Who that is for: Pediatric Healthcare Providers
What that is for: To inform pediatric healthcare suppliers of knowledge accessible on kids with COVID-19.
How to make use of: Refer to this info when managing pediatric sufferers with confirmed or suspected COVID-19. For healthcare suppliers caring for neonates (≤28 days outdated), please seek advice from CDC guidance for evaluating and managing neonates at risk for COVID-19.
Stay-at-home and shelter-in-place orders have resulted in declines in outpatient pediatric visits and fewer vaccine doses being administered, leaving kids in danger for vaccine-preventable ailments. As states develop plans for reopening, healthcare suppliers are inspired to work with households to maintain or carry kids updated with their vaccinations. Primary care practices in communities affected by COVID-19 ought to proceed to make use of strategies to separate well visits from sick visitsexternal icon. Examples may embrace:
- Scheduling sick visits and well-child visits throughout totally different instances of the day
- Reducing crowding in waiting rooms, by asking sufferers to stay outdoors (e.g., keep of their autos, if relevant) till they’re known as into the power for his or her appointment, or organising triage cubicles to display screen sufferers safely
- Collaborating with healthcare suppliers in the neighborhood to determine separate places for offering effectively visits for kids
Healthcare suppliers ought to determine kids who’ve missed well-child visits and/or beneficial vaccinations and make contact with them to schedule in individual appointments, beginning with newborns, infants as much as 24 months, younger kids and lengthening via adolescence. State-based immunization info programs and digital well being data might be able to help this work.
All newborns needs to be seen by a pediatric healthcare supplier shortly after hospital discharge (Three to five days of age). Ideally, new child visits needs to be executed in individual in the course of the COVID-19 pandemic with a view to consider for dehydration and jaundice, guarantee all parts of new child screening have been accomplished and applicable confirmatory testing and follow-up is organized, and consider moms for postpartum despair. Developmental surveillance and early childhood screenings, together with developmental and autism screening, ought to proceed together with referrals for early intervention services and additional analysis if considerations are recognized.
Burden of COVID-19 Among Children
Pediatric circumstances of coronavirus illness 2019 (COVID-19), attributable to extreme acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have been reported. However, there are comparatively fewer circumstances of COVID-19 amongst kids in comparison with circumstances amongst grownup sufferers.1-5
- In the United States, 2% of confirmed circumstances of COVID-19 have been amongst individuals aged <18 years.4
- In China, 2.2% of confirmed circumstances of COVID-19 have been amongst individuals aged <19 years outdated.1
- In Italy, 1.2% of COVID-19 circumstances have been amongst kids aged <18 years.2
- In Spain, 0.8% of confirmed circumstances of COVID-19 have been amongst individuals aged < 18 years.5
Among circumstances in kids reported from China, most had publicity to family members with confirmed COVID-19.6-10
Clinical Presentation in Children
Symptoms in Pediatric Patients
Illness amongst pediatric circumstances look like gentle, with most circumstances presenting with signs of higher respiratory an infection comparable to:
- Nasal congestion
- Sore throat
Outcomes in Pediatric Patients
Relatively few kids with COVID-19 are hospitalized, and fewer kids than adults expertise fever, cough, or shortness of breath. Severe outcomes have been reported in kids together with COVID-19 related deaths. Hospitalization was most typical amongst pediatric sufferers aged <1 yr and people with underlying circumstances.
Although most circumstances reported amongst kids thus far haven’t been extreme, clinicians ought to preserve a excessive index of suspicion for SARS-CoV-2 an infection in kids and monitor for development of sickness, significantly amongst infants and youngsters with underlying circumstances.
