Here's what we now know about how coronavirus affects kids

In early March, when Lauren Rowello’s 7-year-old got a fever and started coughing, COVID-19 briefly crossed her mind. Her spouse and 10-year old son had been coughing too, but they weren’t at all fatigued and had no other symptoms. She thought, “If this is COVID-19, then it’s not going to be that bad for me if I get it,” she recalls. But while her two children recovered within days, Rowello, a 29-year-old who lives in Moorestown, New Jersey and has no pre-existing health conditions, went on to experience a serious case of the illness that left her frequently short of breath and mostly bed-ridden for a month.

The fact that her kids’ experience with the virus was much less intense than hers is not surprising—while COVID-19 can cause severe illness, it’s common for kids' coronavirus symptoms to be mistaken for a run-of-the-mill infection.

Still, as cities start to open up, and kids begin to attend daycares and schools again, it’s normal to worry your kid might be exposed to the virus—especially as news reports are describing a scary inflammatory condition that’s linked to COVID-19. Here’s what you need to know about kids' coronavirus symptoms and what you should do if you think your child has the virus. 

What are kids coronavirus symptoms?

When kids show symptoms of COVID-19, they are often the same ones you hear in adults—most commonly a fever, cough and sore throat, says Elizabeth Murray, a paediatrician at the Golisano Children’s Hospital in Rochester, New York. Other possible symptoms include stomach upset, runny noses and shortness of breath. Some kids also have skin symptoms, specifically reddish purple toes that might look frost-bitten. These are being called “COVID toes” and can occur with or without other symptoms. 

Jennifer Davis’s 6-year-old son, Isaac, had COVID-19 in early April. Cough was the first sign of his illness, followed quickly by a high fever that lasted 8 days, says the Houston mom. “During the day, if he tried to do any activity it would cause the coughing, but he was perfectly content to be cuddled up on the couch and watching a show,” recalls his mom. “The coughing at night was the worst. He would sleep between the coughing fits, but it went on all night long.” Isaac also experienced some other strange symptoms, including burning eyes, a sore back, and, just one day, vomiting. 

His 4-year-old sister, however, had a much milder course of the illness, with sniffles and a cough, and a temperature that hovered between 99F and 99.5F. Her cough lasted about two weeks, while Isaac’s went on for three weeks after his fever broke. (She wasn’t tested for coronavirus, because by the time she showed symptoms, the testing criteria had changed and they were no longer testing kids under 12.) “For her it was like a very mild cold. She wouldn’t even have been sent home by the school nurse,” says Davis.

Because kids infected with COVID-19 often have mild symptoms, Murray says it’s important to consider any kid with symptoms that could be COVID-19 a serious risk to others. If your kid has a persistent cough or a low fever, you’ll want to keep them at home and call off the grandparent or babysitter visit until you’re given the go-ahead by your child’s doctor. “Any other time in our lives, we wouldn’t have necessarily worried about cold symptoms, but now we have to,” says Murray. 

Of course, you won’t know to keep your kid away from others if they don’t show symptoms in the first place, and that’s a very real possibility. “Compared to other age groups, children are more likely to have no symptoms,” says Murray. 

Because kids may carry the virus and not have symptoms, screening questions at daycares and schools may be unreliable in controlling outbreaks, explains Jeremy Friedman, associate paediatrician-in-chief at Sick Kids hospital in Toronto. While it’s still unclear what role kids play in the spread of COVID-10, there is concern that “kids could potentially bring it home and give it to their parents and grandparents and others who might have a much more severe version of it,” says Friedman.

In rare cases, however, COVID-19 can be serious for kids, too. Though still at a lower risk than adults, early data suggest infants are more likely to have severe disease compared to preschoolers and older kids. In a report from the Centers for Disease Control and Prevention (CDC) in the United States, of the 95 paediatric patients who were hospitalized, 62 percent of them were under 1. Kids with underlying health conditions, like suppressed immune systems, obesity, diabetes, seizures or chronic lung disease, are also at higher risk. Though no child in Canada has died from COVID-19, children in other countries have died from the infection, and some of those kids have been previously healthy. In that same CDC report, 0.1 percent, or 1 out of every 1000, kids who tested positive died. Stephen Freedman, professor of paediatrics and emergency medicine at the Alberta Children's Hospital and the University of Calgary, points out, however, that most COVID-19 cases in kids are likely not being recorded in the first place, because the symptoms are too mild or nonexistent to prompt testing. So the actual fatality rate might be much lower.

Can coronavirus cause Kawasaki disease in kids?

