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Objectives Using the National Child Mortality Database (NCMD), this work aims to investigate and quantify the characteristics of children dying of COVID-19, and to identify any changes in rate of childhood mortality during the pandemic. Design We compared the characteristics of the children who died in 2020, split by SARS-CoV-2 status. A negative binomial regression model was used to compare mortality rates in lockdown (23 March-28 June), with those children who died in the preceding period (6 January-22 March), as well as a comparable period in 2019. Setting England. Participants Children (0-17 years). Main outcome measures Characteristics and number of the children who died in 2020, split by SARS-CoV-2 status. Results 1550 deaths of children between 6th of January and 28 June 2020 were notified to the NCMD; 437 of the deaths were linked to SARS-CoV-2 virology records, 25 (5.7%) had a positive PCR result. PCR-positive children were less likely to be white (37.5% vs 69.4%, p=0.003) and were older (12.2 vs 0.7 years, p<0.0006) compared with child deaths without evidence of the virus. All-cause mortality rates were similar during lockdown compared with both the period before lockdown in 2020 (rate ratio (RR) 0.93 (0.84 to 1.02)) and a similar period in 2019 (RR 1.02 (0.92 to 1.13)). Conclusions There is little to suggest that there has been excess mortality during the period of lockdown. The apparent higher frequency of SARS-CoV-2-positive tests among children from black, Asian and minority ethnic groups is consistent with findings in adults. Ongoing surveillance is essential as the pandemic continues. [ABSTRACT FROM AUTHOR]

In October 2018, National Health Service England published new operational guidance for reviewing child deaths, which covers all children who die less than 18 years of age regardless of the cause of death. The Guidance is for all healthcare professionals caring for children as well as senior leaders who commission, provide or regulate children's services. It does not aim to be prescriptive but instead sets out a framework of expectations that intends to be flexible and proportionate. Its essential building blocks will be familiar to practising paediatricians: notification, investigation, review and reporting. It should be regarded as a key pillar in the hospital's governance program. [ABSTRACT FROM AUTHOR]