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

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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.

People with COVID-19 can have fever, cough, trouble breathing, and other symptoms. Problems with breathing happen when the infection affects the lungs and causes pneumonia. Most people who get COVID-19 will not get severely ill. But some do.

This article is about COVID-19 in children.

How is COVID-19 spread? — 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. The virus is passed through tiny particles from the infected person's lungs and airway. These particles can easily travel through the air to other people who are nearby. In some cases, like in indoor spaces where the same air keeps being blown around, virus in the particles might be able to spread to other people who are farther away.

A person can be infected and spread the virus to others, even without having any symptoms. Some strains or "variants" of the virus are more contagious than others and can be spread very easily.

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.

Which children are at risk for severe disease? — Serious symptoms might be more common in children who have certain health problems. 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.

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 was exposed to someone with COVID-19? — If your child was in close contact with someone with COVID-19, they should wear a mask for 10 days when around others indoors in public. If they start having symptoms, they should be tested, whether or not they have been vaccinated. If they do not have symptoms, they should still be tested at least 5 days after they were exposed.

What should I do if my child has symptoms? — If your child has a fever, cough, cold symptoms, or other symptoms of COVID-19, they should get tested. Call your child's doctor or nurse. They can tell you if your child needs to be seen in person. They can also help you decide which test is best and where to get the test.

If your child has symptoms but tests negative with an antigen test (algorithm 1):

●They should get at least 1 more test to confirm that they do not have virus in their body. This can be another antigen test at least 2 days after the first test, or a molecular test.

●They should wear a mask around other people until they get a second negative test.

What should I do if my child tests positive? — Call your child's doctor or nurse. They can tell you if your child needs to be seen in person, how to care for your child, and how to prevent your child from spreading COVID-19 to other people.

●Care for your child – Most children who test positive with a molecular or antigen test can be cared for at home.

If your child's symptoms are severe or if they are at risk for severe illness, the doctor or nurse can tell you if they need to be seen. Depending on their 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.

Do not give your child any new medicines or treatments without talking to a doctor.

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.

●Prevent spreading COVID-19 to other people – There are a few things that you can do to lower this risk:

•Children who test positive for COVID-19 should "self-isolate" for at least 5 days if possible, even if they feel well. Self-isolation means staying apart from other people, even the people that they live with. The 5 days should start the day after you first noticed the child's symptoms or they had a positive test result. If they have a weak immune system or still have a fever, they might need to self-isolate for longer than 5 days.

•For children who are too young to self-isolate, it's still important to try to keep them apart from others in the house as much as possible. If you need to care for a sick child, you can protect yourself by wearing a mask and washing your hands often.

•After self-isolating for 5 days, the child should wear a mask around all other people for at least 5 more days. Some people use antigen tests to decide how long to keep wearing the mask. If you do this, they can stop wearing a mask once they test negative on 2 antigen tests done at least 2 days apart.

If my child had COVID-19, when can they return to sports? — Your child's doctor will talk to you about when they can return to physical activity, including things like gym class and sports. This will depend on your child's age, how sick they were, and whether they have any ongoing symptoms.

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.

How can I prevent my child from getting or spreading COVID-19? — 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. More information about COVID-19 vaccines is available separately. (See "Patient education: COVID-19 vaccines (The Basics)".)

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

●Wearing a face mask in some situations (figure 1)

●Washing hands often (figure 2) – 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.

What if someone in our home is sick? — If someone in your home has COVID-19, they should stay in a separate room if possible. They should also wear a face mask if they need to be around other people at all. Everyone in the house should wash their hands often and clean surfaces that are touched a lot.

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