Answers to the Most Frequently Asked Questions About COVID-19 in Children

❓ Can children get COVID-19?

Children of any age can contract COVID-19, but the disease has been reported significantly less frequently in children than in adults. Overall, data from different countries indicate that cases among children accounted for approximately 1–5% of all confirmed infections.

As of April 2, 2020, only 1.7% of 149,760 confirmed cases in the United States were among children, although children made up approximately 22% of the U.S. population.

❓ Can the virus be transmitted through breast milk?

It is not known for certain whether the virus can be transmitted through breast milk. Reports from China indicated that the virus was not detected in breast milk from women with confirmed COVID-19. However, only six women were included in that study.

❓ Is intrauterine transmission of the virus possible?

In a report describing 38 cases of COVID-19 in pregnant women in China, no cases of intrauterine transmission were identified.

A later study described three cases out of 33 in which newborns developed SARS-CoV-2-positive pneumonia within the first two days of life. The babies were delivered by cesarean section to women with confirmed COVID-19. All affected infants, including a premature baby born at 31 weeks of gestation, recovered.

❓ Are the symptoms different in children and adults?

Overall, the symptoms of COVID-19 are similar in children and adults. However, children are more likely to have mild or asymptomatic infections, although severe cases have also been reported.

Among 291 children and 10,944 adults with confirmed infection in the United States, fever was observed in 56% of children and 71% of adults, cough in 54% of children and 80% of adults, and difficulty breathing in 13% of children and 43% of adults. At least one of these symptoms was present in 73% of children and 93% of adults.

Other symptoms included muscle aches (23% of children and 61% of adults), runny nose (7%), sore throat (24% of children and 35% of adults), headache (28% of children and 58% of adults), nausea and vomiting (11% of children and 16% of adults), abdominal pain (6% of children and 12% of adults), and diarrhea (13% of children and 31% of adults).

Among 171 children with confirmed infection in China, 16% had no symptoms. Fever was reported in 42% of children and cough in 49%; 19% had symptoms of an upper respiratory tract infection, while 65% had pneumonia. Some children presented only with gastrointestinal symptoms.

❓ Can children develop severe COVID-19?

Most children have asymptomatic infections or mild to moderate disease and recover within 1–2 weeks.

However, severe and critical cases have also been reported, as well as isolated deaths among children.

In the United States, risk factors for severe disease in children included age under one year and underlying medical conditions such as chronic lung or heart disease and immunosuppression, including malignancies, chemotherapy or radiation therapy, organ transplantation, and treatment with high doses of glucocorticoids.

❓ Why do children develop COVID-19 less frequently than adults, and why is the infection usually milder in children?

There is no definitive answer to this question. Possible explanations include:

1. Differences in the immune response to coronavirus between children and adults.

2. The more frequent presence of other respiratory viruses in children, which may compete with the coronavirus and thereby reduce the viral load.

3. Differences in the amount of ACE2 protein, which serves as a receptor for the virus, on the surface of cells in different parts of the respiratory tract and other organs in children and adults.

❓ How often do children with COVID-19 require hospitalization?

In the United States, among 2,572 confirmed pediatric cases, hospitalization was required in 6–20% of children, while 0.58–2% required intensive care.

In China, according to a report of 171 pediatric cases, three children required intensive care. All three had underlying medical conditions: hydronephrosis, leukemia, and intussusception.

In a study from Lombardy, Italy, only four of the 1,591 patients admitted to intensive care were under 20 years of age.

❓ How important is laboratory confirmation of COVID-19?

Laboratory confirmation in children has limited clinical significance because the treatment of children with COVID-19 is generally similar to the treatment of children with other respiratory infections.

False-negative results are relatively common with RT-PCR testing. In China, when nasopharyngeal samples were tested, the false-negative rate was 37%, while testing of oropharyngeal samples produced a false-negative rate of 68%.

False-positive results are also possible.

The detection of other respiratory viruses and bacteria, such as influenza virus, respiratory syncytial virus, or Mycoplasma, does not rule out COVID-19. In one study conducted in China, eight out of 20 children were found to have other respiratory pathogens in addition to SARS-CoV-2.

❓ How is COVID-19 treated in children?

Treatment of COVID-19 in children is generally similar to the treatment of other viral respiratory infections.

Treatment is primarily symptomatic and supportive. As with many other viral infections, numerous medications have been shown to affect viruses under laboratory conditions, but it is not necessarily known whether these drugs affect the course or prognosis of the disease in humans. At the time, experimental studies of such medications in patients were underway, while the results of completed clinical trials that had been published were not particularly encouraging.

There were also hopes that blood plasma obtained from people who had recovered from COVID-19 could be used to treat severe cases of the disease.

❓ What about ibuprofen for the symptomatic treatment of COVID-19?

Reports from physicians working in European COVID-19 hotspots suggested that ibuprofen use might be associated with a more severe course of the disease.

At that time, the World Health Organization (WHO) considered that there was insufficient evidence to recommend avoiding ibuprofen.

However, given the uncertainty, it was probably reasonable to use paracetamol rather than ibuprofen as the first-choice antipyretic, and, when ibuprofen was necessary, to use the lowest effective dose.

❓ When will a COVID-19 vaccine become available?

According to optimistic estimates at the time, the development and testing of a vaccine were expected to take at least 18 months.

❓ Can children be vaccinated during the COVID-19 pandemic?

The WHO recommended not delaying routine vaccination during the COVID-19 pandemic. Even a short-term disruption of immunization services could increase the number of susceptible individuals and raise the risk of outbreaks of vaccine-preventable diseases.

Such outbreaks can result in deaths and place additional pressure on healthcare systems that are already under significant strain due to the response to the COVID-19 pandemic.

This was considered particularly important for newborn vaccinations in maternity hospitals, primary immunization, especially against measles and polio, and vaccination against pneumococcal disease for people in high-risk groups.

Roman Shiyan