While knowledge on the incubation interval for COVID-19 within the pediatric inhabitants are restricted, it’s thought to increase to 14 days, just like grownup sufferers with COVID-19.11 In research from China, the reported incubation interval amongst pediatric sufferers ranged from 2 to 10 days.7,12
Pediatric sufferers with COVID-19 could expertise the next indicators or signs over the course of the illness:3,4,6,13-15
- Nasal congestion or rhinorrhea
- Sore throat
- Shortness of breath
- Nausea or vomiting
- Poor feeding or poor urge for food
The predominant indicators and signs of COVID-19 reported thus far amongst all sufferers are just like different viral respiratory infections, together with fever, cough, and shortness of breath. Although these indicators and signs could happen at any time in the course of the total illness course, kids with COVID-19 could not initially current with fever and cough as typically as grownup sufferers.4,15,16 In a report of 9 hospitalized infants in China with confirmed COVID-19, solely half offered with fever.9 Gastrointestinal signs, together with stomach ache, diarrhea, nausea, and vomiting, have been reported in a minority of grownup sufferers.17 In one pediatric case of COVID-19, diarrhea was the one symptom reported.10
There have been a number of stories thus far of youngsters with asymptomatic SARS-CoV-2 an infection.3,6,14,15 In one examine, as much as 13% of pediatric circumstances with SARS-CoV-2 an infection have been asymptomatic.16 The prevalence of asymptomatic SARS-CoV-2 an infection and period of pre-symptomatic an infection in kids will not be effectively understood, as asymptomatic people will not be routinely examined.
Signs and signs of COVID-19 in kids could also be just like these for frequent viral respiratory infections or different childhood diseases. It is vital for pediatric suppliers to have an applicable suspicion of COVID-19, but in addition to proceed to think about and check for different diagnoses, comparable to influenza (see CDC’s Flu Information for Healthcare Professionals for extra info).
Clinical Course and Complications in Children
The largest examine of pediatric sufferers (>2,000) with COVID-19 from China reported that sickness severity ranged from asymptomatic to vital:16
- Asymptomatic (no scientific indicators or signs with regular chest imaging): 4%
- Mild (gentle signs, together with fever, fatigue, myalgia, cough): 51%
- Moderate (pneumonia with signs or subclinical illness with irregular chest imaging): 39%
- Severe (dyspnea, central cyanosis, hypoxia): 5%
- Critical (acute respiratory misery syndrome [ARDS], respiratory failure, shock, or multi-organ dysfunction): 0.6%
Based on these early research, kids of all ages are in danger for COVID-19; nevertheless, problems of COVID-19 look like much less frequent amongst kids in contrast with adults based mostly on restricted stories from China16 and the U.S.4,18 In kids, SARS-CoV-2 could have extra affinity for the higher respiratory tract (together with nasopharyngeal carriage) than the decrease respiratory tract.16
As of April 2, 2020, infants aged <1 yr accounted for 15% of pediatric COVID-19 circumstances within the U.S.4 However, this age group stays underrepresented amongst COVID-19 circumstances in sufferers of all ages (0.3%) in comparison with their share within the U.S. inhabitants (1.2%). Relative to grownup sufferers with COVID-19, there have been fewer kids with COVID-19 requiring hospitalization (6–20%) and ICU admission (0.6–2%).4 Although extreme problems (e.g., acute respiratory misery syndrome, septic shock) have been reported in kids of all ages,4,9,12,19 they look like rare. Based on restricted knowledge on kids with both suspected or confirmed an infection with SARS-CoV-2, infants (<12 months of age) could also be at increased danger of extreme or vital illness in contrast with older kids,16 with hospitalization being most typical amongst kids aged <1 yr and people with underlying circumstances, comparable to power lung illness (together with bronchial asthma), heart problems, and immunosuppression.4 Other stories describe a light illness course, together with in infants.7,9,16
In the United States, as of April 2, 2020, there have been three deaths amongst kids with laboratory-confirmed SARS-CoV-2 an infection which have been reported to CDC, however the contribution of SARS-CoV-2 an infection to the reason for demise in these circumstances is unclear.4
Multisystem Inflammatory Syndrome in Children (MIS-C)
CDC is collaborating with home and worldwide companions to be taught extra about multisystem inflammatory syndrome in children (MIS-C) related to COVID-19.
