COVID-19 and Kids: Frequently Asked Questions
By: Dr. Karen LaSalle, Pediatric Hospitalist and Chief of Pediatrics at Fisher-Titus
Can children get sick from COVID-19?
Kids as young as newborns have been getting COVID-19 since the first wave came through. Sometimes these kids have symptoms and sometimes they don’t. The Delta variant that we are currently seeing as the predominant strain of COVID-19 right now seems to be affecting kids more as we are seeing more positive children.
While the numbers of COVID-19 positive children are still relatively low compared to the general population, hospitalizations have increased, and many children’s hospitals are seeing more children with COVID-19 in their pediatric ICUs. Some of these kids have other conditions that may have put them at increased risk for COVID-19 but many do not.
Why are more kids getting sick with COVID-19 than before?
Like many late variants of viruses, Delta is more contagious than previous versions. It has evolved and gotten better at spreading and infecting people. Since kids under 12 are unable to be immunized, they are the perfect population for Delta to target because it can jump and pass and spread between them. As many adults are immunized and less available to be infected, we can certainly see it affect kids more.
With school starting back up and kids being back together in classrooms, we have seen a bump in cases. In our community we are seeing more kids who have gotten COVID-19 ranging in age from newborns up to older teens. At Fisher-Titus Pediatrics, we’ve seen kids both with and without symptoms. Usually those with symptoms who are seen in the office experience cold-like or influenza-like symptoms. Typically, the kids with more severe symptoms are coming in through the ER and may end up being taken to children’s hospitals.
This is a tough time of year for illness especially in children. As we go back to school, the kids are together in small rooms, maybe not distanced in the same ways they were last year. And it’s still hot enough some days that the air conditioning is on. That combination of being in an enclosed space with air conditioning does put us at increased risk versus being out in the fresh air.
My kid is perfectly healthy. Does that mean they are safe from COVID-19?
No. If your child is exposed to or is infected with COVID-19, there is no good predictor as to whether they are going to have symptoms and whether those symptoms will be serious.
There are things we know are risk factors for developing serious COVID-19 such as obesity and other medical conditions and those hold true for children as well. However, there is no sure bet that just because you have a healthy child without medical problems that they are not going to get sick when they get COVID-19.
What should I do to prevent and/or prepare for COVID-19 with my kids?
Talk to your kids about the importance of prevention measures they can take, especially at school when you’re not there to remind them. They should be practicing proper hand hygiene throughout the day, and you should consider having them wear a mask even if the school does not require one.
You should also check your school’s policy how long kids should be out when they are sick and if they have a plan for distance learning if a child has to be out for illness or exposure to COVID-19.
If your child has asthma or a tendency to wheeze, make sure you have refills of all the medications they need. Even if they have been managing well for a while, COVID-19 or another respiratory illness can still affect them more.
Consider what you will do for childcare if your child must be out due to COVID-19 or other illness. Childcare is difficult to find, but you want to think ahead of time about how you can cover childcare in a way that minimizes the amount of people your child might expose and helps avoid exposing anyone who may be at greater risk for complications from COVID-19 such as older family members.
We know that kids—especially little ones—put their mouths and faces on everything. We need to anticipate that kids will be kids and do everything we can to protect them. We should sanitize and/or hand wash with them every time we think about it, wipe down the surfaces around them, and make sure we are prepared if they get sick whether it be with COVID-19 or another illness.
What does COVID-19 look like in children?
It can look a lot like it does in adults and, the tricky part is that it can look similar to many other bugs that go around this time of year in kids.
In general, kids are more prone to respiratory symptoms. Children with asthma or active airway disease are also more likely to have a prolonged, tight cough that sounds like they just can’t get opened up. Additionally, we are seeing a fair amount of abdominal symptoms in kids with COVID-19 such as abdominal pain and vomiting. They are also more likely to have high fevers.
What is MIS-C?
Anywhere from two weeks to months after a COVID-19 exposure or diagnosis, kids can develop multisystem inflammatory syndrome in children (MIS-C). After a child has already had COVID-19 and gotten it out of their system, their body can begin attacking itself thinking it is COVID-19. It’s a double whammy—you have to watch for the original COVID-19 symptoms in your child and then even if they do well, they’re still not necessarily out of the woods. This can be pretty scary and can even cause multi-system organ failure or sepsis.
