COVID-19 and children: What you should know

Primary Children's Hospital Mar 17, 2020

The following information is provided by Dr. Andrew T. Pavia, University of Utah Health and Primary Children’s Hospital. Dr. Pavia is the George and Esther Gross Presidential Professor and the Chief of the Division of Pediatric Infectious Diseases at the University of Utah and Director of the Hospital Epidemiology Program at Primary Children’s Hospital.

COVID-19, the disease caused by the new coronavirus that was first identified in December in Wuhan, China, has rapidly spread around the world. As of this writing, more than 100,000 cases have been diagnosed worldwide. Cases have been detected in 18 states in the United States. It is almost certain that it will spread to every state in the U.S. within a few weeks, and people have many questions, particularly about children.

There has not been a lot of focus on COVID-19 in children. We are learning more about this new illness every day but now can give a pretty good picture of the disease in children.

COVID-19 appears on average to be much milder in children than it does in healthy adults or in older adults. Of the first 70,000 patients in China diagnosed with COVID-19, only 2.1 percent were children under 19 years old. No children under the age of 9 died according to this report. Only one death was reported in a child 10-19 years.

No. While we don’t know exactly how many children are infected, there are a number of studies where all family members have been tested. These suggest that children are frequently infected, but often have few or no symptoms.

It seems likely that children with serious medical illness may be more at risk of becoming more ill if they become infected, but we don’t know for sure. In adults, those with serious underlying conditions such as heart and lung disease or cancer are more likely to have severe symptoms with COVID-19. No reports yet help us know if this will be true for children.

We don’t yet know how important infected children are in the spread of the disease but we think it is highly likely that infected children can spread COVID-19. With most viral diseases, children are most infectious when they have symptoms since coughing and runny noses help spread droplets with the virus. This is probably true for COVID-19.

Many children have few or no symptoms. Symptoms include fever, runny nose, and dry cough, and occasionally, diarrhea. In a few children, this has progressed to shortness of breath. Some of those with progressive symptoms have developed pneumonia. A very small number have required intensive care.

As with other viral illnesses in children, most can be treated at home and will do well. At present there are no specific drugs to treat the infection. Drink plenty of fluids. Medications to reduce fever may make your child more comfortable.

In general, testing is not necessary, and it is best to avoid visits to a doctor’s office or emergency department if your child has mild or moderate illness. Testing will become more available in the future, but is still largely limited to people who are more severely ill or when knowing the diagnosis will make a difference in treatment or management.

You can think of this as you would any cold or flu. If your child has difficulty breathing, is not able to keep down fluids or is very limp or non-responsive you should seek care immediately. There are good sources of information you can use to help you decide. Utah Department of Health has an information line 800-456-7707. You can also use Intermountain Healthcare’s Connect Care online or through the mobile app.

All Connect Care providers are trained in screening specifically for COVID-19. Connect Care uses a video chat function to be seen by an Intermountain caregiver.

First, we should all take precautions to avoid infection in the first place. Wash hands frequently with soap and water, or if that’s not an option, use alcohol-based hand sanitizer. Clean commonly touched surfaces in your house. Stay home when sick and cover your cough with tissue or cough into your elbow.

If someone in the household is sick, all of these steps become even more important, especially paying attention to cleaning your hands after touching the ill person, handling their tissues, etc. In addition, if age appropriate, the ill person should sleep in a separate bedroom. Avoid sharing household items with the patient. You should not share dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items. After the patient uses these items, you should wash them thoroughly. Wash bed sheets and clothing, especially if they have contact with mucous, blood or stool.

Face masks worn in public do not provide any meaningful protection to healthy people. However, if the person with COVID-19 wears a mask, it helps protect those around them. Caring for a sick child or adult in your house does increase the close exposure. CDC recommends using a face mask if you are cleaning up blood, stool or body fluid such as saliva, sputum, nasal mucus, vomit, urine.

In general, pregnant women are at increased risk of infection and severe complications from viral infections like influenza or related coronaviruses, like those that cause SARS and MERS. However, data from COVID-19 patients have not strongly suggested that this is the case for the current situation. While we do not yet know all the ways that COVID-19 affects pregnant women, it is still important for mothers to protect themselves by washing their hands and avoiding people who are sick.

We have not yet discovered any proof that pregnant women can transmit the COVID-19 virus to babies in the uterus. Scientists and physicians are still studying this to see if it can happen, but for now the risk does not seem high.

We still do not know much about young babies with COVID-19 infection, but severe disease seems to be very rare. There are no reported infant deaths from COVID-19.

The COVID-19 virus has not been found in breastmilk from mothers infected with COVID-19. Transmission from a mother with COVID-19 to her baby seems to be more likely by coughing and sneezing. Nevertheless, the decision for a mother with COVID-19 to breastfeed her baby should be discussed with her doctor.