COVID-19 in Children

BY SECOND CONSULT Published on June 10, 2021

COVID-19 in Children

  • The outbreak of SARS‐CoV‐2 infections exploded all over the world, constituting a major global health concern.  So far, the notifiable cases have mostly been among adults and few cases of children have been reported. 
  • Children with COVID‐19 may be asymptomatic or with mild clinical symptoms compared to adults.6‐8 
  • However, Recently, there have been increasing reports about cases of older school‐aged children and adolescents.

Susceptible Population 

  • Children of all ages are susceptible to SARS-CoV-2 infection. 
  • Children with underlying diseases (such as congenital heart, lung and airway disease, chronic heart and kidney disease, malnutrition, hereditary metabolic diseases, immunodeficiency disease, tumor, etc.) are likely to become severe cases.
  • long-term medication of immunosuppressants. 
  • Infants under 3 months. 

Route of Transmission:

  • Respiratory droplets and close contact 
  • Close contact with infected patients with or without symptoms 
  • aerosol or contact transmission (Live SARS-COV-2 can be isolated from the feces and urine in infected patients). 

Clinical Manifestations and Presentations

  • Fever, dry cough, and fatigue 
  • nasal congestion, runny nose, and sore throat.
  • may have atypical symptoms, presenting as gastrointestinal symptoms such as vomiting, diarrhea or only poor spirit and shortness of breath. 
  • Severe pediatric cases show obvious dyspnea, and may rapidly progress to acute respiratory distress syndrome, septic shock, refractory metabolic acidosis, coagulation dysfunction and multiple-organ failure.


  • COVID-19 should be suspected in patients who meet any one of the criteria in the epidemiological history and any two of the criteria in clinical manifestations.

Epidemiological History

  • Children with a travel or residence history in a community with infected cases reported or region with a serious epidemic within 14 days prior to disease onset.
  • Children with a history of contacting patients infected with SARS-Cov-2 within 14 days prior to disease onset.
  • Clustered cases: two or more cases with fever and/or respiratory symptoms within 14 days in small groups (such as family members, school classmates, etc.).
  • Newborns delivered by mothers with confirmed infection.

Clinical Manifestations 

  • Fever, fatigue, dry cough, and/or other respiratory symptoms
  • In the early phase of the disease, white blood cell count is normal or decreased, or with decreased lymphocytes count.
  • No other pathogens are detected which can fully explain the clinical manifestations.


  • Most children have relatively mild clinical symptoms without fever or pneumonia. They usually recover within 1–2 weeks. 
  • Attention should be paid to appropriate humidity of airways. Management depends on the severity of presentation and local gudielines and early medical intervention recommended in management.


  • Isolation
  • Protection
  • Hand hygiene (Health monitoring, wear masks, reduce close contact with their families, eat and drink separately, maintain hand hygiene, avoid going out and receive follow-up tests).

Limited data regarding the epidemiologic characteristics and clinical features of SARS-CoV-2 in children. However, Studies show that children can be asymptomatic carriers of the virus and suggest children may play a role in the community spread of COVID19.

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