Symptoms and Severity of COVID-19 in Children
C CM after reviewing our clinical outcomes data presents an alternative post COVID-19 infection recommended guideline for cardiology follow up care for patients diagnosed with acute COVID19 diagnosis.
CCM reviewed national data from leading children’s hospital and CDC COVID-19 “Information for Pediatric Health Care Providers for federal guidelines and recommendations”. https://bit.ly/37uFl0A
(See references in the article bibliography)
The updated (CDC/NIH) guidelines distinguish between “symptomatic” and “asymptomatic” patients aged 2- 25 years of age with any of the following signs or symptoms following a positive PCR diagnosis for COVID -19 infection:
Symptoms and Severity of COVID-19 in Children
The incubation period of SARS-CoV-2 symptoms and Severity of COVID-19 in Children (The incubation period of SARS-CoV-2 appears to be about the same for children as in adults, at 2-14 days with an average of 6 days).
Clinical Presentation: Any patient aged 2 years to 25 years with a positive PCR test who exhibits any symptom listed below AND one or more cardiac symptoms should undergo Pediatric Cardiology referral at CCM (404-943-0289).
Most Common Signs or symptoms of COVID-19 in children include:
- Fever – greater than 101.5 and 2 days
- Fatigue and Malaise of greater than 2-day duration
- Headache – moderate and persistent in severity
- Myalgia / Athralgia
- Cough, harsh no- productive
- Nasal congestion or rhinorrhea
- New loss of taste or smell
- Sore throat
- Abdominal pain
- Nausea or vomiting
- Poor appetite or poor feeding
COVID Cardiac Related Symptoms
- Chest Pain +/- Dyspnea
- Dizziness, Pre-Syncope, Syncope
- Shortness of breath or difficulty breathing
Accordingly, CDC/NIH Guidelines for Pediatric Healthcare providers remind us that many children, adolescents and young adults ( < 25 y ears) infected with SARS-CoV-2 may have many of these non-specific symptoms, only have a few (such as only upper respiratory symptoms or only gastrointestinal symptoms), or may be asymptomatic. The most common symptoms in children are cough and/or fever. (11-15)
A recent systematic review estimated that 16% of children with SARS-CoV-2 infection are asymptomatic, 16 but evidence suggests that as many as half of pediatric infections may be asymptomatic. (17)
The signs and symptoms of COVID-19 in children are similar to those of other infections and noninfectious processes, including influenza, streptococcal pharyngitis, and allergic rhinitis. The lack of specificity of signs or symptoms and the significant proportion of asymptomatic infections make symptom-based screening for identification of SARS-CoV-2 in children particularly challenging. (17)
The MMWR (CDC) Severity of Illness in Children states “ Since mid-May 2020, CDC has been tracking reports of multisystem inflammatory syndrome in children (MIS-C), a rare but serious condition associated with COVID-19.” https://bit.ly/3qIBg0g
“While children infected with SARS-CoV-2 are less likely to develop severe illness compared with adults, children are still at risk of developing severe illness and complications from COVID-19. Weekly COVID-19 hospitalization surveillance data show that the rate of hospitalization among children is low compared with that of adults, but hospitalization rates among children are increasing. (18)
About 1 in 3 children hospitalized with COVID-19 in the United States were admitted to the intensive care unit, similar to the rate among adults“. (19,20)
More Info for those interested in: SEVERE PEDIATRIC MIS-C: Current evidence suggests that children with certain underlying medical conditions and infants (age <1 year) might be at increased risk for severe illness from SARS-CoV-2 infection. 11,14 Of the children who have developed severe illness from COVID-19, most have had underlying medical conditions.
- There is limited evidence about which underlying medical conditions in children might increase the risk for severe illness. Current evidence suggests that children with medical complexity, with genetic, neurologic, metabolic conditions, or with congenital heart disease might be at increased risk for severe illness from COVID-19. Similar to adults, children with obesity, diabetes, asthma or chronic lung disease, sickle cell disease, or immunosuppression might also be at increased risk for severe illness from COVID-19.
- While healthcare providers should maintain a high index of suspicion for SARS-CoV-2 infection in these populations and monitor the progression of illness closely, it appears that most infants 21 and children with certain underlying conditions such as cancer 22 who are infected with SARS-CoV-2 do not usually develop severe COVID-19 illness.
- Hospitalization rates in the United States are higher among Hispanic/Latino children and non-Hispanic Black children compared with non-Hispanic White children. Studies of hospitalized children have found that obesity was the most prevalent underlying condition. 19 Additional studies are needed to identify the association between SARS- CoV-2 infection and obesity to find possible clinical interventions and strategies to reduce hospitalization risk. (19)
Similar to adults, children with severe COVID-19 may develop respiratory failure, myocarditis, shock, acute renal failure, coagulopathy, and multi-organ system failure. Some children with COVID-19 have developed other serious problems like intussusception or diabetic ketoacidosis. 14,2,23 Children infected with SARS-CoV-2 are also at risk for developing Multisystem Inflammatory Syndrome in Children (MIS-C). 24 For the case definition, recommended evaluation, and current data on MIS-C cases in the United States, visit MIS-C Information for Healthcare Providers.