COVID-19 (peds)

This page is for pediatric patients. For adult patients, see: COVID-19. For transmission precautions see: Prevention of COVID-19 transmission in the healthcare setting.

Background

• No data currently exists to determine if children with underlying medical conditions (asthma, or special healthcare needs) at increased risk

Epidemiology among Children

• 2% of cases amongst < 2 years of age (NOTE: 13% in only one major city in China)
• Mostly because of household exposures (from adults)
• Vast majority of cases in US are in adults
• Transmission in pediatrics
  • Shedding for longer than adults (up to 22 days, some up to 30 days)
  • Mostly goes from adults to children (not the other way around)

Clinical Features

Acute Pediatric Presentation

• Fever (50-80%), cough, congestion, rhinorrhea, sore throat
• GI in some cases (at least one case with GI sx first then respiratory symptoms after)
• 50% of peds cases with fever, 30% with cough

Pediatric Disease Course

• Mostly mild (for unclear reasons) except for only 2 cases:
  • 13 month developed ARDS and ICU care
  • 3 year old needed ICU
• No deaths in children under 10 (from china so far)
• Radiographic: same as adults (bilateral, pulmonary lesions, GGO; some with unilateral).
• Can rarely develop Multisystem inflammatory syndrome(MIS-C)

Differential Diagnosis

Pediatric fever

• Upper respiratory infection (URI)
• UTI
• Sepsis
• Meningitis
• Febrile seizure
• Juvenile rheumatoid arthritis
• Pneumonia
• Acute otitis media
• Whooping cough
• Unclear source
• Kawasaki disease
• Neonatal HSV
• Specific virus
  • COVID-19 (peds)
    • MIS-C

Evaluation

Diagnostic Findings

• Mild CRP or AST elevations
• No consistency on WBC (mild leukocytosis, leukopenia)
• Few coinfections have been reported (with RSV, Influenza, mycoplasma).
  • Coinfection unlikely (but possible) at this time

Management

See prevention of COVID-19 transmission in the healthcare setting for PPE recommendations

• Supportive care, isolation at home best unless needing hospitalisation
• Infection prevention and support!!! handwashing and PPE
• No remdesavir trials in children

See Also

• COVID-19
• COVID-19: Example hospital protocols
• COVID-19: Management of recovered patients
• COVID-19 (peds)
• COVID-19 Vaccine (Moderna)
• COVID-19 Vaccine (Pfizer-BioNTech)
• COVID-19 in pregnancy