How COVID-19 Affects Children and Pediatric Care

Sonja Rasmussen, MD, MS

Early data suggest the effects of coronavirus disease 2019 (COVID-19) on children are less severe than for adults. But questions remain regarding children with special healthcare needs, according to a recently published research letter.

Sonja Rasmussen, MD, MS, and a colleague from the University of Florida College of Medicine, aimed to address what is known about COVID-19 in children and considerations for pediatric healthcare workers.

Although children are generally more susceptible to influenza (flu) complications, so far, they have experienced lower-than-expected rates of COVID-19, Rasmussen, from the pediatrics department at the University of Florida College of Medicine, and her partner wrote. And deaths in children are rare.

In fact, in more than 72,000 cases in China, 1.2% were in patients aged 10-19 years old and .9% were in those <10 years old. Only 1 death in the study was an adolescent, and no children 0-10 years old died.

COVID-19 manifestations among children appear similar to adults.

According to previous research, among 28 pediatric patients reported, the age ranged from 1 month to 16 years old. Some patients were asymptomatic at diagnosis, while others had fever, fatigue, dry cough, and other respiratory symptoms.

The transmission of the virus is also likely the same as adults, and it is unknown whether COVID-19 can be transmitted through breastmilk, though among 6 mothers who had breastmilk samples tested for SARS-CoV-2, all were negative.

Still, clinicians and patients alike must monitor children and the possibility of infection.

“The lower-than-expected rates of children affected by COVID-19 in China might be because of decreased exposure to the virus, decreased infection with the virus because of immunity to other coronaviruses, or decreased likelihood of illness, even when infected with the virus,” the authors wrote.

What’s more, asymptomatic children could pass the virus to adults.

In the US, there have been no ICU admissions or deaths reported among individuals <19 years old among 4226 patients through March 16. Children with comorbidities, including asthma or pulmonary, cardiac, neuromuscular, or genetic diseases could experience COVID-19 differently than others in their age group who are healthy.

Pediatric healthcare workers must prepare their offices, facilities, and communities for increased spread of COVID-19. The providers need to make special accommodations to isolate children who are potentially sick with the virus from those who are otherwise healthy while in the waiting room. Provider should focus on minimizing exposures for those with special healthcare needs.

Healthy children should be limited from visiting the healthcare facility for nonurgent reasons to prevent widespread transmission. To do this, telephone triage and an expansion of existing telehealth capabilities will be necessary.

Because of school closures, pediatricians should advocate to alleviate unintended consequences of health disparities on children by finding ways for children who are dependent on school lunches to maintain nutrition. Mental health services can also be provided for stress management for families whose routines have been severely impacted.

“Surveillance of COVID-19 in the pediatric population, including seroprevalence studies, is needed to better understand its influence on US children,” the authors wrote. “Clinicians need to work with school and community leaders to implement interventions that slow disease spread and prevent severe illness and death, while ensuring that unintended consequences of these interventions on children are minimized.”

The article, “Coronavirus Disease 2019 and Children What Pediatric Health Care Clinicians Need to Know,” was published online in JAMA Pediatrics.