COVID in Children - How Does the COVID Affect Kids?

There has been little media coverage about COVID in children, and one of the reasons is because COVID is less prevalent and less severe in children. The case fatality rate of COVID in the pediatric population is also less compared to the adult population.
As a result, there are many misconceptions about COVID in children. So in this video, let’s break down what we do know. And I’ll try to best answer some of the most commonly asked questions regarding COVID in children.

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Are children immune to COVID?
No, children are not immune to COVID, which is why states have shut down schools.
Children do have a relatively lower chance of getting COVID compared to adults. While about 22% of the United States population are children less than 18 years old, only about 2% of patients with COVID infection are children. In addition, about 90 percent of cases are household and community exposure; the other 10 percent of cases were associated with travel.

What are the symptoms of COVID in children?
In most cases, symptoms of children with COVID are similar to those of adults, including fever, cough, shortness of breath, nasal congestion or running nose, sore throat, diarrhea, nausea or vomiting, fatigue, headache, myalgia, and poor feeding or low appetite.
However, children are less likely to present with typical COVID symptoms. For example, in one CDC report, 73% of pediatric patients had fever, cough, or shortness of breath compared with 93% of adults age 18 to 64 years who had these symptoms during the same time.
Most of the children with COVID were asymptomatic or had mild or moderate symptoms. In a large study of 2143 pediatric patients in China, the data showed:
- 4% of patients were asymptomatic (no clinical symptoms with normal chest imaging)
- 51% had mild symptoms (fever, cough, fatigue, and myalgia)
- 39% had moderate symptoms (pneumonia with symptoms or subclinical cases with abnormal chest imaging)
- 5% of cases are severe (dyspnea, hypoxia, or central cyanosis)
- Less than 1% of cases are critical (acute respiratory distress syndrome [ARDS], shock, respiratory failure, or multi-organ dysfunction)

There are symptoms and complications of COVID that are more specific to children. For example, one of the more severe complications is a multi-system inflammatory syndrome in children (MIS-C). MIS-C can present with persistent fever, inflammation, and evidence of single or multi-organ dysfunction (shock, respiratory, cardiac, gastrointestinal, renal, or neurologic disorder). In addition, some children with MIS-C may present with Kawasaki disease symptoms, which can present with fevers, red eyes, body rashes, a sore throat, swollen hands and feet, swollen lymph nodes neck, red & dry, cracked lips, a “strawberry” tongue.

While the links between COVID and MIS-C are unclear and are generally rare, dozens of children in New York City and Europe have been identified with MIS-C since the beginning of the COVID pandemic, and 3 de@ths have occurred in NYC.

Doctor Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine
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