There hasn’t been that much media coverage about Covid-19 in children. And one of the reason is because Covid-19 is less prevalent and less severe in children. The case fatality rate of Covid-19 in the pediatric population is also less as compared to the adult population.
As a result there are many misconceptions about Covid-19 in children. so in this article let’s break down what we do know, and I’ll try to best answer some of the most commonly asked questions when it comes to Corona Virus in children.
Are the children immune to COVID-19?
No, they’re not immune and this is why states have shut down schools. Children do have a relatively lower chance of getting attacked by the virus as compared to adults while about 41% of the India’s population and 30% of the world’s population are children less than the age of 18.
Only about 2% of patients with Covid 19 infection are children in US while about 90% of cases are the results of household
and community exposure. The other 10% are cases that are associated with travel.
What are the Symptoms of COVID-19 in Children?
In most cases, symptoms of Covid-19 in children are similar to those of adults which includes fever, cough shortness of breath ,nasal congestion or runny nose sore throat, nausea, vomiting, diarrhea, fatigue, headache, body aches (Myalgias) and poor feeding or low Appetite.
However, Covid-19 in children are less likely to present with typical symptoms and one CDC report says 73% of pediatric patients had symptoms of fever, cough or shortness of breath. And this is compared with 93% of adults between the ages of 18 and 64 who had these same symptoms during the same time. Most of the times Covid-19 in children, cases were asymptomatic or had mild or moderate symptoms.
In a large study of over 2,100 pediatric patients in China, the data showed about,
- 4% of the patients are asymptomatic meaning they had no clinical symptoms. They also had normal chest imaging meaning a normal chest X-Ray.
- About 51% had mild symptoms,so this includes fever, cough, fatigue, Myalgia.
- About 39% had moderate symptoms and there including things like pneumonia on the chest X-Ray.
- 5% of cases were severe meaning they had shortness of breath, low oxygen levels. Some even had
Cyanosis meaning bluish or purplish tint of the lips and face.
- Less than 1% of cases were critically ill meaning they had either acute respiratory distress syndrome (ARDS), shock, respiratory failure, heart failure, kidney failure.
There are symptoms and complications of Covid-19 in Children. One of the more severe complication is something called Multi-system inflammatory syndrome (MIS-C) where C stands for children.
So MIS-C could present with persistent fever, inflammation and evidence of single or multi organ dysfunction like shock, respiratory failure, cardiac failure, kidney failure. Some children with MIS-C may present with symptoms of Kawasaki disease. And this includes things like fevers, Red Eye, Body Rashes, Sore throat, swollen hands and feet, Swollen lymph nodes in the neck, Red and dry cracked lips and a strawberry tongue.
while the links between COVID and MIS-C are unclear, and are generally rare. Dozens of children in New York City in Europe have been identified with MIS-C since the beginning of the COVID pandemic and three deaths have occurred in New York City.
What are the Risk Factors of COVID-19 in Children?
In a statistical study done at Children’s National Hospital in Washington DC, researchers found some interesting patterns of cover 19 infections in children.
- Infants that were less than 12 months and then older children and this included the age 15 to 25 were more likely to require hospitalization. Also these older children and young adults were most likely to receive critical care.
- Children with COVID were more likely to have underlying conditions. The most common was asthma. However children with Asthma don’t have a higher risk of hospitalization or being critically ill.
- The only symptom that is more common and hospitalized versus not hospitalized pediatric patients is shortness of breath and contrast minor symptoms like runny nose, sore throat, cough, headache. All these are more common in non-hospitalized patients compared to the hospitalized once. The data makes sense since respiratory support is a primary reason that patients with COVID require hospitalization.
- 94% of pediatric patients with COVID don’t have co-infection with other viruses or bacteria so of the 6% who had a co infection it was usually with Enterovirus or Rhino virus.
Can a pregnant women who tested positive pass the infection to their babies?
There’s been no evidence of vertical transmission or direct transmission of the virus through blood from Covid-19 positive mothers to their babies. There’s also been limited evidence that mothers with confirmed covert infection can transmit the infection to their infants through the breast milk.
However the mother can still pass on the virus to the infants after delivery through respiratory droplets. The CDC recommends PCR testing for infants of women with suspected or confirmed Covid-19. The CDC also recommends physical separations of infant’s for mothers with confirmed COVID-19 at the time of birth.
If COVID-19 positive mother’s wish to breastfeed or have skin-to-skin contact with their infants, they should wear face coverings in practice hand hygiene. Children younger than two years of age should not wear face coverings as this puts them at higher risk of suffocation.
When should children go for COVID testing?
According to the CDC, testing strategies including testing criteria and specimen types are mostly identical for children and adults except for neonates. So children who have symptoms and fall into any of the following groups should be tested.
- If they have an underlying condition that may increase the risk for severe disease such as congenital heart disease and other heart disease, asthma and immuno compromising condition like HIV, former preterm infants in Neuro muscular disease with dysfunctional airway clearance, poorly controlled type 1 diabetes and severe obesity.
- Known physical contact with patients who had confirmed COVID within the past 14 days.
- If they present with severe illness like if they have a new requirement for supplemental oxygen.
- If they’re currently hospitalized except for neonates in a neonatal intensive care unit whose mothers are negative for COVID.
