COVID-19 Signs and symptoms in Children

Fever and cough are the most common reported symptoms in children. In Cases from the United States 56% of children had fever, 54% had cough, and 13% had shortness of breath; The majority of children had at least one of these symptoms.About 16% of children with confirmed infection from Wuhan Children’s hospital were asymptomatic. 19% of children had upper respiratory infection and 65% had pneumonia. Fever was the most common symptom occurring at some point during the illness. Other common symptoms were throat redness and cough. Less common symptoms were fatigue, runny nose, nasal congestion, diarrhea, and vomiting. Some children presented with only gastrointestinal symptoms. Lab findings were variable between children. Some with low white blood cell count and a smaller percent with low lymphocytes. Procalcitonin was elevated in 64% and C-reactive protein in 20% of children. Chest x-rays can show consolidation or be unremarkable. Chest CT findings included ground glass opacity, local patchy shadowing, bilateral patchy shadowing, and interstitial abnormalities. These findings may be present before symptoms. Most children appear to have mild to moderate disease and recover within 1-2 weeks of symptom onset,  although there have been some severe including fatal cases. In a series of 731 children from China with confirmed COVID 19 disease, 55% of cases were mild or asymptomatic, 40% were moderate- evidence of pneumonia without hypoxemia, 5% were severe, and 1% were critical with acute respiratory distress syndrome, failure, shock. 

COVID 19- Infants and Children at greater risk for severe disease-Hospitalization and intensive care admission were more common among infants less than 1 year old and children with underlying conditions. Among 345 children in the United States with confirmed COVID 19 testing 23% had an underlying condition. -chronic pulmonary disease (including moderate to severe asthma)-cardiovascular disease-immunosuppression (related to cancer, chemotherapy, radiation, hematopoietic cell or organ transplant, high doses of glucocorticoids)-blood disorders (sickle cell disease; use of blood thinners)-chronic kidney disease undergoing dialysis-chronic liver disease -pregnancy-endocrine disorders (diabetes mellitus)-severe obesity (BMI>40)It is unclear why COVID 19 appears to be less common and severe in children but some considerations are–less vigorous immune response to the virus in children-lower viral load in the respiratory tract of children-the receptor for SARS-CoV2 may be expressed differently in the respiratory tract of children