Children and COVID-19 Risk

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Coronavirus in kids is possible, although they usually experience only mild symptoms or no symptoms at all. There are cases, though, where COVID-19 symptoms in children are severe, and some children have died from the novel coronavirus (SARS-CoV-2).

While research is ongoing, there is evidence the coronavirus in some children may lead to a ‘multi-inflammatory disease’ that shares similarities with toxic shock syndrome and Kawasaki disease. Although rare, parents and their doctors should be aware of these possible symptoms so they can seek further evaluation from pediatric infectious disease, rheumatology or critical care specialists.

Common COVID-19 symptoms vary slightly in children.

Like adults suffering from the coronavirus infection, COVID-19 symptoms in children include fever, cough, sore throat, excessive fatigue, and diarrhea. Thus far, most children experience mild, or even no noticeable symptoms.

The reason for this is not clear, but some experts speculate it could be because children have antibodies to fight off the virus: Some coronaviruses cause the common cold and, because young children are exposed to so many cold viruses (and producing antibodies against them), they may have antibodies that provide some defense against the novel coronavirus. The medical community refers to this natural phenomenon as ‘cross reactivity.’

It’s also possible children’s immune systems respond to the virus differently than those of adults. An adult’s immune system may be more aggressive in fighting off the virus, leading to greater inflammation and more damage to the body.

ACE2 proteins could be responsible for children’s milder symptoms.

Researchers have been looking at the differences in how adults and children respond to COVID-19. The difference may lie in a protein called ACE2 (angiotensin-converting enzyme 2). ACE2 is what SARS-CoV-2 uses to infect cells.

There is some evidence that the increased prevalence of ACE2 proteins in the lung cells of children compared to adults could provide some protective effects against severe COVID-19. That finding could be explained by the fact that ACE2 has a role in controlling inflammation. Furthermore, patients with chronic conditions (that normally do not affect children) displayed a low level of ACE2. Lower levels of ACE2 could result in more severe inflammation and serious, life-threatening COVID-19.

A new U.S. study, Human Epidemiology and Response to SARS-CoV-2 (HEROS), is looking at the rate of children infected with SARS-CoV-2 who develop COVID-19. The study includes children with asthma and allergic diseases, and will look at the levels of ACE2 in these children compared to children without such allergies. The results may help us understand why children are less likely to develop COVID-19.

Take your child to the ER if they experience severe symptoms.

Although most children thus far have not suffered from severe cases of COVID-19, there are some symptoms parents should watch for and, if spotted, should warrant a visit to the emergency room. These severe symptoms include:

  • Difficulty breathing
  • Can’t keep liquids down
  • Bluish lips
  • New confusion or unable to wake up and be alert

Call 911 or contact the emergency room en route to notify them of your impending arrival and find out what the admission procedures are.

Infants can contract COVID-19.

Infants also are at risk for contracting the coronavirus. In fact, a study of more than 2,100 children in China with suspected or confirmed COVID-19 between late December and early February revealed that close to 11% of infants with the disease suffered from severe or critical coronavirus. Experts suspect this is because their immune systems are not fully developed. In addition, their smaller airways make them more susceptible to breathing difficulties.

Asthma may lead to more severe symptoms.

Children living with asthma may experience more severe symptoms from COVID-19; although, there is no evidence that most children with asthma actually do experience more severe symptoms of the coronavirus. Even so, it’s important for parents to carefully monitor their child. If you notice new breathing difficulties or other potential COVID-19 symptoms in your child, discuss them with your child’s doctor to see if further evaluation is necessary.

Some children may suffer from a multi-system inflammatory disease.

A new COVID-19 complication showing up in the United Kingdom and United States—an emerging syndrome referenced as ”Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19”—is affecting some children, characterized by gastrointestinal symptoms and cardiac inflammation.

Although currently rare, some children exhibit the same characteristics associated with Kawasaki disease, an illness that could lead to enlarged coronary arteries or even coronary artery aneurysms. In other instances, children experienced abdominal distension and other GI symptoms. Experts agree more research is necessary to determine the relationship between this syndrome and COVID-19.

Monitor children with compromised immune systems for symptoms.

Children with underlying conditions that result in a compromised immune system could experience more severe coronavirus symptoms quickly due to their weakened immune defenses. These conditions include autoimmune disorders, such as lupus, Crohn’s disease, rheumatoid arthritis, cancer (or its treatment), diabetes, serious heart conditions, and chronic kidney disease, to name a few. If your child has such a condition, contact your child’s specialist and ask about additional precautions your family can take to prevent infection and COVID-19.

If your child is showing symptoms of COVID-19, contact your child’s pediatrician for further evaluation.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 May 12
  1. Coronavirus in Babies and Kids. Johns Hopkins Medicine.
  2. COVID-19 (Coronavirus) in Babies and Children. Mayo Clinic.
  3. COVID-19 and a Serious Inflammatory Syndrome in Children: Unpacking Recent Warnings. Boston Children’s Hospital.
  4. Cristiani L, Mancino E, Matera L, et al. Will Children Reveal Their Secret? The Coronavirus Dilemma. Eur Respir J. 2020 Apr 2: 2000749.
  5. Coronavirus and Kids: Symptoms and Who’s at Risk. Hackensack Meridian Health.
  6. Possible Biological Explanations for Kids’ Escape from COVID-19. TheScientist.
  7. Study to determine incidence of novel coronavirus infection in U.S. children begins. U.S. National Institutes of Health.
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