Right now, there are an increasing number of kids in pediatric ICUs across the country with MIS-C. It’s important to note that MIS-C is showing up in kids who had totally asymptomatic COVID-19 to start. Sometimes parents never even know their child was exposed to COVID-19 before they develop MIS-C and end up very sick.
Some of the symptoms of MIS-C to watch for after a COVID-19 infection are abdominal pain, bloodshot eyes, chest pain/tightness, diarrhea, feeling extra tired, headache, rash, vomiting, and more. If a child is having trouble breathing, has persistent pain or pressure in their chest, is confused, is unable to wake or stay awake, or has pale, gray, or blue-colored skin you should seek emergency care.
The good news is while MIS-C can be scary and serious, most children who were diagnosed with this condition have gotten better with medical care.
What should I do if my child wakes up on a school day not feeling well?
If your child has symptoms of any illness, particularly if there’s a fever but really anything that’s outside of their norm, the most important thing to do is to keep them home and away from others. No matter if it’s COVID-19 or another illness, you don’t want to put them in room with other people and other kids where they can spread whatever it is they have. There are a lot of other illnesses that go around in kids that are not COVID-19 such as strep, RSV, colds, and flus and we want to prevent the spread of those as well.
How should I manage my child’s illness at home?
For the beginning of the illness whether it’s COVID-19 or anything else, treatment doesn’t really vary. You are still going to treat their symptoms. If their breathing is comfortable and they just have cold-like symptoms, control their temperature with Tylenol and Ibuprofen and keep them well hydrated. If they have asthma or active airway disease that requires breathing treatments or albuterol, it’s important to keep those up during their illness. Some parents prefer to boost a little bit of Vitamin C, Vitamin D, and Zinc during their child’s illness—especially if they have confirmed COVID-19—and those things are all fine as long as you do not exceed their daily allowances of those things.
It’s important to remember that fevers occur with many types of illness, and they are a good thing—they are the body’s way of fighting the infection. As long as fevers aren’t in that scary range, which we typically think of as greater than 105, monitoring the fever at home and replacing fluids is totally fine. If the fever continues for longer than 4 days, you’re going to want to call your child’s primary care provider.
If your child cannot keep anything down, can’t eat or drink appropriately, they seem very uncomfortable, they seem confused, or they’re spending almost their whole day asleep, you should see immediate care for your child.
Should I get my child tested for COVID-19?
If you need to know their diagnosis for any reason, getting tested for COVID-19 is definitely a good idea. Additionally, you should consider who your child comes in contact with. Even if your child doesn’t have serious symptoms and you are treating them well at home, there are others who could have been exposed to COVID-19 by your child and testing can help you notify those people so they can monitor for symptoms, stay home, and avoid spreading it to anyone else.
If your child is tested for COVID-19, keep in mind that children may be less likely to test positive, particularly on rapid tests and particularly early on in their illness. If you have an early negative test but symptoms persist, I wouldn’t be afraid to test again 4-5 days into the illness and continue to treat the illness as though it were as contagious and as serious as COVID-19.
When can my child resume normal activities after being sick?
This depends on what they are resuming, whether they were positive for COVID-19, and whether they can mask when they resume.
As a general rule, kids can go back to school 24-48 hours after they are feeling better/symptoms have resolved. This means they are back to acting like their normal selves, don’t have any symptoms like vomiting or cough, and they have not had a fever without the use of Tylenol or ibuprofen. You should consider being extra cautious in younger kids who cannot wear a mask when they return versus older kids who can. Additionally, school and daycare policies vary on when a child can return after illness so be sure to check to confirm what that policy is for your school.
If your child did test positive for COVID-19, they—and the rest of your household—will have to follow the same quarantine/isolation guidelines as adults with COVID-19 have to. You should keep in touch with your primary care providers to know when you are cleared to discontinue quarantine/isolation.
If your child had COVID-19 and is cleared to return to school, they should still stay out of recreational sports until they’ve been evaluated by their primary care provider which may or may not include additional testing. Children with symptomatic COVID-19—even if they recover on their own without hospitalization or additional medical care—are at increased risk for cardiomyopathy and other heart issues so they need to be cleared by a doctor before returning to sports.
