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15th September 2020

Covid in children

Infection rates, common presentations, transmission, PIMS-TS and guidance on school attendance

This information is sourced from the The UK Research and Innovation (UKRI), the Royal College of Paediatric and Child Health (RCPCH) and the Lancet:

Infection rates in children

  • Infection with Covid-19 has been reported in all age groups, including infants, children and young adults
  • There have been far fewer confirmed cases of Covid-19 disease in children than adults (children consistently make up 1-5% of total case numbers in reports)
  • Teenagers are more susceptible to Covid-19 disease than younger children

What role do children play in transmission?

  • The importance of children in transmitting the virus is difficult to establish, particularly because of the number of asymptomatic cases
  • There is some evidence that their role in transmitting the virus is limited

Symptoms in children

  • Most infected children present with mild symptoms or are asymptomatic
  • Children’s symptoms vary slightly from those seen in adults and tend to be milder
  • Cough or fever are observed in around half of symptomatic children, which is less often than in adults
  • In contrast, upper respiratory symptoms such as a runny nose or sore throat occur in 30-40% and diarrhoea and/or vomiting are found in around 10% (sometimes this is the only symptom); this is more often than in adults

Are there any signs that could help differentiate Covid-19 from other childhood respiratory viral infections?

  • There appears to be little in the way of clinical signs in children to differentiate Covid-19 from other childhood respiratory virus infections
  • There have not been any firm descriptions of wheeze with Covid-19 in the literature so far

Which symptoms will warrant testing for Covid-19 and children remaining away from school whilst awaiting results? 

  • Children with simple cold symptoms such as coryzal symptoms (runny noses) or sore throats without fever who would normally have attended schools in other times should not be tested for Covid-19
  • This will ensure that children are not unnecessarily kept away from schools and exposed to inappropriate testing
  • Symptoms which warrant a Covid test and adherence to isolation guidance are: new continuous cough, fever, loss of, or change in, sense of smell or taste

Is it safe to give ibuprofen to a child who has tested positive for Covid-19 or is highly likely to be positive?

  • There is currently insufficient evidence to establish a link between use of ibuprofen, or other NSAIDs, and contracting or worsening of Covid-19
  • Experts at RCPCH recommend that parents treat symptoms of fever or pain related to Covid-19 with either paracetamol or ibuprofen

Atypical Kawasaki disease, now provisionally called paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS)

  • In late April, the UK’s Paediatric Intensive Care Society issued an urgent alert to GPs following a small rise in the number of critically ill children with overlapping features of toxic shock syndrome and atypical Kawasaki disease
  • On 1st May the RCPCH published guidance on this syndrome, now called PIMS-TS
  • The symptoms are: persistent fever >38.5°C, evidence of single or multi-organ dysfunction (shock, cardiac, respiratory, renal, gastrointestinal or neurological disorder) with signs of inflammation (neutrophilia, elevated CRP and lymphopaenia)  (See clinical and laboratory features page 4
  • Some but not all of these children tested positive for Covid-19 at the time of diagnosis of this syndrome
  • The recognition of this disease late in the first pandemic wave might relate to its rarity
  • Alternatively PIMS-TS might represent a post-infectious inflammatory syndrome

See also: 

How should we approach common childhood illnesses in the context of Covid-19?

11 primary care pathways for remotely assessing children (includes remote assessment of fever, cough and breathlessness)