You may have heard reports of a scary inflammatory disease linked to COVID-19, sometimes referred to as Kawasaki disease. Kawasaki disease is a term to describe an overzealous immune reaction which often follows a bacterial or viral infection or other triggers. It usually involves high fevers accompanied by red eyes, red cracked lips, red tongue (sometimes called strawberry tongue), skin rash and red swollen hands and feet. Rarely, inflammation in the heart vessels can lead to long-term heart problems and even death. In any given year, a children’s hospital like Sick Kids sees more than 100 kids with Kawasaki Disease.

A similar reaction seems to be happening in rare cases with COVID-19, though the COVID-19-linked Kawasaki reaction looks to be a more severe inflammatory response. It’s being called various names, for example, Kawasaki-like or “paediatric multisystem inflammatory syndrome”, and doctors are trying to learn all they can about this response to the virus.  

Although some kids have died from this reaction, it is a very small number, and doesn’t mean that coronavirus is suddenly more fatal for kids. “The rare deaths from this syndrome will not change the overall fatality rate, nonetheless, every death is tragic,” says Freedman.

The good news is, the Kawasaki-like disease is treatable with medications. And there’s hope that greater awareness of the possibility of a Kawasaki-like reaction will lead to earlier identification and treatment, and therefore better outcomes. (With Kawasaki Disease, the risk of chronic heart complications is lower if children are treated within 10 days of the onset of symptoms).

The other good news is that while COVID-19 can be easy to miss in kids, the Kawasaki reaction is “not subtle,” as Murray puts it. According to Friedman, “there is a persistent, pretty high, hard to treat fever, often for four or more days.” In addition, a child with this reaction may have a rash, red eyes, red lips, red or swollen palms and soles. Kids having a Kawasaki-like reaction will be low-energy, “not themselves at all” and may experience vomiting and diarrhea, says Friedman. 

The syndrome seems to arise two to four weeks after a child has contracted COVID-19, says Friedman, but keep in mind parents might miss the signs of COVID-19 and only see the Kawasaki-like signs.

How should you treat kids coronavirus symptoms?

Even though coronavirus tends to be less severe in kids, you still need to be on the lookout for the illness and be prepared that your kid could be knocked out by it for a few days. (It is a virus, after all.) Because information regarding testing for coronavirus changes frequently, if your kid is showing any symptoms (including just the COVID-toes skin symptoms) you’ll want to call their doctor or visit your public health authority’s website right away to find out if they should be tested at a COVID-19 clinic, assessed in the doctor’s office or through a virtual appointment or just kept an eye on at home. (Remember that testing is important so public health officials can trace the infections, so don’t hesitate to test, even if symptoms are mild.)

The way you take care of a kid with coronavirus is the same as you would for a cold or flu—make sure they get plenty of rest and drink lots of liquids. If your child is feverish and uncomfortable, you should give them acetaminophen or ibuprofen, says Friedman, who adds that earlier concerns about ibuprofen worsening symptoms have since been shown to be unfounded. Cough and cold medications are not recommended for kids under 6. (In Isaac's case, the cough medications his mom gave him didn’t really help, anyway.) 

Of course, if at any point you get worried about your child’s symptoms, you shouldn’t hesitate to take them to the hospital. Freedman says parents should especially be concerned about difficulty breathing, a persistent high fever and prolonged lethargy. If you’re unsure if your kid is having breathing difficulties, Murray suggests parents “think of how someone looks after taking a big run. Muscles are sucking in around their ribs, they breath through their mouth, trying to take large breaths. The difference here is that the person hasn’t been out for a run, they are just working hard to breath,” she explains.

Even if your child has a suspected or confirmed positive case of COVID-19, you don’t have to worry about them being alone in the emergency room. An adult caregiver will be allowed to stay, Freedman explains. “We’ve seen a dramatic decline in emergency department attendance in children, and we want to make sure that parents are not staying home beyond the point of where they normally would take their children in,” says Freedman.

If your kid has coronavirus, you’ll likely also be advised to quarantine your family, which means no one leaves the house. “They told us we had to quarantine for three days after his fever went away and symptoms improve,” says Davis. However, they weren’t advised to keep Isaac away from other members of the family. “He slept with me every night. Someone needs to take care of them,” says Davis, who believes she may have actually had COVID-19 and been the one to pass it on to Isaac, but that was before testing was available to her. In Rowello’s case, her doctor said her kids needed to stay home for 14 days. 

Now that he’s recovered, Isaac is still staying close to home, and his mom says he and his sister won’t be attending the summer camp at their daycare, like they usually do. “We’re not ready for that. I don’t know if they can get sick again,” she says. Luckily, her kids seem fine with the new arrangement. “They think it’s great to be home. Every day is family day.” 

With files from Claire Gagné