Covid-19 in Children
Because of more infectious omicron variant, covid-19 is currently very prevalent within the community again, particularly in school-aged children. Covid is a mild illness in most children, but it’s important to be aware of the symptoms, and test and isolate when necessary to help reduce the spread and protect vulnerable people.
It’s also important to remember that lots of illnesses can cause symptoms such as fever and coughing, and so we need to be aware of the signs of potentially serious infection in children.
Covid Symptoms in Children
What are the Main Symptoms of Covid in Children?
Children have slightly different symptoms of covid compared to adults.
The ZOE COVID app monitors symptoms in people who test positive for covid (1). They found the most common symptoms in children to be:
- Fever
- Headache
- Persistent cough
- Sore throat
Young children also report more tummy pain, whereas older children are more likely to have the main covid symptoms including anosmia (loss of sense of smell).
Other symptoms include
- Tiredness
- Muscle aches
- Snotty nose
- Change or loss of sense of taste or smell
In 2020, the most common symptoms in children admitted to hospital were (2):
- Fever (70%)
- Cough (39%)
- Nausea and vomiting (32%)
- Difficulty in breathing (30%)
We asked our Instagram followers what symptoms their children had with covid…
My Child Has Covid…
How Should I Manage Them?
Children with covid should be managed similarly to any other viral illnesses. This includes
- Plenty of fluids
- Paracetamol or ibuprofen if your child has a fever and it is bothering them
- Keeping them comfortable
When Should I Be Worried About My Child with Covid?
Most children will have minimal symptoms with Covid-19 and will manage well at home.
Seek urgent medical attention if…
- Your child is having less than 50% of their normal fluid intake
- Your child is having less than 50% of their normal number of wet nappies or wees – this is a sign of dehydration
- You are worried about your child
- Your child has difficulty in breathing
- You have a baby under three months with a temperature of more than 38°C or a baby three-to-six months with a temperature of more than 39°C
- You child has signs or symptoms of PIMS (see below)
- You are worried about your child and cannot cope at home
Can Children Get Skin Changes with Covid?
Skin changes have been seen in children with Covid, including changes to the colour of their fingers and toes, and widespread very itchy rashes. These are usually self-limiting and do not need any additional treatment (4).
However, there are two types of rashes which require urgent medical attention in A&E
- A widespread itchy rash with high fevers and other symptoms like swelling of hands, and severe headaches – this could be a sign of PIMS
- A purpuric rash (areas of purple/ black under the skin which do not fade when pressed on with a glass) – this could be a sign of other severe infections such as meningitis.
Is Covid Dangerous in Children?
How Many Children Get Admitted to Hospital?
Very few children are getting admitted to hospital because of covid.
In the first five days of January, 142 children under 5 and 77 children aged 6-to-17 were admitted to hospitals in England with covid (5). However, for most of these children they will have been admitted for reasons other than covid.
There has been a slight increase in the number of babies under the age of one being admitted with the omicron variant compared to previous variants (6). Of the infants admitted to hospital in December and January, around 1 in 8 required oxygen treatment and the average length of stay was two days. In general, children who are admitted with omicron have been generally less unwell and required less support than children admitted earlier in the pandemic (7).
Is My Child at Risk of Complications from Covid?
There are some children who are at greater risk of complications from covid. These include children who…
- Are more susceptible to infections, for example children with cancer or some genetic conditions
- Have severe or multiple learning disabilities
- Have Down’s syndrome
- Have a problem with their brain or nerves such as cerebral palsy
Children with well controlled asthma do not have an increased risk of hospitalisation. However, research has shown that children with severe asthma with a recent hospital admission or who have had many courses of oral steroids are around 6 times more likely to be hospitalised with covid compared to children without asthma (8).
What is PIMS?
PIMS stands for paediatric inflammatory multisystem syndrome. It is very rare and tends to occur in teenagers but can also happen in children (9). It usually starts a few weeks after covid infection. Symptoms include:
- Rash – this is usually widespread and itchy
- Fever lasting a few days
- Weakness
- Swelling of hands and feet
- Red lips and eyes
- Tummy pain
Most children with these symptoms after covid will not have PIMS. However, if you suspect your child could have PIMS or is unwell with some of the symptoms above, see your GP urgently or go to A&E.
How Many Children Get Long Covid?
The true number of children with long covid is not currently known. A UK study last year showed that 1 in 7 children who test positive for covid will still have symptoms 15 weeks after infection (10). This study was done before the vaccination programme started in children, and so we do not currently know how this will impact long covid in children.
Vaccination in Children
Is my Child Eligible for Covid Vaccination?
Currently, vaccinations are offered to everyone over the age of 12 in the UK.
Five-to-11-year-olds who are clinically vulnerable or live with someone who is clinically vulnerable are also eligible for vaccination. However, they will be given a smaller dose than in older children and adults (11).
What are the Benefits of Vaccination?
For any vaccination, there are benefits and risks. It is up to parents to decide if the benefits outweigh the risk for their child.
Most children who are unvaccinated with covid will have a mild illness. However, vaccination does protect children and teenagers against hospitalisation with covid.
