Reassuring Facts About COVID-19 in Children

The COVID-19 virus initially presented a number of unknowns. Transmission modes, risk factors, and effective treatments all required research to better manage its spread. Another concern was how the virus impacts children. Fortunately, experts believe children suffer less severe effects than adults. In fact, some children may not experience any symptoms at all.

“They might get a runny nose or a mild sore throat, maybe an upset tummy or vomiting and diarrhea. The symptoms usually get better on their own within several days. Children usually recover spontaneously and don't need anything other than supportive care, like Tylenol for fever or pain, and plenty of clear fluids,” states Dr. Stan Calderwood, pediatrician and pediatric hematologist oncologist at Dignity Health.

Some children will develop viral pneumonia. This occurs when the virus moves from the upper airway down into the lower airway or the lungs where it cause an inflammatory response. Symptoms may include shortness of breath, coughing, or chest pain.

In this situation, additional treatments may be required such as dexamethasone for inflammation, oxygen support, and new antiviral medications that are becoming available. In rare cases, they may need admission to the intensive care unit for intubation and airway support. “Fortunately, the data from the CDC currently suggests this is a really, really rare thing in children,” notes Dr. Calderwood.

When Should You Bring Your Child to the Doctor?

While most of the mild symptoms can be addressed at home, parents should take their child to the doctor if a fever persists for longer than two or three days, if at any point they appear to be having trouble breathing or working really hard/struggling to breathe, or if they have a severe cough.

Additionally, they should see a physician if they have any tiredness or lethargy, color changes where they look pale or cyanotic, or have GI symptoms like vomiting or diarrhea—which also often leads to dehydration. “Those are all reasons you would want to bring your child to the doctor for immediate attention,” says Dr. Calderwood.

SIRS & Kawasaki Disease

Systemic inflammatory response syndrome (SIRS) is one COVID-related complication that does affect children more severely. The key features of SIRS include persistent high-grade fever, lethargy and lack of appetite. Other potential symptoms may be skin rashes, red eyes, mouth sores, swelling hands and feet, and change in urine output.

“It bears a lot of resemblance or overlap to another condition we've known about for a long time called Kawasaki disease. Many of the symptoms are the same, but Kawasaki disease also causes inflammation in the blood vessels, especially blood vessels that
supply the heart muscle. This can cause blockage of blood flow to the heart. Both are potentially very dangerous conditions,” cautions Dr. Calderwood.

No identifiable, known cause exists for either SIRS or Kawasaki disease. The thought for both is that there's a trigger, often a virus or an infectious process. It could also be a toxin in the environment. The immune system then attempts to respond to that trigger.

“Anytime we get an infection, our immune system kicks in to try to get rid of the infectious agent and heal up the damaged tissues. Usually, that immune response is controlled and functional, but sometimes it gets out of hand. Instead of a localized, systemic, inflammatory response to an infection, it goes generalized,” explains Dr. Calderwood.

He illustrates this phenomenon as the difference between a campfire and a forest fire. “A campfire is a small fire, well-contained, with a specific purpose. Maybe to keep us warm or cook our food. Every once in a while, a campfire will set off a forest fire, which is big and destructive. We don't really know why some kids will go from the campfire to forest fire, but once the forest fires starts, it's really critical to get immediate treatment to try and bring the fire under control and contain the damage.”

Treatment Options

Kawasaki disease is treated with immunoglobulins, which are antibodies that are collected during blood donation. If the child is treated within 10 days of the onset of Kawasaki disease, prognosis for recovery is excellent—up to 90 percent recovery rate. If the inflammation persists for too long, damage may be irreversible. Some children will suffer from coronary artery aneurysms and heart disease later on in life.

With SIRS, newer medications are available that are designed to inhibit the chemicals the body produces that trigger inflammation.

“They are proving to be very effective as well. Developing SIRS or Kawasaki—yes, it's a bad thing. But, if we get to it early, the vast majority of children will recover and lead normal, healthy lives,” assures Dr. Calderwood.

Caution First: You Can Do Your Part

As scary as the COVID-19 pandemic has been, Dr. Calderwood encourages parents to trust the experts.

“I want parents to feel reassured that the vast majority of children who get a COVID infection do perfectly fine. You still need to be cautious; wear a mask, wash your hands, stay away from people who are sick, isolate yourself at home. If you are feeling sick, see a doctor right away. But, for children just know it is not as serious an illness as it might be for adults, especially adults who have comorbidities like lung disease, heart disease, and diabetes.”

**To listen to an interview on this topic with Dr. Stan Calderwood, pediatrician and pediatric hematologist oncologist at Dignity Health in Bakersfield. Visit dignityhealth.org/bakersfield/podcasts.