Can children develop coronavirus disease 2019 (COVID-19)?

Updated: Jun 25, 2021
  • Author: David J Cennimo, MD, FAAP, FACP, FIDSA, AAHIVS; Chief Editor: Michael Stuart Bronze, MD  more...
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Data continue to emerge regarding the incidence and how children are affected by COVID-19, especially for severe disease. A severe multisystem inflammatory syndrome linked to COVID-19 infection has been described in children. [56, 57, 58, 59]

The American Academy of Pediatrics reports children represent 14.2% of all cases in the 49 states reporting by age, over 4 million children have tested positive in the United States since the onset of the pandemic as of June 17, 2021. This represents an overall rate of 5,347 cases per 100,000 children. During the 2-week period of June 3-17, 2021 there was less than a 1% increase in cumulated number of children who tested positive, representing 30,184 new cases. In the week from June 10-17, 2021, children represented 24.6% of the new weekly cases. Children were 1.4-3.3% of total reported hospitalizations, and between 0.1-1.9% of all child COVID-19 cases resulted in hospitalization. [60]   

In September 2020, the CDC published the demographics of SARS-CoV-2-associated deaths among persons aged 21 years and younger. At the time of publication, approximately 6.5 million cases of SARS-CoV-2 infection and 190,000 associated deaths were reported in the United States. Persons younger than 21 years constitute 26% of the US population. Characteristics of the 121 COVID-related deaths among this population reported between February 12 to July 31, 2020 include [61]

  • Male: 63%
  • Younger than 1 year: 10%
  • Aged 1-9 years: 20%
  • Aged 10-20 years: 70%
  • Hispanic: 45%
  • Black: 29%
  • Native American or Alaska persons: 4%
  • Underlying conditions: 75%
  • Died after hospital admission: 65%
  • Died at home or emergency department: 32%

Clinical characteristics and outcomes of hospitalized children and adolescents aged 1 month to 21 years with COVID-19 in the New York City area have been described. These observations alerted clinicians to rare, but severe illness in children. Of 67 children who tested positive for COVID-19, 21 (31.3%) were managed as outpatients. Among 46 hospitalized patients, 33 (72%) were admitted to the general pediatric medical unit and 13 (28%) to the pediatric intensive care unit (PICU). Obesity and asthma were highly prevalent, but not significantly associated with PICU admission (P = .99).

Admission to the pediatric intensive care unit (PICU) was significantly associated with higher C-reactive protein, procalcitonin, and pro-B type natriuretic peptide levels and platelet counts (P < .05 for all). Patients in the PICU were more likely to require high-flow nasal cannula (P = .0001) and were more likely to have received remdesivir through compassionate release (P < .05). Severe sepsis and septic shock syndromes were observed in 7 (53.8%) patients in the PICU. ARDS was observed in 10 (77%) PICU patients, 6 of whom (46.2%) required invasive mechanical ventilation for a median of 9 days. Of the 13 patients in the PICU, 8 (61.5%) were discharged home, and 4 (30.7%) patients remain hospitalized on ventilatory support at day 14. One patient died after withdrawal of life-sustaining therapy associated with metastatic cancer. [62]

A case series of 91 children who tested positive for COVID-19 in South Korea showed 22% were asymptomatic during the entire observation period. Among 71 symptomatic cases, 47 children (66%) had unrecognized symptoms before diagnosis, 18 (25%) developed symptoms after diagnosis, and 6 (9%) were diagnosed at the time of symptom onset. Twenty-two children (24%) had lower respiratory tract infections. The mean (SD) duration of the presence of SARS-CoV-2 RNA in upper respiratory samples was 17.6 (6.7) days. These results lend more data to unapparent infections in children that may be associated with silent COVID-19 community transmission. [63]  

An Expert Consensus Statement has been published that discusses diagnosis, treatment, and prevention of COVID-19 in children.

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