Take Home points:

• Otherwise healthy children in the US have not often had poor health outcomes associated with COVID-19 infection.
• Prevention of infection is the most important factor at this time.
• COVID illness in your child will most likely look like a common cold. The same type of home treatment is appropriate.
• Testing may be needed and is increasingly available. Antibody testing is just becoming available, and it is still unclear what these results will mean.
• Continue to take your child to well-care visits! Doctor’s offices are working hard to provide a safe environment for this.
• See the American Academy of Pediatric’s healthychildren.org information site for more details.
• UPDATE: see my more recent post about Pediatric Multisystem Inflammatory Syndrome for more details.

The good news: children do well the vast majority of the time if they have COVID infection

• Luckily it appears that children do overall well with COVID. In fact many children can have no symptoms. Surprisingly, it appears that the regular flu virus is more dangerous to children.
• What’s the risk? There have been various preliminary studies based on data from China that have mentioned a small but significant risk for a small number of previously healthy children, a risk that is increased for children under 12months old. However, in the US so far it appears that children are having lower levels of illness, and are recovering from this virus. There have been a small number of children who died (5 as of this writing), that were found to have COVID. It isn’t clear yet if the cause of death was COVID or whether there were other complications.
• What are we supposed to think about this? Presently the current direct reports in the US, even in significant hot-spots like NYC, actually show a large drop in the volumes of children getting sick or having to be hospitalized for any reason, including COVID. Pediatricians are actually jumping in to help with adult COVID patients, and the pediatric hospital beds are being used for adults.
• While the thought of our children getting COVID is frightening, parents should be reassured that in the event that children get infected, they do well in the huge majority of instances.

What you can do to prevent COVID

It is most important at this point to use social distancing measures and hygiene to keep your children from contracting this virus, and passing it on to more vulnerable patients. For more details, here is some great information from the American Academy of Pediatrics. Thus far these measures have been very effective in controlling the virus, especially in the western states. Some special notes:

• Children older than 2 years old should wear a mask when out in public, to both help prevent infection, and to help prevent the spread of COVID if your child happens to be infected and has no symptoms.
• If your child has special health needs, including lung disease, heart disease, or serious neurodevelopmental issues you would want to be extra careful to avoid infection, as your child could be at greater risk for complications.

What to do if your child gets sick

• Given the current season, with both viral infections and allergies present, it is rather likely that your child will show symptoms you might interpret as possible COVID infection.
• The symptoms of COVID in children are extremely variable. The most typical picture would be significant fever and low energy, possibly with muscle aches, cough and even nausea and diarrhea. Often lots of congestion is NOT part of the COVID picture. Confusingly, there are a variety of symptoms in children, including no symptoms.
• There are a few unusual symptoms noted in COVID. Loss of smell and taste is often reported, even in cases without any other symptoms. More rarely, there is an odd finding, dubbed “COVID toes”, which is a harmless condition, but that may indicate your child had the Coronavirus. Finally, there are emerging reports of a really rare but scary pediatric inflammatory syndrome. Generally you don’t need to think about this condition, but if your child has significant vomiting and diarrhea, rash, and fever, they need to be seen in person as soon as possible. See my newer post that specifically discusses this syndrome
• If your child is only mildly ill, I would recommend care at home as described below. Social distancing measures and hygiene for the patient and family members will help protect your family and your community.
• If you truly suspect your child has COVID you can schedule a virtual or in-person visit with your child’s doctor or at Carbon Health, and testing can be undertaken if necessary.
• We share your frustration over the variable accuracy of the testing available. Antibody testing is becoming more widespread (and will be offered by Carbon shortly), but we would like to provide as accurate a test as possible given what’s available.
• Regardless of whether or not your child is tested, the treatment is identical to the treatment for a common cold. Rest, lots of fluids, fever control, and parental observation are critical.
• Encouraging rest and napping are probably the most important aspect of home treatment. Screens are great for distraction, but don’t count as rest. Provide significant screen free intervals to allow your child to become bored and thereby take short naps during the day.
• It would be very rare, but if your child has fever that lasts more than 72 hours, seems to be getting progressively worse, is sleeping too much, or has signs of increased work of breathing, he / she would need to be seen for an in-person evaluation. A child with significant respiratory distress needs to be seen urgently, in an Emergency Department setting.
• Isolating a case in your house: see this page from the CDC for important information on caring for an ill family member, and what it means to temporarily isolate that person in your home.

Don’t forget about your child’s Well Care!

It is critical that we maintain the physical and mental health of our children, including immunizing them, during this pandemic. While it’s understandable that families will be avoiding doctor’s offices during this pandemic,

• we still need to keep other vaccine preventable diseases at bay
• we still want to monitor our children’s weight, growth, and development
• we want to give our children a place to discuss their health and their worries.

Most pediatricians are working extremely hard to provide safe care environments where the risk of coronavirus transmission is very low.

Virtual pediatric care is becoming the norm, and can help fill some portion of this need. By whatever means, see your child’s doctor for well care and maintain their vaccination status!

About Benjamin King, MD

Dr. Benjamin King is Carbon Health’s Pediatric Medical Director. has been practicing medicine for over 16 years and completed his medical degree at UC Davis School of Medicine. His pediatric residency was completed at Lucile Packard Children’s Hospital at Stanford University.

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