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COVID-19 Update


Coronavirus in Babies and Kids

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With all the sobering news about the new coronavirus and COVID-19, the disease the virus causes, worried moms and dads can generally feel better about one detail: At present, the disease seems to be much milder in babies and children. However, it’s important to understand recent reports about pediatric inflammatory multisystem syndrome, or PIMS, a very rare condition that might be related to exposure to the coronavirus.

Aaron Milstone, M.D., M.H.S., a pediatrician at the Johns Hopkins Children’s Center and an infectious disease expert at The Johns Hopkins Hospital, provides information on symptoms and keeping babies and kids safe, along with an overview of PIMS.

What are coronavirus symptoms in babies and children?

Generally, COVID-19 symptoms are milder in children than in adults. In a recent study published in Pediatrics of COVID-19 in Chinese children, 90% of those who tested positive for the disease had mild symptoms, or none at all.

Fever and cough are common COVID-19 symptoms in both adults and children; shortness of breath is more likely to be seen in adults. Children can have pneumonia, with or without obvious symptoms. They can also experience sore throat, excessive fatigue or diarrhea. Learn more about COVID-19 symptoms.

However, serious illness in children with COVID-19 is possible, and parents should stay alert if their child is diagnosed with, or shows signs of, the disease. In the study, 10% of infants with a positive COVID-19 test became critically ill. Severe illness rates were lower in older children, but there were rare cases of children in each age group requiring hospitalization, and one 14-year-old who died.

It’s important to follow guidelines if you think your child is sick with COVID-19 and if your child is diagnosed with COVID-19. Parents and caretakers should trust their instincts and contact their pediatrician or family care practitioner if their child seems ill, especially if cough or fever are present.

Pediatric Inflammatory Multisystem Syndrome (PIMS)

Doctors at children’s hospitals in the U.S. and the U.K. have noted that a small number of children between ages 2 and 15 have experienced a condition called pediatric inflammatory multisystem syndrome, or PIMS. 

Some, but not all, of the children with PIMS had tests showing they had exposure to SARS-CoV-2, the coronavirus that causes COVID-19. Doctors are urgently trying to determine if and how PIMS and COVID-19 are related.

PIMS can cause inflammation of the blood vessels throughout the body. The inflammation can limit blood flow, damaging the heart and other organs. PIMS has features in common with toxic shock syndrome and an illness called Kawasaki disease.

Certain symptoms may mean an inflammatory problem such as Kawasaki disease or PIMS. Parents should look out for:

  • Abdominal (belly) pain
  • Vomiting and diarrhea
  • A red rash
  • Red, cracked lips
  • Red eyes
  • High fever
  • Swollen glands on one or both sides of the neck
  • Swollen hands or feet

PIMS, like Kawasaki disease, is very rare. But if your child has these symptoms, call your doctor. PIMS may be treated with a plasma transfusion to reduce the inflammation and protect the heart and other organs from possibly lasting damage. Learn more about this rare inflammatory condition

What are the signs that a child with COVID-19 requires immediate emergency medical attention?

Parents or caretakers should immediately contact urgent or emergency medical care if they notice these warning signs in a child:

  • Difficulty breathing or catching his or her breath
  • Inability to keep down any liquids
  • New confusion or inability to awaken
  • Bluish lips

5 Tips Kids Need to Know about Covid-19

How to Protect Your Kids from the Coronavirus and COVID-19

Milstone says, “Children are exposed to COVID-19 when the virus contacts their eyes, nose, mouth or lungs. This usually occurs when a nearby infected person coughs or sneezes, which releases respiratory droplets into the air and onto the child’s face or nearby surfaces such as tables, food or hands.”

He says the best way to prevent children from becoming sick with COVID-19 is to avoid exposing them to people who are (or who might be) sick with the virus: 

  • Avoid crowds. Keep kids away from crowded areas when possible.
  • Stay away from sick people. Keep children at least 6 feet away from anyone who is sick with a cough or fever, including family members.

Hand-washing and Coronavirus Prevention for Children

How to wash hands. Milstone advises parents to teach kids to wash their hands regularly, with soap and warm water, for at least 20 seconds. “They can help keep track of time by singing the ABCs, which takes about 20 seconds to finish,” he says.

When to wash hands. Kids should wash their hands after using the bathroom, sneezing, coughing or blowing their nose, before eating (even snacks) and immediately after coming inside from playing outdoors.

Kids who balk. Milstone says, “If your child is refusing to wash their hands or becoming very upset when asked to do so, it might help to give them a small reward, such as a sticker, to celebrate each time they wash their hands. Compliment them for doing a really good job while washing their hands.” It also helps when parents set an example by washing their own hands frequently.

If soap and water are not available, Milstone says the next best option is hand sanitizer containing at least 60% alcohol.

Other Coronavirus Prevention Tips for Families

Cough and sneeze with care. “Encourage everyone in the family to cough and sneeze into their elbow, instead of their hands, and to wash their hands after each time this occurs,” Milstone says. “Throw away tissues after they are used,” he adds.

Keep hands off faces. Parents should remind children to avoid touching their face as much as possible. Milstone says it can help if kids carry a toy that will keep their hands busy, but he notes that parents should wash those toys regularly.

Keep things clean. Wipe down toys and surfaces your child touches regularly, especially when traveling or when near a person who is sick. Clean surfaces at home and store cleaners in cabinets that are either too high for your child to reach or are secured with childproof cabinet locks. (More cleaning recommendations are available from the Centers for Disease Control and Prevention.)

Address anxiety and stress. Talking things over as a family can help identify specific fears and clarify the facts. It also helps for families to discuss a plan in case someone gets sick, if a school closes or something else happens that interrupts the normal routine.

“Children will look to you when deciding how to feel about COVID-19. If you feel calm and prepared, they are likely to feel similarly,” Milstone notes.

Illustrated tablet with multiple choice answer selections

Coronavirus (COVID-19) Self-Checker

Check symptoms. Protect yourself. Get information.

Children with Medical Conditions

Asthma: Children with asthma may have more severe symptoms from COVID-19 or any other respiratory disease, including the flu. As yet, there are no indications that most children with asthma experience severe symptoms due to the coronavirus, but observe them carefully and, if symptoms develop, call the child’s doctor to discuss next steps and to arrange appropriate evaluation as needed.

Diabetes: Control of blood sugar is key. Children with well-managed diabetes are not expected to be more susceptible to COVID-19. But poorly controlled diabetes can weaken the immune system, so parents and doctors should watch these children carefully for signs and symptoms that may require evaluation.

Kids and families can reduce coronavirus risk together

Though much more is yet to be understood about the new coronavirus, COVID-19 seems to have less serious health consequences for children than for adults, which is encouraging news. Still, it is important to avoid infection among children and help prevent the virus from spreading. Families with children can work together to reduce the risk.

Scientist carefully insets a pipette into a test tube.

Coronavirus (COVID-19)

What you need to know from Johns Hopkins Medicine.

Updated May 13, 2020

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