Coronavirus disease 2019 (Covid-19) is an infectious disease caused by a new coronavirus called SARS-CoV-2 discovered in late 2019. Although most children affected by Covid-19 have mild symptoms, there are cases of severe Covid-19 infection and complications in a few. Children can also contract and spread the virus in the same way adults do (1).
According to the American Academy of Pediatrics and the Children’s Hospital Association, 13% of all Covid-19 cases in the US involve children (1). Hospitalization and intensive care may be required for a few children with special health care needs.
Read this post to know about the risks, symptoms, complications, diagnosis, and treatment options for Covid-19 in children.
Does Covid-19 Affect Children In The Same Way As Adults?
The spread of Covid-19 is the same in adults and children, but the majority of children may have mild symptoms or no symptoms compared to adults who can be more symptomatic (2). Although rare, Covid-19 can be severe and life-threatening among children with underlying health conditions.
The virus may spread from an infected person to others through respiratory droplets when they cough, sneeze, speak, or breathe. These droplets can spread the illness if inhaled or if they come into contact with the eyes, mouth, or nose. Current evidence suggests that the virus is spread between close contacts, typically within one meter.
The smaller respiratory droplets (aerosols) may remain in the air and travel more than one meter. This may cause the virus to spread in the air in poorly ventilated or crowded indoor spaces. Touching the face, eyes, nose, or mouth with unwashed hands after contact with contaminated surfaces may also cause illness.
An infected person can be more infectious before developing symptoms and during the early stage of illness, and those with severe disease can remain infectious for longer (3).
The Centers For Disease Control And Prevention (CDC) and the World Health Organization (WHO) recommend the following precautions to prevent Covid-19 infection (1).
- Wear masks and face shields: You may encourage children to wear masks outside the home. Mask should cover the face and nose. Do not put masks on children younger than two.
- Maintain hand hygiene: Wash hands frequently with soap and water for 20 seconds or rub the hands with an alcohol-based sanitizer containing more than 60% alcohol. You may tell your children to wash their hands until they complete singing r humming the entire happy birthday song twice to understand the duration of hand wash.
- Practice respiratory hygiene: Cover the mouth and nose with the elbow or a tissue while coughing or sneezing. You may tell the child to dispose of the tissue immediately and wash their hands.
- Avoid touching the face: Encourage your children not to touch their eyes, face, nose, or mouth with unwashed hands.
- Practice social distancing: Tell your children to maintain a social distance of six feet or two meters from anyone who doesn’t live in the same household. You may describe this distance as the length of an adult bicycle or a door height to let them understand better.
- Limit outdoor activities: You may ask your child to limit outdoor games and sports until the pandemic is over.
- Clean and disinfect the house: Use sanitizing wipes or soap and water to clean and disinfect the common contact surfaces, such as door handles and switches, at home. Wash clothes and toys as well.
Encourage your child to do indoor physical activities to promote their physical wellbeing. And instead of in-person visits, they may connect with friends online and participate in virtual activities and games.
Who Are At A Higher Risk Among Children?
Children with weakened immune systems and chronic conditions such as asthma, diabetes, heart diseases, chronic lung disease, and obesity may have a higher risk of contracting Covid-19 than healthy children (4).
Covid-19 Symptoms In Children
The incubation period for SARS-CoV-2 is the same in adults and children; two to 14 days, with an average of five to six days. Some children with Covid-19 infection can be asymptomatic (no signs of being sick) or have mild symptoms. Covid- 19 symptoms in children may include (5)
- Chills or fever
- Breathing troubles
- Muscle aches (myalgia) or body aches
- New loss of taste or smell
- Sore throat
- Runny nose (rhinorrhea)
- Nasal congestion
- Poor appetite
- Abdominal pain
Some children may have pneumonia with or without clinical features. Parents should be alert to the new onset of symptoms in children with Covid-19, as these symptoms are also seen in other common infectious and noninfectious childhood illnesses such as streptococcal pharyngitis, influenza, and allergic rhinitis.
Seek immediate medical care if you notice the following in your child.
- Difficulty breathing or catching breath
- Inability to keep down any liquids
- New confusion or inability to awaken
- Bluish lips
Possible Complications Of Covid-19 In Children
Children with severe Covid-19 infection are at risk for developing complications. The possible complications of Covid-19 in children may include (6)
- Respiratory failure
- Acute renal failure
- Myocarditis (Inflammation of the heart muscle)
- Multi-organ failure
- Diabetic ketoacidosis
- Multisystem inflammatory syndrome in children (MIS-C)
MIS-C is a severe complication of Covid-19 infection in children. It is characterized by inflammation of various parts of the body, including the major organs, and often interferes with organ functions. Excessive immune response to Covid-19 is believed to be a significant cause of MIS-C.
