Children and COVID-19: What is currently known?

They’re little. Even as they grow taller than their own parents, to them, children remain vulnerable beings requiring protection. It’s natural for any parent to worry about their kids at a time like this when a pandemic is rampantly spreading across the world.

It’s also unsettling because SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), the virus that causes t COVID-19, is new to the human species, meaning that humans have no prior immunity to it and the full extent of its impact and associated risks is not known.

Are children more at risk?

According to the Centers for Disease Control and Prevention (CDC) and evidence accumulated thus far, children represent a small percentage of individuals showing signs and symptoms of COVID-19.

A recent review of published literature indicates that children account for one to five percent of all confirmed COVID-19 cases.

Based on this evidence, children do not appear to be at any more risk of contracting infection than adults.

Initial research findings in China (February 2020) indicated that children, ranging in age and into adolescence, accounted for around 2% of confirmed COVID-19 hospitalisations. Children were noted to be less symptomatic, and thus were not tested as much as adults.

From the studies conducted already, the outbreak in China prompted massive isolation strategies among the public and this could have contributed to the low number of infections in children.

“Children were almost automatically shielded through isolation and thus weren’t exposed to pathogens to the same degree. Those who fell ill were more likely exposed to someone with an infection within their own households,” comments Dr Nematswerani.

Of the reported cases, most infected children presented with very mild disease and recovered fairly quickly and fully mostly within one to two weeks from onset of symptoms. In most cases among children, COVID-19 did not result in severe illness or death.

“Although the number of confirmed cases remain low this could change if recommended preventive measures are not adhered to., Social distancing and everyday preventive behaviors remain important for all age groups as patients with less serious illness and those without symptoms may still contribute to spreading the disease to others” says Dr Noluthando Nematswerani, Discovery Health’s Head of the Centre for Clinical Excellence.

“Children remain susceptible to the infection, and severe infection could occur.Those with undelying chronic medical conditions may be at higher risk of severe or even life-threatening illness similar to what is observed in adult patients.,” she adds.”

“Based on emerging research findings, it appears that children with no signs of illness or those presenting with very mild symptoms may be transmitting the disease to others.”

“There is still plenty yet to be determined about the impact of SARS-CoV-2 and its overall impact on human populations, including children.”

The small number of cases in children and the mild presentation of their illness is not well understood and remains an area of ongoing research.

What about babies – is there a greater risk?

Fewer cases of COVID-19 have been reported in babies. Recent data suggests that infants (children younger than one year) may indeed be more likely to experience severe illness if they contract COVID-19 as this age group represented a higher number of children admitted to intensive care units.

Another study showed that infants had at least one family member with confirmed COVID-19, which indicates that transmission would have been from a family member.

It is not yet known whether the infection can be transmitted through breast milk. Preliminary data from a small sample of patients indicated that no virus was detected in breast milk of infected mothers.

Droplet transmission (from talking, coughing or sneezing) could occur through close contact during breast or bottle feeding.

Mothers with confirmed COVID-19 or symptomatic mothers with suspected COVID-19 should take precautions to prevent transmission to their babies by:

• Minimising direct contact with their babies. The baby can be fed expressed breast milk or infant formula by another caregiver until the mother has recovered as long as the other caregiver is healthy and follows hygiene precautions
• If direct contact with the baby cannot be avoided, using a face mask and regularly washing hands with soap and water, or using alcohol-based hand sanitisers
• If you are pumping breast milk, washing your hands before pumping and wearing a mask while pumping. If possible, the pumping equipment should be thoroughly cleaned by a healthy person.

The reports suggest that children of all ages, including newborns, can become infected with COVID-19.

“Babies younger than one year are seemingly more vulnerable and at higher risk of serious or severe illness,” adds Dr Nematswerani.

Are the signs and symptoms the same for children as they are in adults?

For the most part, according to the CDC, children present with similar symptoms to those of adults. Thus far, children’s symptoms have been relatively mild when compared to those of adults.

The symptoms of COVID-19 are similar in children and adults, but fewer infected children have symptoms. COVID-19 appears to be milder in children than in adults, although severe cases have been reported.

What does COVID-19 look like for children?

Common presentation:

• Fever
• Dry cough
• Pneumonia (53%)

Other reported symptoms:

• Tiredness

A runny nose or nasal congestion and, in some instances, gastrointestinal symptoms have been recorded, including:

• Abdominal discomfort or pain
• Diarrhoea
• Vomiting
• Nausea

Should children wear cloth face masks?

As part of the lockdown regulations for level 3, everyone in South Africa has to wear a cloth face mask in public. Does this ‘everyone’ include children? Yes, the CDC now recommends that everyone aged two or older wears a face mask in public.

According to the CDC and the American Academy of Pediatrics, children under two years should not wear a face masks because it can make it difficult for them to breathe.

Face masks have to cover the nose and mouth. Studies have shown that people with COVID-19 who do not have any symptoms can spread the infection when in close contact with others. The virus spreads through the droplets people produce when they speak, cough or sneeze. The mask limits how far these droplets can travel.

Most children with COVID-19 have very mild disease or do not show any symptoms at all. This means they are part of the category of people who can spread the disease while not feeling ill.

Masks on their own are not enough to stop the spread of COVID-19. While they can help limit the spread of the disease, the main measures to protect children and adults remain washing hands for at least 20 seconds with soap and water or alcohol-based sanitiser, and keeping at least 1.5 to 2 metres away from others.

Anyone of any age can become ill with COVID-19. Researchers continue to study the virus, the disease, and how to treat it. “It’s still early days, but all of us in the medical profession are learning more every day,” concludes Dr Nematswerani.

• Read more: Teach children to protect themselves from COVID-19

All medical information found on this website including content, graphics and images, is for educational and informational objectives only. Discovery Health publishes this content to help to protect and empower all South Africans by promoting a better understanding of COVID-19.