Should my child be vaccinated for COVID-19?
The Pfizer-BioNTech COVID-19 is approved for children age 12 and older and we absolutely recommend any child who can be vaccinated do so. I encourage parents to have a conversation with their child’s doctor and ask any questions you may have. Your child’s doctor will know their medical history and be the best person to address any concerns or hesitations you might have about your child getting their COVID-19 vaccine.
I also encourage parents to have that conversation with their children. It is stressful any time you have to make these types of decisions for your children, even when you have good scientific evidence like we do in the case of the COVID-19 vaccine. However, many parents find that when you involve your child in that shared decision-making process, it gets a little easier and they find that their children are interested. You can talk to them about the risks, the benefits, and things to think about and encourage them to ask their doctor any questions they have as well.
I’m pregnant or trying to become pregnant. Should I be vaccinated?
The CDC, American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal Medicine, the World Health Organization, and other professional organizations in the fertility and reproductive field have all recommended that pregnant women and those who are trying to get pregnant now or might in the future, receive the COVID-19 vaccine. There is no evidence suggesting that any of the approved COVID-19 vaccines cause a loss of fertility in men or women.
COVID-19 is hitting the mom/newborn population. Since COVID-19 has increased in the community and the Delta variant has been more active, we are seeing more unanticipated preterm deliveries which is known to be associated with COVID-19. We are also seeing more problems with blood pressure in pregnancy—also a known complication of COVID-19—leading to induction before 40 weeks.
COVID-19 infection during pregnancy can also cause some pretty scary things in newborns even if the baby never gets sick with COVID-19 which, thankfully, they rarely do. Newborns whose moms had COVID-19 while pregnant are more likely to be born with growth issues, breathing issues, or early because their mom was sick with COVID-19.
What should I do if I have a newborn who is still breastfeeding and I get COVID-19?
The American Academy of Pediatrics recommends that if a mom has active COVID-19 but is well enough to care for her baby and desires to breastfeed, she should do so. Yes, there is always a chance that you can pass COVID-19 to the infant but you can take precautions while caring for them. Breastfeeding is good for the baby and the antibody boost they get from breastmilk will help them stay well.
To help prevent spreading COVID-19 to your breastfeeding newborn, make sure you wear a mask and use proper hand hygiene when breastfeeding or caring for your newborn in other ways. Even though they are getting your antibodies, they still can get sick so these precautions are important. If you have tested positive for COVID-19, talk to your doctor and/or your child’s doctor about how you can protect your baby.
Is RSV more prevalent right now?
We are seeing more RSV right now than is usual for this time of year and it’s even affecting older kids a little bit more than usual. We’ve all been away from each other because of social distancing and now that we are coming back together, we are seeing a lot of other infections besides COVID-19 such as RSV.
RSV is part of the family of respiratory viruses that causes a condition called bronchiolitis in very young kids. In older kids, it can sometimes cause a nasty respiratory infection that can lead to pneumonia and asthma problems. RSV is more dangerous in kids under one or two because it causes their airways to swell and it produces a thick mucous that makes it hard for air to get into their lungs.
Typically, like with most viral illnesses, you will likely see RSV start with a fever that comes on quickly, a snotty/runny nose, cough, and then it might eventually evolve into rapid breathing. Kids who really struggle with RSV tend to have rapid breathing, they might wheeze, look a little pink in the cheeks, or try to reposition themselves either on their bellies with backside up in the air or by leaning forward.
The most important thing to watch for is how hard a child is working to breath. In babies under 4 months, it’s especially important to keep their nose cleaned out and suctioned with saline drops because if they can’t breathe through their nose, it’s hard for them to breathe at all. If you notice that they are struggling to breathe, you should seek care as soon as possible.
RSV and other respiratory tract infections peak at about 3-5 days, but the cough can linger for weeks afterwards. If your child continues to have fevers or seems to get worse after that fifth day, it’s important to have them seen by a doctor.
RSV is contagious. A child with an RSV diagnosis should be away from everybody else for at least those first 5 days, and at least 48 hours after the fever ends.
For more information on COVID-19 testing and vaccination at Fisher-Titus, click here.