Impact of COVID-19 on Children: Understanding and Prevention

By Jennifer E. Cho, MD, FACOG

As we enter the full swing of autumn, with cooler weather and schools reopening, the persistent spread of COVID-19 remains a concern. Many schools have adopted both online and in-person classes, particularly due to heightened concerns about transmission among children. This article explores what we know about the virus and its impact on young members of our communities.

How Does COVID-19 Affect Children?

Children of all age groups can contract COVID-19, though they tend to display milder symptoms than adults. According to data from the Centers for Disease Control (CDC), approximately 5.5% of infected cases occur in children under 18. For the latest data regarding coronavirus, visit CDC's COVIDView. In a systematic review of 1,475 children, only 2% were seriously affected, and 0.7% were at risk (Liguoro, et al.). Why COVID-19 affects children less severely is not fully understood. However, children with certain medical conditions like congenital heart disease, chronic neurological conditions, genetic disorders, and metabolic diseases, including diabetes and sickle cell disease, seem to face higher risks.

Common Symptoms in Children

Symptoms in children resemble those in adults but are generally milder. Among children aged 0-9, common symptoms include fever/cough/respiratory difficulties (63%), headache (15%), diarrhea (14%), rhinitis (13%), muscle pain (10%), nausea/vomiting (10%), abdominal pain (7%), and loss of taste or smell (1%). Among those aged 10-19, symptoms vary slightly: fever/cough/respiratory difficulties (60%), headache (42%), muscle pain (30%), diarrhea (14%), nausea/vomiting (10%), loss of taste or smell (10%), rhinitis (8%), and abdominal pain (8%). Unspecified skin changes, similar to hives or papular rash, have also been reported, as have “COVID toes,” though direct linkage to the virus remains unconfirmed. Infants under 12 months may exhibit additional symptoms such as unexplained fever and irritability, with minor respiratory difficulties (Stokes EK, et al.).

Transmission Among Children

Most children acquire the virus at home, typically from infected adults like parents or grandparents. The role of children in community transmission is unclear, as evidence of them being primary spreaders in communities is limited. This may be due to lower viral loads and milder symptoms.

Multi-System Inflammatory Syndrome in Children

There have been reports of symptoms akin to Kawasaki disease among children in North America and Europe. Symptoms observed include prolonged fever, hypotension, gastrointestinal issues, rash, myocarditis, and inflammation. These rare symptoms are under investigation, with no current explanation of their pathology or confirmed connections to COVID-19.

Prevention Measures for Children

Preventive measures applicable to adults, such as social distancing, mask-wearing in enclosed spaces, and handwashing, apply equally to children. For younger ones, staying home and avoiding crowded places is recommended.

Steps to Take if COVID-19 is Suspected in Your Child

If a child exhibits symptoms, it is advisable to contact a physician or pediatrician for guidance. Persistent breathing difficulties or fever necessitates a visit to a doctor or hospital. In cases of mild symptoms, isolating the child at home is recommended for recovery.

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