“Children who are medically complex, who have serious genetic, neurologic, metabolic disorders, and with congenital (since birth) heart disease might be at increased risk for severe illness from COVID-19,” the CDC says.
At the beginning of the pandemic, children were thought to be at a lower risk for contracting the virus compared to adults. Kelly Fradin, MD, a board-certified pediatrician and author of Parenting in a Pandemic: How to help your family through COVID-19, tells Verywell that this misconception can be attributed to the substantial testing shortages at the time. Still, she says children typically exhibit more mild symptoms.
“Research continues to suggest that children under 10 are less likely to catch and transmit the virus, likely due to differences in the presence of ACE2 receptors where the virus binds,” she says.
What Is a Medical Complexity in Children?
Smita Malhotra, MD, a Los Angeles-based pediatrician and author, tells Verywell that children who are medically complex have compromised immune systems and require more intensive care than children with no underlying medical conditions.
“Medically complex children can get very sick from the common cold," she says. “Therefore, they are also more susceptible to developing severe illness from COVID-19.”
Neurological Conditions
Fradin adds that neurological conditions are part of these medical complexities. Certain neurological conditions, such as cerebral palsy, can cause people to struggle with clearing phlegm and leave them with a more limited supply of energy when they need to exert respiratory effort.
“For these reasons, we find that children [with neurological conditions] are at a higher risk for severe outcomes from many respiratory infections, such as influenza and RSV,” she says.
Genetic Conditions
Fradin says that the rarity of most genetic conditions in children makes predicting how COVID-19 will effect these kids difficult. An exception, however, is Down syndrome, which effects about 1 in every 700 babies born each year.
“Preliminary research has indicated these children may be at increased risk, which we could have guessed based on the fact that the syndrome is associated with impairments in immune functioning, obesity, and structural abnormalities that may increase risk,” she says.
Metabolic Conditions
Fradin says an example of a metabolic condition mentioned by the CDC includes diabetes, and that juvenile diabetes may increase a child’s risk of developing a more severe case of COVID-19.
Congenital Heart Disease
Malhotra says congenital heart disease does not increase a child’s odds of contracting COVID-19, but it can make the effects of COVID-19 more severe.
“This is due to the inflammatory response that COVID-19 initiates in the body which can weaken an already fragile heart,” she says.
Symptoms of COVID-19 in Children
According to Fradin, fever, cough, and muscle aches are the most common symptoms to watch out for in children, though congestion, headaches, and sore throats could also be COVID-19 red flags.
“The variety of presenting symptoms in both children and adults is striking," Fradin says. “Symptoms vary by age; newborns and the elderly experience different symptoms. Only half infected people have a fever, even when we use a low cutoff for fever, like 99.5° F or 100.4° F,” she says.
Multisystem Inflammatory Syndrome in Children (MIS-C)
Beginning in April, doctors began identifying a potential link between COVID-19 and a condition called multisystem inflammatory syndrome in children (MIS-C). This syndrome triggers inflammation throughout various parts of the body, including internal organs. This is thought to be a result of a dysregulated immune system from COVID-19. Symptoms include:
Fever lasting more than 3 daysAbdominal painNeck painDiarrhea or vomitingRashBloodshot eyesFatigueTrouble breathingChest painConfusionInability to wake up or remain awakeBluish lips or face
“Although the children are often critically ill, MIS-C seems quite rare and highly treatable,” Fradin says. “Most children are discharged within a week and anticipated to have a full recovery. There are likely subtle differences in the immune systems of children who come down with MIS-C.”
Treatment Options
Fradin says that most children infected with COVID-19 will exhibit mild symptoms and require only outpatient care. Those admitted to hospitals require tailored treatment plans based on their age and condition.
“Regarding direct infection with coronavirus, most of the children hospitalized or requiring intensive care have either had a serious underlying condition or multiple viruses," Fradin says. “It’s also worth noting that infants under 2 months and children over 12 seem more likely to require hospitalization.”
If your child does have any of the medical complexities or underlying conditions mentioned, the CDC suggests the following action items:
Give medicines as prescribed for your child’s underlying conditions. Make sure that you have at least a 30-day supply of your child’s medicines. Discuss your child’s specific conditions and risk for severe illness from COVID-19 with your healthcare provider. Stay up-to-date on well-child visits and vaccines.
In addition to reiterating the CDC guidelines, Malhotra says parents and caregivers should prioritize the emotional wellbeing of their children throughout the pandemic.
“[Parents] should remember to care for their child’s mental health as much as their physical health by creating a safe space for their child to express their feelings and fears and validating them,” she says. “Children are incredibly resilient, but they need the support of a consistent, reliable and nurturing caregiver.”
The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.