Patients with MIS-C have offered with a persistent fever and quite a lot of indicators and signs together with multiorgan (e.g., cardiac, gastrointestinal, renal, hematologic, dermatologic, neurologic) involvement, and elevated inflammatory markers.
Healthcare suppliers who’ve cared or are caring for sufferers youthful than 21 years of age assembly MIS-C standards ought to report suspected circumstances to their native, state, or territorial well being division. For extra info together with a full case definition, please go to MIS-C Information for Healthcare Providers.
Testing, Laboratory Findings, and Radiographic Findings
Diagnosis of COVID-19 requires detection of SARS-CoV-2 RNA by reverse transcription polymerase chain response (RT-PCR) testing. Testing methods, together with clinical criteria for considering testing and recommended specimen type, are the identical for kids and adults. CDC’s steering for evaluation and management of neonates at risk for COVID-19 particulars particular testing issues for newborns. For extra details about testing, go to Evaluating and Testing Persons for Coronavirus Disease 2019 (COVID-19), Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons for COVID-19, and Frequently Asked Questions on COVID-19 Testing at Laboratories.
There are restricted knowledge on laboratory findings related to COVID-19 in pediatric sufferers. Unlike grownup sufferers with COVID-19,20,21 there have been no constant leukocyte abnormalities reported in pediatric sufferers.22 Additional research are required to know the laboratory findings related to pediatric circumstances of COVID-19.
Chest x-rays of youngsters with COVID-19 have proven patchy infiltrates in keeping with viral pneumonia, and chest CT scans have proven nodular floor glass opacities;14,23,24 nevertheless, these findings will not be particular to COVID-19, could overlap with different diagnoses, and a few kids could haven’t any radiographic abnormalities. Chest radiograph or CT alone will not be beneficial for the analysis of COVID-19. The American College of Radiology additionally doesn’t advocate CT for screening or as a first-line check for analysis of COVID-19. (See American College of Radiology Recommendationsexternal icon)
Treatment and Prevention
Currently, there aren’t any particular medication accepted by the U.S. Food and Drug Administration (FDA) for remedy or prevention of COVID-19. Treatment stays largely supportive and consists of prevention and administration of problems. Healthcare amenities, together with pediatric healthcare amenities, ought to make sure that infection prevention and control policies, together with universal source control, are in place to attenuate likelihood of publicity to SARS-CoV-2 amongst suppliers, sufferers, and households. CDC has printed particular steering, together with an infection prevention and management issues, for inpatient obstetric healthcare settings and the evaluation and management of neonates at risk for COVID-19.
The resolution to handle a pediatric affected person with gentle to average COVID-19 within the outpatient or inpatient setting needs to be selected a case-by-case foundation. Pediatric healthcare suppliers ought to think about the affected person’s scientific presentation, requirement for supportive care, underlying circumstances, and the power for folks or guardians to look after the kid at dwelling. For extra info on dwelling care of sufferers not requiring hospitalization go to: Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for Coronavirus Disease 2019 (COVID-19). There have been restricted knowledge on which underlying circumstances in kids would possibly improve their danger of an infection or illness severity. People of all ages, together with kids and adolescents, with certain underlying medical conditions comparable to power lung illness or average to extreme bronchial asthma, critical coronary heart circumstances (e.g., congenital coronary heart defects), immunocompromised circumstances (e.g., most cancers present process remedy), extreme weight problems (physique mass index [BMI]≥40), diabetes, power kidney illness on dialysis or liver illness may be at increased danger for extreme sickness from COVID-19 and needs to be monitored for signs or indicators of concern by their caregivers at dwelling and by their scientific suppliers.