What should I do when my Child tested positive?
Children who have confirmed COVID-19 through lab testing can be managed at home if they are asymptomatic or have mild to moderate symptoms and they don’t have an underlying medical condition that warns them being in the hospital.
What are the measures for parents whose children tested positive?
- This can involve one separating children with COVID from other family members who don’t have Covid. Ideally the affected children should have a separate room in isolated bathroom if possible. Parents should also limit visitors to the house.
- Notify the pediatrician before the visits which will help the pediatrician to better prepare for their visit.
- Keep COVID-19 positive family members away from pets in the household. Also avoid sharing personal household items like dishes, cups, utensils, towels, pillows. Caretakers should wash these items with water and soap after affected children use them.
- Clean all HIGH-TOUCH objects and surfaces including counters, doorknobs, bathroom fixtures, toilets, phones, keyboards, mouse, tablets etc. Use a household cleaning spray or wipes according to instructions on the label.
- If the symptoms or the conditions worsen, call your pediatrician right away. Some of these warning signs include things like shortness of breath or difficulty breathing chest pain, having blue or purplish lips or face and findings that are suggestive of shock such as cold and clammy skin, confusion or if the child is feeling very lethargic. So all children who have severe or critical symptoms are going to require hospitalization in supportive therapy like supplemental oxygen. Patients with MIS-C may require specialists doctors from pediatric infectious-disease, Rheumatology cardiology and critical care to manage the complex symptoms they exhibit.
How should I protect my children from getting COVID infection?
- Hand-washing with soap and water for at least 20 seconds. Hand sanitizer with an alcohol content greater than 60% is also useful. However, it should be noted that hand sanitizers should be out of reach of small children as the ingestion of even small amounts of liquid hand sanitizers with the high alcohol content can make children sick.
- Practice social distancing ,which means no play dates. Avoiding team sports like baseball. And avoid birthday parties with large gatherings. Children older than 2 should also wear face covering if they have to encounter other people such as the doctor’s clinic or grocery stores.
- Teach your children to cough and sneeze into a tissue or if they don’t have a tissue available then into the inner elbow. That way they’re not spreading the germs.
- Wash stuffed animals or fabric toys according to the manufacturer’s instructions in the hottest water possible before drying them completely.
- Clean and disinfect surfaces and objects at home using household cleaning sprays or wipes.
- If possible, teach your children to avoid touching their face especially if they have dirty hands.
- Follow state and federal guidance on travelling and stay at home.
What special care should I take if my child has an Asthma?
Children with moderate and severe asthma are at higher risk for more severe symptoms if they do get COVID? There’s not enough evidence that asthma alone increases the risk of contracting COVID infection.
Children with asthma should continue their medications regardless of COVID-19. Because having good asthma control minimizes the chance of an asthma creating any sort of problem and there is no evidence that asthma medications can worsen the course of Covid-19 in Children.
DO Asthma Infected children required for routine check-ups?
Children younger than the age of 2 years old especially those receiving vaccinations should continue to visit their pediatricians clinic for their routine physicals and vaccinations. Parents of children older than two years old can ask their pediatricians clinic whether a phone or an Internet appointment can substitute for a physical appointment. For children over the age of two years old who have to visit their pediatricians Clinic physically they should wear a face covering to minimize the exposure to the Covid-19 in Children.
What are the outcomes of Covid-19 in children?
Most cases of Covid-19 in Children recovered completely without any severe consequences. Very few children will go on to develop MIS-C or require hospitalization. The case fatality rate for Covid-19 in children was lower than 1% .
The latest data from the CDC till late May showed that there have been 12 deaths due to Covid-19 in children younger than 14 years old in the United States. The data also shows that there are 76 deaths due to Covid-19 in the age bracket of 15 to 24. So this is much lower compared to older populations. Also the younger the age the more likely to have a better outcome if someone does have COVID-19.
How should we talk to Our Children about COVID-19?
There has been a lot of news coverage about COVID-19 which can be frightening and overwhelming for both parents and children. The American Academy of Pediatrics has provided the following tips for parents to provide excellent communication between parents and their children through this challenging period.
Let your kids know that many people such as doctors and scientists are doing as much as they can
to keep everyone safe from COVID-19.
- Give kids the feeling of having control Remind your children that there are things that they can do to help such as washing their hands, coughing into their sleeves and elbow, practicing social distancing and getting enough sleep and wearing masks if they’re aged 2 and above.
- Monitor signs of anxiety Children may not express their worrying thoughts verbally, but they might do it through different behaviors such as Hard to get pleased, Getting too much dependent, having trouble sleeping or seem more distracted. Trying to reassure them and having a regular daily routine can help them through this difficult time.
- Monitor media exposure and interpretations Keep younger kids away from frightening images on TV and the Internet. For older children, discuss together what they hear from the news in social media while correcting misinformation and rumors they may hear.
- Be a good role model Children imitate adults around them and your actions and behaviors are more effective than actual words. So hand-washing, using hand sanitizers not touching your face with food or dirty hands and being kind to others and wearing a mask if they are older than 2 years of age.
So what are the measures and care which you are taking of your children? Please comment below in 2-3 sentences.
Also Read, Impact of COVID-19 on Education System