Pediatric infections with COVID-19

Clinical Question

COVID-19 in pediatric populations - General information about infection and testing.

Key Findings

  • Testing of children is similar to current criteria for adults
  • COVID-19 symptoms tend to present as mild with higher prevalence of GI symptoms and can be asymptomatic making children a potential vector of transmission
  • Children who develop severe disease tend to be infants and younger children

Summary of Information

What are current hospital policies for testing kids?

Varies, some examples:

  • Children’s National Hospital in DC: Only offering drive-up testing with referral, referral can be given if patient is at an increased risk due to underlying condition or if child has a family member in a high-risk category.[1]
  • Children’s Hospital Colorado: Only testing children who meet specific, high-risk criteria for testing and may need to be hospitalized.[2]
  • At Rady Children’s: Only testing hospitalized patients with symptoms consistent with COVID-19, symptomatic individuals who have chronic medical conditions or are immunocompromised (diabetes, heart disease, receiving immunosuppressive medications, chronic lung disease, or chronic kidney disease), or those who have had close contact with a patient with COVID-19 or a history of travel to affected geographic areas within 14 days of symptom onset.[3]

Are children the primary vector?

  • No current studies specifically answering this question but many articles such as those below suggest that since many children are asymptomatic and may have poor hand hygiene they could be important vectors.[4][5][6]
  • Additionally there is some concern now for fecal-oral transmission after multiple studies have shown persistent fecal viral shedding though still unclear the extent of the viral viability in fecal samples.[7][8]

What is the disease course in pediatric patients?

  • Can present with wide range of symptoms: fever, cough, URI sx, abdominal pain, nausea, vomiting, diarrhea
    • Prevalence of GI symptoms seems to be higher in pediatric populations vs adults; one case report described a patient who presented with only mild diarrhea.
  • Can also be completely asymptomatic even in case of high viral load
  • Typically recover in 1-2 weeks
  • Disease course tends to be mild[6], only rarely progressing to lower respiratory infection
  • Diagnostic studies:
    • Often see elevated procalcitonin
    • Chest CT can show patchy consolidations and ground-glass opacities, similar to adult findings (although findings are typically less severe due to milder disease course)[6]
    • CT findings resolve with treatment
  • According to one Chinese study on 2143 pediatric cases, the proportion of severe/critical cases was higher in younger children and infants, and in general there were fewer severe/critical cases in children than adults (5.9% vs 18%)

What is the rate of kids needing to be hospitalized?

  • Difficult to assess accurately given children with mild symptoms are not consistently being tested
  • According to CDC’s Morbidity and Mortality Weekly Report from February 12 - March 16, 2020: Among ages 0-19, 2%-2.5% were hospitalized and none died
    • Severe Outcomes Among Patients with Coronavirus
  • In a study from China looking at 2143 pediatric cases: The overall rate of severe or critical pediatric cases was 5.9% compared to 18% in adults. Children were categorized as severe if they had dyspnea with central cyanosis, O2 sat of < 92% or other hypoxia manifestations; categorized as critical if ARDS, shock, encephalopathy, myocardial injury, heart failure, coagulation dysfunction or acute kidney injury. “The proportion of severe and critical cases was 10.6 %, 7.3%, 4.2%, 4.1% and 3.0% for the age group of < 1, 1-5, 6-10, 11-15 and ≥16 years, respectively.[9]

Gaps in knowledge

  • Routine testing may provide more information about asymptomatic/carrier rates in pediatric populations.

New articles not yet incorporated

A Mini Review on Current Clinical and Research Findings for Children Suffering from COVID-19. medrxiv.org

Author Information

Authors: Natalie Oberhauser-Lim, Yalda Dehghan; UC San Diego School of Medicine
Completed on: March 25, 2020
Last revised on: Not yet revised

Reviewed by: Marsha-Gail Davis MD
Reviewed on: April 27, 2020

This summary was written as part of the CoRESPOND Earth 2.0 COVID-19 Rapid Response at UC San Diego. For more information about the project, please visit http://earth2-covid.ucsd.edu

References

  1. DC children’s hospital opens drive-up coronavirus testing | WTOP. https://wtop.com/coronavirus/2020/03/dc-childrens-hospital-opens-drive-up-.... Accessed April 18, 2020.
  2. Coronavirus Resources and Updates from Children’s Colorado. https://www.childrenscolorado.org/conditions-and-advice/coronavirus-covid1.... Accessed April 18, 2020.
  3. Health Alerts: Coronavirus. https://www.rchsd.org/health-safety/health-alerts/. Accessed April 18, 2020.
  4. Understanding how COVID-19 affects children vital to slowing pandemic, doctors say. ScienceDaily. https://www.sciencedaily.com/releases/2020/03/200319125201.htm. Accessed April 18, 2020.
  5. Young people play vital role in stopping spread of COVID-19 | American Academy of Pediatrics. https://www.aappublications.org/news/2020/03/19/coronavirus031920. Accessed April 18, 2020.
  6. Xiao Li, Kun Qian, Ling-ling Xie, Xiu-juan Li, Min Cheng, Li Jiang, Bjoern W. Schuller. MedRxiv 2020. doi:https://doi.org/10.1101/2020.03.30.20044545
  7. Fan Q, Pan Y, Wu Q, et al. Anal swab findings in an infant with COVID-19. Pediatr Investig. 2020;4(1):48-50.  [PMID:32328338]
  8. Kam KQ, Yung CF, Cui L, et al. A Well Infant with Coronavirus Disease 2019 (COVID-19) with High Viral Load. Clin Infect Dis. 2020.  [PMID:32112082]
  9. Dong Y, Mo X, Hu Y, et al. Epidemiology of COVID-19 Among Children in China. Pediatrics. 2020;145(6).  [PMID:32179660]
  10. Wu Y, Guo C, Tang L, et al. Prolonged presence of SARS-CoV-2 viral RNA in faecal samples. Lancet Gastroenterol Hepatol. 2020;5(5):434-435.  [PMID:32199469]