Severe problems related to COVID-19 in pediatric sufferers haven’t been well-described. One newly described extreme complication, multisystem inflammatory syndrome (MIS-C), is being investigated by CDC and companions. The remedy of extreme and significant circumstances of pediatric sufferers with COVID-19 within the hospital could embrace administration of pneumonia, respiratory failure, exacerbation of underlying circumstances, sepsis or septic shock, or secondary bacterial an infection. Situations during which a affected person requires extended hospitalization may lead to secondary nosocomial infections.
Several organizations have printed pointers associated to the remedy and administration of COVID-19 sufferers, together with pediatric sufferers:
For info concerning discontinuing transmission-based precautions and disposition of sufferers with COVID-19 in healthcare settings, please see: Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance).
- Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention. JAMA
- Livingston E, Bucher Ok. Coronavirus Disease 2019 (COVID-19) in Italy. JAMA
- Su L, Ma X, Yu H, et al. The totally different scientific traits of corona virus illness circumstances between kids and their households in China – the character of youngsters with COVID-19. Emerging Microbes and Infection 2020; 9(1): 707-13.
- CDC COVID-19 Response Team. Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020. MMWR Morbidity and Mortality Weekly Report. ePub: 6 April 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6914e4external icon.
- Tagarro A, Epalza C, Santos M, et al. Screening and Severity of Coronavirus Disease 2019 (COVID-19) in Children in Madrid, Spain. JAMA Pediatr
- Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological options of 36 kids with coronavirus illness 2019 (COVID-19) in Zhejiang, China: an observational cohort examine. Lancet Infect Dis
- Cai J, Xu J, Lin D, et al. A Case Series of youngsters with 2019 novel coronavirus an infection: scientific and epidemiological options. Clin Infect Dis
- Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia related to the 2019 novel coronavirus indicating person-to-person transmission: a examine of a household cluster. Lancet 2020; 395(10223): 514-23.
- Wei M, Yuan J, Liu Y, Fu T, Yu X, Zhang ZJ. Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China. JAMA
- Ji LN, Chao S, Wang YJ, et al. Clinical options of pediatric sufferers with COVID-19: a report of two household cluster circumstances. World journal of pediatrics : WJP
- Lauer SA, Grantz KH, Bi Q, et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med
- Sun D, Li H, Lu XX, et al. Clinical options of extreme pediatric sufferers with coronavirus illness 2019 in Wuhan: a single heart’s observational examine. World journal of pediatrics : WJP
- Zheng F, Liao C, Fan QH, et al. Clinical Characteristics of Children with Coronavirus Disease 2019 in Hubei, China. Curr Med Sci
- Xu Y, Li, Xufang, et al. Characteristics of pediatric SARS-CoV-2 an infection and potential proof for persistent fecal viral shedding. Nature Medicine
- Lu X, Zhang L, Du H, et al. SARS-CoV-2 Infection in Children. New England Journal of Medicine
- Dong Y, Mo X, Hu Y, et al. Epidemiological Characteristics of 2143 Pediatric Patients With 2019 Coronavirus Disease in China. Pediatrics
- Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA
- Team CC-R. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) – United States, February 12-March 16, 2020. MMWR Morb Mortal Wkly Rep 2020; 69(12): 343-6.
- Kamali Aghdam M, Jafari N, Eftekhari Ok. Novel coronavirus in a 15-day-old neonate with scientific indicators of sepsis, a case report. Infect Dis (Lond) 2020: 1-3.
- Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med
- Huang C, Wang Y, Li X, et al. Clinical options of sufferers contaminated with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395(10223): 497-506.
- Henry BM, Lippi G, Plebani M. Laboratory abnormalities in kids with novel coronavirus illness 2019. Clin Chem Lab Med
- Chen F, Liu ZS, Zhang FR, et al. [First case of severe childhood novel coronavirus pneumonia in China]. Zhonghua er ke za zhi = Chinese journal of pediatrics 2020; 58(3): 179-82.
- Feng Ok, Yun YX, Wang XF, et al. [Analysis of CT features of 15 Children with 2019 novel coronavirus infection]. Zhonghua er ke za zhi = Chinese journal of pediatrics 2020; 58(0): E007.