Patient education: COVID-19 and children (The Basics)

What is COVID-19? — COVID-19 stands for "coronavirus disease 2019." It is caused by a virus called SARS-CoV-2. The virus first appeared in late 2019 and quickly spread around the world.

There are different "variants," or strains, of the virus that causes COVID-19. Some variants seem to spread more easily than the original virus. Certain variants might also make people sicker than others. In the US, most cases of COVID-19 are from the "Omicron" variants.

The virus that causes COVID-19 mainly spreads from person to person. This usually happens when an infected person coughs, sneezes, or talks near other people.

A person can be infected, and spread the virus to others, even without having any symptoms.

This article is about COVID-19 in children.

Are COVID-19 symptoms different in children than adults? — Not really. In adults, common symptoms include fever and cough. Many people have other cold symptoms like a stuffy nose, headache, sneezing, or sore throat. In more severe cases, people can develop pneumonia and have trouble breathing. Children with COVID-19 can have these symptoms, too, but are less likely to get very sick. Some children do not have any symptoms at all.

Other symptoms can also happen in children and adults. These might include feeling very tired, shaking chills, muscle aches, diarrhea, vomiting, or loss of taste or smell. Babies with COVID-19 might have trouble feeding. There have also been some reports of rashes or other skin symptoms.

Can COVID-19 lead to other problems in children? — This is not common, but it can happen. There have been rare reports of children with COVID-19 developing inflammation throughout the body. This can lead to organ damage if it is not treated quickly. Experts have used different names for this condition, including "multisystem inflammatory syndrome in children" ("MIS-C") and "pediatric multisystem inflammatory syndrome." The symptoms can appear similar to another condition called "Kawasaki disease." They include:

●Fever that lasts longer than 24 hours

●Belly pain, vomiting, or diarrhea

●Rash

●Bloodshot eyes

●Headache

●Being extra tired or acting confused or irritable

●Trouble breathing

Call your child's doctor or nurse right away if your child has any of these symptoms.

Is there a test for the virus that causes COVID-19? — Yes. If you think that your child might have COVID-19, they should get tested. This involves taking a swab from inside of their nose or mouth. Some tests use a saliva sample. These tests can help you or the doctor figure out if your child has COVID-19 or another illness.

There are 2 types of tests used to diagnose COVID-19:

●Molecular tests – These look for the genetic material from the virus. They are also called "nucleic acid tests" or "PCR tests." You can get a molecular test at a doctor's office, clinic, or pharmacy. Depending on the lab, it can take up to several days to get test results back.

Molecular tests are the best way to know if a person has COVID-19. That's because they can detect even very low levels of virus in the body.

●Antigen tests – These look for proteins from the virus. They can give results faster than most molecular tests. You can buy antigen tests to use at home for children age 2 and older. You can also get an antigen test at a doctor's office, clinic, or pharmacy.

Antigen tests are not as accurate as molecular tests. They are more likely to give "false-negative" results. This is when the test comes back negative even though the person actually is infected. If a person has symptoms or knows that they were exposed to the virus, experts recommend "repeat testing." This means getting tested again a few days later if an antigen test is negative.

There is also a blood test that can show if a person has had COVID-19 in the past. This is called an "antibody" test. Antibody tests are generally not used on their own to diagnose COVID-19 or make decisions about care. But public health experts can use them to learn how many people in a certain area were infected without knowing it.

What should I do if my child gets COVID-19? — If your child has mild symptoms, they should stay home, rest, and drink plenty of fluids. You can also give them acetaminophen (sample brand name: Tylenol) to relieve fever and aches. If this does not help, you can try medicines like ibuprofen (sample brand names: Advil, Motrin).

If you take your child to a walk-in clinic or a hospital because of their symptoms, tell someone right away why you are there. The staff might ask your child to wear a mask or to wait someplace where they are less likely to spread their infection.

Whether or not they see a doctor or nurse, your child should stay home and away from others while they are sick with COVID-19.

How is COVID-19 treated? — Most children with mild COVID-19 can be cared for at home.

Children with certain health problems are at risk for severe illness. These include serious genetic or neurologic disorders, congenital (since birth) heart disease, sickle cell disease, obesity, diabetes, chronic kidney disease, asthma and other lung diseases, or a weak immune system.

If your child's symptoms are severe or if they are at risk for severe illness, call their doctor or nurse for advice. They can tell you if your child needs to be seen. Depending on the situation, the doctor or nurse might suggest treatment, even if your child only has mild symptoms. Treatment can lower their risk of getting sicker. Options might include pills that they take for a few days or another medicine that is given by IV.

If you are taking care of your child at home, the doctor or nurse will tell you what symptoms to watch for. Some children with COVID-19 suddenly get worse after being sick for about a week. The doctor or nurse can tell you when to call the office and when to call for emergency help. For example, you should get emergency help right away if your child:

●Has trouble breathing

●Has pain or pressure in their chest

●Has blue lips or a blue face

●Has severe belly pain

●Acts confused or not like themselves

●Cannot wake up or stay awake

If you have a baby and they are having trouble feeding normally, call the doctor or nurse for advice.

When can my child return to school and other activities? — Your child should not return to school until their symptoms are improving and their fever has been gone for at least 24 hours without taking medicine such as acetaminophen. After that, if they are feeling better, they can also go back to their normal activities when they feel ready.

In some cases, the doctor will want to see your child and do an exam to make sure it's safe for them to return to sports. They might do tests, too. Once the doctor says it's safe, children should go slowly as they get back to their usual activities. For example, they might start with 15 minutes of gentle exercise on the first day back, and gradually increase this over time.

Even after your child has been allowed to return to sports, they should pay close attention to how they feel. Stop activities and call the doctor or nurse right away if your child has any new symptoms like shortness of breath, a fast heartbeat, chest pain, or feeling faint.

Can COVID-19 be prevented? — In the US, a vaccine to prevent COVID-19 is available for adults and children age 6 months and older. Getting your child vaccinated is the best way to protect them.

People who are vaccinated have a much lower risk of getting sick from the virus. The best way to protect babies younger than 6 months is for as many older people as possible to get vaccinated, including siblings, parents, and caregivers.

In addition to vaccines, there are other things people can do to lower their chances of getting COVID-19. For example:

●Wash hands often (figure 1) – This is especially important after being out in public. If you are not near a sink, you can use a hand sanitizing gel. Keep sanitizer out of young children's reach, since the alcohol can be harmful if swallowed. If your child is younger than 6 years old, help them when they use sanitizer.

●Wear a face mask in some situations (figure 2). Masks can help protect both the wearer and others around them.

●Keep children home when they are sick. When possible, avoid close contact between your child and others in the home.

●Teach children to cover their mouth and nose with the inside of their elbow when they cough or sneeze.

●If someone in your home is sick, regularly clean things that are touched a lot. This includes counters, bedside tables, doorknobs, computers, phones, and bathroom surfaces.

●Make sure that there is good ventilation (air flow) in your home. When possible, open windows to let fresh air in.

If you are sick and you have a baby, it's important to be extra careful when feeding or holding them. Even though experts do not know if the virus can be spread through breast milk, it is possible to pass it to your baby or other children through close contact. You can protect your baby by washing your hands often and wearing a face mask while you feed them. If possible, you might want to have another healthy adult feed your baby instead.

Where can I go to learn more? — You can find more information about COVID-19 at the following websites:

●US Centers for Disease Control and Prevention ("CDC"): www.cdc.gov/COVID19

●World Health Organization ("WHO"): www.who.int/emergencies/diseases/novel-coronavirus-2019

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