Children who have asymptomatic Covid-19 can also develop MIS-C, so seek prompt medical care if you notice any signs and symptoms in your child. The common signs and symptoms of MIS-C include fever, abdominal (gut) pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes, and tiredness (7).
Can Children Get Tested For Covid-19?
Yes, your child’s pediatrician can help you identify if your child needs a Covid-19 test and the type of test required. Children and adolescents with Covid-19 symptoms should get a test without delay. If the test result is positive, you may alert their close contacts about the exposure. Doctors may also recommend Covid tests before medical procedures and surgeries.
The types of Covid-19 tests may include (8)
NAATs or nucleic acid amplification tests are molecular tests done to look for pieces of SARS-CoV-2 in the respiratory tract. These tests help identify the presence of active infection by analyzing nasal or throat swabs or saliva. The PCR (polymerase chain reaction), LAMP (Loop-mediated isothermal amplification), and NEAR (nicking enzyme amplification reaction) tests are the different types of molecular tests used to detect Covid-19 infection.
PCR is a highly accurate test considered the standard gold test to determine active Covid-19 infection. LAMP and NEAR are tests recommended during emergencies.
Antigen tests use nasal or throat swabs to detect Covid-19. Positive results from these rapid tests are often reliable. However, if the result shows negative, you may have to perform a PCR test on your child to rule out Covid infection.
Antibody or serology tests check blood samples to identify antibodies (proteins) that fight SARS-CoV-2 in the body. This is not useful for diagnosing a current infection since the immune system may take time to make antibodies. However, it can predict if your child had a past infection without symptoms.
Asymptomatic children who have come in close contact with a Covid-19 positive person may wait up to four days to get tested. Close contact is defined as having been less than six feet from the infected person for at least 15 minutes over 24 hours.
Treatment For Covid-19 In Children
There are no specific drugs approved for treating coronavirus disease 2019 (Covid-19) in children. Treatment options mainly include supportive care with prevention and management of symptoms. The treatment options may include the following (9) (10).
- Oxygen therapy is administered for children with hypoxia (low oxygen levels)
- Fluid resuscitation (IV fluids) and mechanical ventilation, including ECMO, are given for severe cases based on the symptoms.
- Remdesivir, an antiviral agent, is recommended for children aged 12 years or older and weighing at least 40kg. Evaluation of the safety and efficacy of remdesivir treatment on children with Covid-19 is ongoing.
- Dexamethasone is recommended by the National Institutes of Health (NIH) for children who are on mechanical ventilation for Covid-19 respiratory disease.
- Symptomatic treatments are provided to relieve symptoms.
- Antibiotics are given only to children with bacterial co-infection.
The symptomatic and supportive care may vary for each child depending on the severity of illness and complications.
Home Treatment For Covid-19
Children with mild Covid-19 infection are allowed to stay at home during treatment. Although it can be treated at home, it is crucial to seek medical care to confirm the diagnosis and get appropriate prescriptions. Home treatments for Covid-19 in children may include
- Getting plenty of rest.
- Following a healthy diet with sufficient calorie intake.
- Consuming an adequate amount of water.
- Administering ibuprofen (advil/motrin) or tylenol (acetaminophen) for fever and body aches
- Monitoring the symptoms and keeping a record of them.
Encourage the child to stay in a room away from other family members. Home isolation and other covid precautions help prevent the spread of infection among other family members.
Parents should also keep an eye on any changes in symptoms and signs of complications during homecare. Seek medical care if the symptoms become more severe or the child has a new onset of symptoms or complications.
Covid-19 Vaccines For Children
Covid-19 vaccines have been approved for children in some countries. The CDC recommends that everyone 12 years and older get a Covid-19 vaccine, such as the Pfizer-BioNTech COVID-19 Vaccine, to protect against Covid-19. Vaccines can protect children from severe illness even if they get Covid-19 infection (11).
Some children may experience pain on the vaccination site, fever, swelling, etc., after vaccination. These are normal signs that the vaccine is effective and the body is building protection. Doctors may ask you and your children to wait up to 30 minutes within the vaccination site after vaccination to intervene if there are any immediate reactions. You may return for the second dose on the date mentioned by the doctor.
As of now, vaccination for children younger than 12 years is not recommended by the CDC. You may refer to the official pages for the availability of vaccines for younger children in the future.
Your child can get Covid-19 vaccines with other vaccines on the immunization schedule at the same visit without waiting for 14 days. Widespread vaccination is the only measure to prevent the pandemic. Even after vaccination, you may ask your child to follow Covid-19 precautions to reduce exposure and infection with new strains of SARS- CoV-2.
Although Covid-19 may cause mild illness in children, parents should pay attention to the symptoms of MIS-C and other complications. Covid positive family members seeking home treatments should avoid close contact with children at home. Encourage your child to eat healthily and do indoor physical activities.