Coronavirus in Babies and Kids

Children of all ages can become ill with coronavirus disease 2019 (COVID-19). But most kids who are infected typically don’t become as sick as adults and some might not show any symptoms at all. Know the signs and symptoms of COVID-19 in babies and children, why children might be affected differently by COVID-19 and what you can do to prevent the spread of the virus.

How likely is it for a child to become sick with coronavirus disease 2019 (COVID-19)?

While all children are capable of getting the virus that causes COVID-19, they don’t become sick as often as adults. Most children have mild symptoms or no symptoms.

According to the American Academy of Pediatrics and the Children’s Hospital Association, in the U.S. children represent about 13% of all COVID-19 cases. Research suggests that children younger than ages 10 to 14 are less likely to become infected with the virus that causes COVID-19 compared to people age 20 and older.

However, some children become severely ill with COVID-19. They might need to be hospitalized, treated in the intensive care unit or placed on a ventilator to help them breathe, according to the Centers for Disease Control and Prevention (CDC).

In addition, children with underlying conditions, such as obesity, diabetes and asthma, might be at higher risk of serious illness with COVID-19. Children who have congenital heart disease, genetic conditions or conditions affecting the nervous system or metabolism also might be at higher risk of serious illness with COVID-19.

Research also suggests disproportionately higher rates of COVID-19 in Hispanic and non-Hispanic Black children than in non-Hispanic white children.

Rarely, some children might also develop a serious condition that appears to be linked to COVID-19.

Why do children react differently to COVID-19?

The answer isn’t clear yet. Some experts suggest that children might not be as severely affected by COVID-19 because there are other coronaviruses that spread in the community and cause diseases such as the common cold. Since children often get colds, their immune systems might be primed to provide them with some protection against COVID-19. It’s also possible that children’s immune systems interact with the virus differently than do adults’ immune systems. Some adults are getting sick because their immune systems seem to overreact to the virus, causing more damage to their bodies. This may be less likely to happen in children.

Can children get coronavirus?

Yes. Although in a majority of cases disease seems to be milder in young children, parents and caregivers should understand that children can be infected with SARS-CoV-2, the coronavirus that causes COVID-19, and can transmit it to others.

According to the American Academy of Pediatrics, more than 4 million children have tested positive for COVID-19 since the start of the pandemic.

In rare cases, children can become very sick with COVID-19, and deaths have occurred. That’s why it is important to use precautions and prevent infection in children as well as adults.

Can newborns get COVID-19?

It appears that women infected with the coronavirus can, in very rare cases, pass the disease to her baby. Infants can also become infected shortly after being born. According to the U.S. Centers for Disease Control and Prevention (CDC), most newborns who test positive for the coronavirus have mild symptoms or none at all, and recover, but serious cases have occurred. Pregnant women should take extra precautions to avoid the coronavirus.

What are coronavirus symptoms in babies and children?

Generally, COVID-19 symptoms are milder in children than in adults, and some infected children may not have any signs of being sick at all.

Symptoms for children and adults include:

• Cough
• Fever or chills
• Shortness of breath or difficulty breathing
• Muscle or body aches
• Sore throat
• New loss of taste or smell
• Diarrhea
• Headache
• New fatigue
• Nausea or vomiting
• Congestion or runny nose

Fever and cough are common COVID-19 symptoms in both adults and children; shortness of breath is more likely to be seen in adults. Children can have pneumonia, with or without obvious symptoms. They can also experience sore throat, excessive fatigue or diarrhea.

However, serious illness in children with COVID-19 is possible, and parents should stay alert if their child is diagnosed with, or shows signs of, the disease.

Which COVID-19 vaccines has the FDA authorized for children?

On May 10, 2021, the FDA expanded its emergency use authorization (EUA) for the Pfizer/BioNTech COVID-19 vaccine to include adolescents 12 to 15 years old. Previously, the Pfizer vaccine was authorized for use in children 16 years and older. For now, this is the only vaccine authorized in the U.S. for anyone under age 18.

Pfizer has been conducting age de-escalation studies, in which its vaccine is tested in groups of children of descending age. The EUA’s expanded authorization was based on results from a Phase 3 trial of children ages 12 to 15. The trial enrolled 2,260 adolescents; half received the Pfizer mRNA vaccine, the other received a saltwater placebo.

The immune response in the vaccinated adolescent group was even stronger than that in vaccinated 16- to 25-year-olds enrolled in an earlier study. In addition, a total of 16 symptomatic cases of COVID-19 were reported during the trial, all in the placebo group, which meant that the vaccine had been 100% effective in preventing COVID-19.

Vaccine-related side effects were mild and included pain at the injection site, tiredness, headache, chills, muscle pain, fever, and joint pain. Pfizer has also started testing the vaccine in children younger than 12 years.

I have been hearing about heart problems in kids and young adults following the COVID vaccine. Should I still get my child vaccinated?

There has a been a higher-than-expected number of heart inflammation cases after vaccination with the mRNA COVID-19 vaccines, particularly among boys and young men. However, the CDC still strongly recommends that all children 12 years and older be vaccinated.

As of July 12, 2021, 1,047 reports of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the outer lining of the heart) had been reported in people under age 30, particularly in male teens and young adults, after vaccination with the Pfizer/BioNTech or Moderna mRNA vaccines The CDC’s Advisory Committee on Immunization Practices (ACIP) has said available data “suggest likely association of myocarditis with mRNA vaccination in adolescents and young adults.” Even with the increased risk, heart inflammation is a rare occurrence.

