiene for in-hospital guardians.49	To facilitate social distancing and minimise the chance of nosocomial spread
Visitor policy	Restrict all non-essential visitors.49 Restrict visitors for suspected or confirmed cases.49 Restrict visitation by any ill individual or family member.49	To reduce the number of vectors and minimise the chance of nosocomial spread
Child protection	Designate areas separate from general wards for children who may require protection during the pandemic. Strengthen social service structures during pandemics.	To protect children
Training	Training programmes to introduce virtual didactics. Consider altering trainee minimum requirements in light of declines in surgical volume and learning time. Increased collaborative learning between training programmes across borders.	To minimise the disruption to paediatric surgery workforce growth To strengthen surgical training programs

HCW, healthcare worker.