With the delta variant, vaccination reduce the risk of infection in teenagers by over 50%. This helps protect the vulnerable population and prevents school absences (12). The effect of vaccination for the omicron variant is less well known. Data from Israel shows that the incidence of omicron in recently vaccinated children was less than half that of unvaccinated children. However, it seems like this protection decreases around five months after vaccination (13).
What are the Risks of Vaccination?
There are side effects of vaccination, but these are generally mild and include arm soreness, fever, and inflamed lymph nodes.
There is a very small risk of heart inflammation called myocarditis after vaccination. In the UK this occurred after 11 in every million doses (14).
Testing in Children
When Should My Child Get a PCR?
You should get a PCR test for your child if they have any of the three main covid symptoms (fever, new cough, or change/loss of sense of smell), or if you have been told to get a PCR by track and trace.
Should My Child Be Taking Regular Lateral Flow Tests?
Government guidance is that children in secondary school should be taking twice-weekly lateral flow tests and reporting them on the government website. Children under 11 do not need to do regular lateral flows, but children over 5 should take daily lateral flows if they have a known covid contact (15).
Protecting My Child From Covid
How Can I Protect my Child?
With such widespread community transmission, it is now very difficult to completely avoid covid. Maintaining good hand hygiene, wearing a mask where possible, and avoiding unwell contacts will help reduce your child’s risk. Vaccination will also help protect them from catching covid, and from becoming very unwell from covid.
Should I Stop Soft Play?
It is a personal decision to stop or reduce activities such as soft play for your child. Every parents need to balance the risk of catching covid with the benefits of play and socialisation.
Covid, Pregnancy, and Breastfeeding
I am Pregnant – Should I get Vaccinated?
There are risks of catching covid in pregnancy for both mother and baby, especially if you catch it after 28 weeks.
Vaccination in pregnancy is safe and helps reduced risk of complications from covid infection (16).
I Had Covid in Pregnancy – Is My Baby Immune?
Research has shown that babies of mothers who had covid in pregnancy, particularly in early pregnancy, had some antibodies against covid. The babies also had higher levels of immune cells which react quickly to infection. However, this does not mean that your baby will be completely immune to covid, and these antibodies decrease within the first few months of life (17).
I’m Breastfeeding and Have Covid – What Precautions Should I Take?
There is no evidence that covid can be transmitted through breastmilk (18).
If you do have covid and you are breastfeeding, you should…
- Ensure you wash your hands thoroughly for 20 seconds with soap and water before touching your baby
- Avoid coughing and sneezing around your baby – you could wear a mask if you are worried about this.
Some mothers may wish to express milk and bottle feed during this time, but this is an individual choice. For most babies, the benefits of breastfeeding outweigh the risk of covid.
My Child Has Had Covid…
Will This Affect Their Normal Vaccination Schedule?
Normal childhood vaccinations are so important to protect your child against other severe infections such as measles and whooping cough.
If your child currently has covid, or symptoms of covid, you should wait until they are out of isolation to get their vaccination.
Do not delay getting your child’s routine vaccinations if they are currently well.
If you are unsure if your child should get their vaccination on the day, ring your GP practice who will be able to give you some advice.
The current covid data and rules are everchanging. This information was accurate at the time of writing (January 2022). Please check NHS and government websites for updated information on Covid in children.
Contributors: Hannah Saunders (final year medical student)
References
- https://covid.joinzoe.com/post/covid-in-children-webinar
- https://www.bmj.com/content/370/bmj.m3249
- https://www.nhs.uk/conditions/fever-in-children/
- https://www.yourcovidrecovery.nhs.uk/managing-the-effects/effects-on-your-body/skin-disorders/
- https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-hospital-activity/
- https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1046475/S1483_CO-CIN_Child_admissions_and_severity_by_epoch.pdf
- https://www.bmj.com/content/376/bmj.o110
- https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00491-4/fulltext
- https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/paediatric-inflammatory-multisystem-syndrome-pims/#:~:text=Paediatric%20Inflammatory%20Multisystem%20Syndrome%20(PIMS)%20is%20a%20new%20condition%20that,off%20infection%2C%20injury%20and%20disease.
- https://www.bmj.com/content/374/bmj.n2157
- https://www.rcpch.ac.uk/resources/covid-19-vaccination-children-young-people
- https://www.imperial.ac.uk/news/231959/covid-19-vaccination-cuts-infection-risk-half/
- https://www.timesofisrael.com/vaccinated-kids-half-as-likely-to-get-omicron-but-protection-fades-fast-study/
- https://www.gov.uk/government/publications/jcvi-update-on-advice-for-covid-19-vaccination-of-children-and-young-people/jcvi-statement-on-covid-19-vaccination-of-children-and-young-people-22-december-2021
- https://www.gov.uk/government/publications/guidance-for-contacts-of-people-with-possible-or-confirmed-coronavirus-covid-19-infection-who-do-not-live-with-the-person/guidance-for-contacts-of-people-with-possible-or-confirmed-coronavirus-covid-19-infection-who-do-not-live-with-the-person
- https://www.nhs.uk/conditions/coronavirus-covid-19/people-at-higher-risk/pregnancy-and-coronavirus/
- https://www.nature.com/articles/s41590-021-01049-2
- https://www.who.int/news-room/commentaries/detail/breastfeeding-and-covid-19