Table 1. Recommendations for children and adolescents with inflammatory bowel disease during the COVID-19 pandemic.

General

Wash hands frequently

Maintain social distancing (minimum distance of 1m)

Cover mouth and nose when coughing or sneezing

Wear face masks

If you have fever, cough or difficulty breathing, seek medical care as soon as possible

Face-to-face visits should be replaced with telemedicine whenever possible

Medical staff should monitor patients with active disease or flare via telephone calls

Physical exercise is essential and may be practiced at home via the internet

Psychological/ psychiatric support may be required

Specific

At this stage, IBD does not seem to be a risk factor for SARS-CoV-2 infection in children and adolescents

Adherence to drug therapy should be reinforced

Vaccination should be updated, particularly annual influenza vaccination

Active IBD disease should be treated according to standard IBD care, since risks outweigh the risk of COVID-19-related complications

Infusion centers during the COVID-19 pandemic

In stable children, switching from infliximab to adalimumab should be discouraged unless intravenous infusions cannot be provided

Combination biologic/immunomodulatory therapy may carry a higher risk compared to monotherapy

Elective endoscopic examinations and surgical procedures should be postponed during the epidemic

Colonoscopy should be replaced with fecal calprotectin test.

Source: adapted from Turner D, Huang Y, Martín-de-Carpi J, Aloi M, Focht G, Kang B, Zhou Y, Sanchez C, Kappelman MD, Uhlig HH, Pujol-Muncunill G, Ledder O, Lionetti P, Dias JA, Ruemmele FM, Russell RK; Paediatric IBD Porto group of ESPGHAN. Corona Virus Disease 2019 and Paediatric Inflammatory Bowel Diseases: Global Experience and Provisional Guidance (March 2020) from the Paediatric IBD Porto Group of European Society of Paediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2020;70(6):727-33;⁽²⁷⁾ Queiroz NS, Barros LL, Azevedo MF, Oba J, Sobrado CW, Carlos AS, et al. Management of inflammatory bowel disease patients in the COVID-19 pandemic era: a Brazilian tertiary referral center guidance. Clinics (Sao Paulo). 2020;75:e1909.⁽²⁹⁾

IBD: inflammatory bowel disease; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.