​The Advances Made In Understanding Pediatric COVID-19

Posted by Reeve Staff in Daily Dose on July 27, 2022 # COVID-19

maskWhen COVID-19 led to worldwide closures of businesses and schools, little was known about the disease or its effects. The initial focus was protecting the most vulnerable of our population from becoming infected. Because the emphasis was on the elderly and immunocompromised, COVID-19's effects and infection rates among children were largely unknown.

COVID-19 Infection Among Children

A report from the Centers for Disease Control and Prevention (CDC) in December of 2020 found that COVID-19 cases among children ages 0-17 years were less than those reported for adults. The report noted that since March of 2020, the number of cases among children has increased. But, the actual incident rate was unknown because of the lack of widespread testing and the prioritization of testing for those with severe illnesses and adults. Hospitalization rates of children with COVID-19 were also lower than those of adults.

As the pandemic continues to affect the world, researchers have invested more time in tracking the infection rate and effects of COVID-19 among children. The most recent reports show that children may have similar amounts of the virus in the body in their nasopharynx (the passageway in the throat where air travels from the nose to lungs) as adults.

The measures taken at the beginning of the pandemic may directly cause the lower rate of pediatric COVID-19 cases. In addition, researchers and doctors believe the quarantine and social distancing measures combined with school closures in the early part of the pandemic may be a part of the lower transmission rates of COVID-19 among children.

Symptoms of COVID-19 in Children

Children have an incubation period of COVID-19, 2-14 days, similar to adults. Some of the signs of COVID-19 in children are

  • Fever
  • Fatigue
  • Headache
  • Cough
  • Nasal congestion
  • Loss of taste or smell

A child with COVID-19 may have several of the symptoms listed, upper respiratory issues, or be asymptomatic. The CDC reports the most common symptoms are cough or fever. However, their findings also discovered that almost 50% of children with COVID-19 might be asymptomatic.

The Severity of COVID-19 in Children

Researchers found that children infected with COVID-19 are at a decreased risk of developing severe illness compared to adults. Yet, children remain at risk of developing complications and severe infection resulting from COVID-19. Studies also point to the rise in hospitalizations among children with COVID-19, including one in three children admitted to the intensive care unit. In addition, according to the National Institutes of Health (NIH), children under the age of two or in underserved communities were at a higher risk of being hospitalized for COVID-19 symptoms.

Children under one or with underlying medical conditions may have an increased risk of developing severe symptoms of COVID-19. Unfortunately, there is little information on which underlying medical conditions increase the risk of children developing severe illnesses. However, the CDC found that children with genetic, neurological, metabolic, or congenital heart diseases are potentially more susceptible to severe COVID-19 symptoms. A report from the NIH confirmed the CDC's findings. Further, it stated that deaths associated with COVID-19 in those under 21 were higher in underserved populations and those with underlying medical conditions.

An issue with diagnosing COVID-19 among children is its symptoms can mirror other illnesses. For example, the signs of influenza and other respiratory infections overlap with the symptoms of COVID-19.

Side Effects of COVID-19 in Children


Researchers continue to try to understand some of the side effects of COVID-19 in children. A multisystem inflammatory syndrome of hyperinflammation is one side effect of COVID-19. Researchers found it resembles

  • Toxic shock syndrome,
  • Kawasaki disease shock syndrome, or
  • Atypical Kawasaki disease.

Kawasaki disease leads to swelling of blood cell vessel walls. The inflamed blood cells' circulation often results in the coronary arteries. Other symptoms of Kawasaki disease include swelling of glands and mucus membranes inside the nose, mouth, throat, and eyes. Another inflammatory side effect, pediatric multisystem inflammatory syndrome, is temporarily connected with pediatric COVID-19.

An issue parents face when confronted with the possibility of their child having multisystem inflammatory syndrome is how they should proceed. Multisystem inflammatory syndrome looks a lot like common viral symptoms in children. Therefore, knowing if a child is experiencing typical COVID-19 symptoms or has multisystem inflammatory syndrome is challenging. However, if a child also has conjunctivitis, skin rash, swollen limbs, cracked lips, red tongue, or eyes, they may have a multisystem inflammatory syndrome. Unfortunately, symptoms like headaches, extreme sleepiness, disorientation, or confusion complicate the diagnosis.

A multisystem inflammatory syndrome connected with COVID-19 is relatively new. The newness of the disease creates an issue of treatment standards. Researchers at Johns Hopkins Children's Center know children diagnosed with multisystem inflammatory syndrome almost always have pediatric COVID-19. Some children with COVID-19 were asymptomatic, but they developed multisystem inflammatory disease a few weeks later. If left untreated, the child faces severe illness.

Long Covid-19

Children who aren't vaccinated against COVID-19 have an increased risk of contracting COVID-19. The American Academy of Pediatrics continues to track the rate of pediatric COVID-19 in children. While the highest reported rates of the Omicron variant occurred in the winter of 2022, the number of cases in June 2022 is higher than in June 2021.

People diagnosed with COVID-19 risk developing long COVID-19 or other symptoms. For long COVID to be diagnosed, the symptoms must last at least two months and aren't explained by other causes or illnesses. Yet, until recently, little research was done on pediatric long COVID. A study in Denmark evaluated the risk of long COVID among children (0-14).

The researchers compared children diagnosed with COVID-19 to undiagnosed children. Many, approximately one in three, of the diagnosed children experienced symptoms that lasted over two months. Some examples of long COVID symptoms in children are:

Ages 0-3

  • Rashes
  • Mood swings
  • Upset stomach
  • Cough
  • Decrease or loss of appetite

Ages 4-11

  • Mood swings
  • Difficulty remembering or concentrating
  • Rashes

Ages 12-14

  • Fatigue
  • Mood swings
  • Memory or concentration issues

COVID-19 Vaccinations for Children

The CDC recommends COVID-19 vaccinations for children six months or older. Children ages five or above should receive a booster if they are eligible. The COVID-19 vaccine can prevent a child from getting COVID-19 or spreading it to others. Additionally, the vaccine can decrease the severity of the symptoms if a child should get COVID-19.

The Food and Drug Administration (FDA) has approved the Pfizer/BioNTech and Moderna COVID-19 vaccines for children as young as six months. Moderna is authorized for children six months to 17 years old, while Pfizer/BioNTech COVID-19 vaccine is approved for children six months to four years of age. Pfizer/BioNTech was previously authorized for children five years or older.

Next Steps

Dr. Alison L. Miller, at the University of Michigan School of Public Health, discussed the Danish findings and what they mean for healthcare. Focusing on schools and daycares is vital because the teachers and other staff can recognize the symptoms before pediatricians. Unfortunately, teachers are overburdened and need support. Dr. Miller suggests that connecting care across the school and medical settings can build support for those in the system while creating a safety net of care for children.

A combination of building safety nets and the approval of COVID-19 vaccines for children six months or older could provide the care needed to prevent or decrease the symptoms of pediatric COVID-19.

Christina Sisti, DPS, MPH, MS is a bioethicist and health care policy advocate. She works to create awareness and improve health care policy for those with long-term health issues.

This publication was supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $160,000 with 100% funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, ACL/HHS or the U.S. government.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.