Myocarditis and pericarditis after vaccination was most common in males ages 16 to 24. Cases tended to occur within several days after the second mRNA vaccine dose. Most people who developed myocarditis or pericarditis had mild cases and recovered completely after treatment.

If your child develops any of the following symptoms within a week of vaccination, seek medical care:

• chest pain
• shortness of breath
• feeling like your heart is beating fast, fluttering, or pounding.

This or any other potential significant side effect of a vaccine is always of special concern in children. While the risk of COVID causing severe illness and hospitalization is much lower compared to adults, it’s important to remember that at least 491 children ages 0 to 17 years have died from COVID. In addition, long-term adverse health effects even after mild infection in children are now being recognized.

It’s understandable that many parents will be uncomfortable with either choice, vaccinate now or wait. But the rise of the more contagious and possibly more dangerous Delta variant, combined with the protection offered by herd immunity, supports the CDC recommendation that all children ages 12 year and older get vaccinated.

How does COVID-19 affect children?

Children, including very young children, can develop COVID-19. Many of them have no symptoms. Those that do get sick tend to experience milder symptoms such as low-grade fever, fatigue, and cough. Some children have had severe complications, but this has been less common. Children with underlying health conditions may be at increased risk for severe illness.

A potentially severe and dangerous complication can occur in children. Called multisystem inflammatory syndrome in children (MIS-C), it can lead to life-threatening problems with the heart and other organs in the body. In this condition, different body parts, such as the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs, can become inflamed.

Symptoms of MIS-C can include

• fever lasting more than a couple of days
• rash
• “bloodshot eyes”(redness of the white part of the eye)
• stomachache
• vomiting and/or diarrhea
• a large, swollen lymph node in the neck
• neck pain
• red, cracked lips
• a tongue that is redder than usual and looks like a strawberry
• swollen hands and/or feet
• irritability and/or unusual sleepiness or weakness.

Many conditions can cause symptoms similar to those of MIS-C. Your doctor will first want to know if your child has been around someone who has tested positive for the virus and will ask about all of the above symptoms. Results of the physical examination, a COVID-19 diagnostic or blood antibody test, and other medical tests that check for inflammation and how organs are functioning can support the diagnosis of MIS-C.

Call the doctor if your child develops symptoms, particularly if their fever lasts for more than a couple of days. If the symptoms get any worse or just don’t improve, call again or bring your child to an emergency room.

Doctors have had success using various treatments for inflammation, as well as treatments to support organ systems that are having trouble. While there have been some deaths, most children who have developed MIS-C have recovered.

The journal Lancet Child & Adolescent Health published a study that looked at the long-term health effects of MIS-C on 46 children hospitalized with MIS-C between April and September 2020. All of the children had systemic inflammation; most also had problems related to gastrointestinal, heart, and kidney function, and clot formation. By six months after the children were discharged from the hospital, most of these problems had resolved, without lasting organ damage in most cases. About one-third of the children continued to have muscle weakness, fatigue, and mental health difficulties. But the study could not determine whether these effects were due to MIS-C in particular, or to hospitalization, or other factors.

When will children be able to get the COVID-19 vaccine?

In May 2021, the FDA expanded its emergency use authorization (EUA) for the Pfizer/BioNTech COVID-19 vaccine to include adolescents 12 to 15 years old. Previously, the Pfizer vaccine was authorized for use in children 16 years and older, while the Moderna and Johnson & Johnson vaccines are authorized for people 18 years and older. Moderna is also conducting age de-escalation studies, in which the vaccines are tested in groups of children of descending age. Johnson & Johnson plans to do the same.

The EUA’s extended authorization was based on results from a Phase 3 trial testing its vaccine in children ages 12 to 15. The trial enrolled 2,260 adolescents; half received the Pfizer mRNA vaccine, the other received a saltwater placebo. The immune response in the vaccinated adolescent group was even stronger than that in vaccinated 16- to 25-year-olds enrolled in an earlier study. In addition, a total of 16 symptomatic cases of COVID-19 were reported during the trial, all in the placebo group. Vaccine-related side effects were mild and included pain at the injection site, tiredness, headache, chills, muscle pain, fever, and joint pain. Pfizer has also started testing the vaccine in children younger than 12 years.

In June 2021, Moderna applied to the FDA for EUA of their mRNA vaccine for use in children ages 12 to under 18 years. The company announced promising results of a Phase 2/3 study in adolescents in May. The study enrolled 3,732 children ages 12 to 17. Two-thirds received two doses of the Moderna mRNA vaccine and one-third received a placebo. The immune response generated by the vaccine in adolescents was found to be at least as good as the immune response the vaccine generated in adults. Starting two weeks after the second vaccine dose, no cases of COVID-19 occurred in the vaccine group, compared to four cases in the placebo group. Vaccine side effects were mild to moderate, with injection site pain, headache, fatigue, muscle pain, and chills being the most common. The study did not identify any significant safety concerns. The results were announced in a press release. Moderna is also studying the vaccine in children between the ages of 6 months and 12 years.

The age de-escalation studies are done to confirm that the vaccines are safe and effective for each age group. They also identify the optimal dose, which must be effective, but with tolerable side effects.

The age de-escalation studies are smaller than the adult trials; rather than recruiting tens of thousands of participants, they will recruit 2,000 to 3,000 participants within each age group. As in the adult trials, some children in each trial will get a placebo.

The FDA will review data from the de-escalation trials to decide whether to authorize the vaccines for each age group.