How COVID-19 affects kids

COVID-19 has dramatically affected the global community, with more than 4.5 million confirmed cases worldwide. While first thought to primarily affect adults, it has now emerged as a growing concern for children as well. According to a study published in the journal Pediatrics, thousands of children have been confirmed to have the disease, though most cases are mild or asymptomatic, which means they experience no signs or symptoms of illness.
However, what experts find concerning is that a very small number of children with COVID-19 or who test positive for having antibodies — showing they had a prior COVID-19 infection — experience multisystem inflammatory syndrome (MIS-C). MIS-C is a rare, life-threatening condition — similar to Kawasaki disease or toxic shock syndrome — that can cause dangerous inflammation in the eyes, skin, blood vessels and heart.

Answers to your top 5 questions about COVID-19 in kids
According to Dr. Howard Smart, a board-certified pediatrician and pediatric department chair for Sharp Rees-Stealy Medical Group, children, especially young children, are at increased risk for contracting COVID-19. This is because they do not reliably take precautions to prevent it, though he emphasizes that a majority of the pediatric cases will be mild or without any symptoms at all.
Dr. Smart answers some of parents’ most pressing questions related to children and COVID-19.

Would you still call COVID-19 in children rare, as they did at the beginning of the pandemic?
Children seem to represent about 2% of symptomatic cases and they comprise 22% of the population, so this means they certainly seem to have a lower risk of significant problems due to COVID-19 than other age groups. What we do not know is how many children have COVID-19 without ever having any symptoms, or with mild symptoms that go unrecognized as COVID-19.
On the other hand, it is extremely likely that children spread this disease very efficiently, even if they do not have symptoms. We cannot count on them to wash their hands often and correctly, keep their masks on, avoid touching their face, sneeze and cough into their elbows, or maintain their physical distance from other kids or adults.
Children with COVID-19, whether or not they have symptoms, will have infectious virus in their mouths and noses, and probably in their intestinal tract. Therefore, it will most certainly be on their hands and everything they touch. This can last for a couple of weeks after infection.

Which children are at greatest risk of becoming severely ill due to COVID-19?
Children with underlying medical conditions — such as asthma, cystic fibrosis or other chronic lung disease, congenital heart disease, diabetes — or conditions with immune suppression, such as cancer, autoimmune disease or sickle cell disease, are at greater risk for severe illness due to COVID-19.

What signs of COVID-19 should parents watch for?
How do these differ from symptoms in adults?
In adults, about 93% of people with COVID-19 have fever, cough or shortness of breath. In children, this is only 73%, meaning just over one-quarter of children had none of those symptoms. And only a little more than half reported fever.
Other symptoms reported in children include runny nose, sore throat, headache, muscle aches, abdominal pain, nausea, vomiting and diarrhea.

Will the emergence of MIS-C affect how we think about and treat COVID-19 in children?
This is a troubling development because children can become quite ill. It seems that, rather than being caused by the coronavirus itself, this syndrome is a result of the body’s immune response to the virus. It can occur up to several weeks after infection.
Symptoms include:

• Prolonged fever

• Red eyes

• Rash

• Swollen cracked lips

• “Strawberry tongue” (a swollen, bumpy tongue)

• Abdominal pain

• Swollen lymph nodes

• Swollen hands or feet

• Severe lethargy

• Vomiting or diarrhea

It is, thankfully, very rare and is treatable when care is sought in a timely manner, so it is not something parents should be overly concerned about.

When should parents seek emergency care for a child experiencing symptoms of COVID-19?
The most common emergency is difficulty with breathing. This virus causes pneumonia and low oxygen levels in a small number of children — the most sensitive outward sign of this in a child will be rapid breathing. As mentioned, a significant number of kids will have no fever or cough, so this may be the only sign of trouble.
Dehydration from vomiting, diarrhea and not drinking will result in dry mouth, no tears and decreased urine production. Other emergencies will be more obvious, especially significant lethargy.
If your child is sick, even mildly so, do not hesitate to contact your pediatrician. We will tell you if we think you should bring your child in for examination.
Visiting the doctor is safe. We continuously perform entry screening and environmental disinfecting to minimize exposure to germs, and all patients and visitors are required to wear a personal face covering.

Learn more about what Sharp HealthCare is doing to respond to the COVID-19 pandemic.