COVID-19 in babies and children

September, 25th, 2024

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Anyone can get COVID-19, also called coronavirus disease 2019, including children. Find out about the symptoms, testing and medical issues linked to COVID-19 in children. And learn how to help prevent COVID-19, especially in children at high risk of serious illness.

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How likely is it for a child to become sick with coronavirus disease 2019 (COVID-19)?

Data tracking between 2020 and 2023 found that children made up about 18% of all people with reported COVID-19 in the United States.

While children are as likely as adults to catch the virus that causes COVID-19, kids are less likely to become seriously ill. From 2020 to the end of March 2024, children up to age 17 accounted for about 1.5% of people who needed to be treated for COVID-19 in the hospital.

But some children with COVID-19 need to be hospitalized, treated in the intensive care unit or placed on a machine to help them breathe, called a ventilator. Very rarely, COVID-19 can cause death.

Some health issues might raise a child’s risk of serious illness with COVID-19, such as:

• Having more than one chronic disease, including those of the heart, lung or nervous system.
• Not being up to date with COVID-19 vaccination.
• Having a weakened immune system.
• Being born before the due date, called prematurity.
• Having obesity.
• Having type 1 or type 2 diabetes.

This is not a complete list. Other health issues, such as sickle cell disease, may be linked to more-serious COVID-19.

Having more than one risk factor raises the chance of serious COVID-19. Age younger than 1 year or older than 12 also raises the risk. And if a medical condition isn’t under control, that can raise the risk of serious COVID-19.

A COVID-19 vaccine might prevent your child from getting the virus that causes COVID-19. It also may prevent your child from becoming seriously ill, having to stay in the hospital or dying of COVID-19.

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How are babies affected by COVID-19?

Babies under age 1 might be at higher risk of serious illness with COVID-19 than are older children. This may be mostly due to the fact that babies born prematurely have the highest risk.

In general, the virus that causes COVID-19 doesn’t spread from the pregnant person to the unborn baby. Infants typically get COVID-19 from a sick caregiver after delivery.

Pregnant people can help lower an infant’s risk by getting the COVID-19 vaccine during pregnancy. Some evidence suggests protection can pass to the unborn baby and continue after birth.

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What are the symptoms of COVID-19 in children?

Children with COVID-19 may have serious or mild symptoms or no symptoms at all. Symptoms may show up from 2 to 14 days after contact with the virus that causes COVID-19.

The most common symptoms are fever and a cough, including a barking cough linked to croup. For many children, symptoms are like those of other lung and breathing illnesses, called respiratory illnesses, and may include:

• Sore throat.
• Stuffy or runny nose.
• Headache.
• Feeling very tired, called fatigue.
• Nausea, vomiting or loose stools, called diarrhea.
• Chills.
• Muscle aches and pain.

Testing can help figure out if the virus that causes COVID-19 is the cause.

COVID-19 symptoms also may include problems breathing or shortness of breath, as well as new loss of taste or smell.

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Breathing trouble

Get emergency help right away if your child is working hard to breathe. Symptoms of breathing trouble include grunting, flaring the nostrils, or having the chest pull at the collarbone and rib with a breath. Other symptoms of trouble breathing are shortness of breath at rest; rapid breathing; or wheezy, noisy or raspy breathing. In babies, this may show as not being able to cry or feed.

Get emergency help for other symptoms of serious illness, such as:

• Fever higher than 100.4 degrees Fahrenheit (38 degrees Celsius) in a child younger than 3 months old.
• Problems swallowing, for example, drooling in children younger than age 3 and in older children, not being able to swallow or open the mouth fully.
• Skin, lips or nail beds that are gray or blue.
• New confusion.
• Trouble staying awake or waking up.
• Chest pain or pressure that is constant.
• Vomiting or diarrhea that doesn’t stop.
• Dehydration, which in babies younger than 3 month means fewer than three wet diapers in 24 hours.

This list doesn’t include every emergency symptom. If the child you’re taking care of has symptoms that worry you, get help. Let the healthcare team know about a positive test for COVID-19 or symptoms of the illness.

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Testing for COVID-19

Testing for COVID-19 can help you quickly figure out if the COVID-19 virus is the cause of your child’s illness. Testing helps you act quickly to prevent serious illness in kids who are at higher than average risk. It also helps protect others who may be at high risk.

Test for COVID-19 if you know you or your child was exposed to the virus or if you have symptoms. Testing during times when many people in your area have COVID-19 can help stop the spread of the virus that causes the illness.

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What is multisystem inflammatory syndrome in children (MIS-C)?

Multisystem inflammatory syndrome in children (MIS-C) is a serious condition linked to infection with the virus that causes COVID-19.

With MIS-C, children have fever, blood markers of inflammation and serious disease throughout the body. Organs such as the brain, eyes, heart, lungs, kidneys, digestive system and skin may become inflamed. MIS-C symptoms are treated in the hospital as the illness runs its course.

MIS-C is rare. In 2023, the U.S. Centers for Disease Control and Prevention received 117 reports of MIS-C. Most of these children had no medical issues before getting MIS-C.

Symptoms usually show up in about 2 to 6 weeks after infection with the virus that causes COVID-19.

Symptoms of MIS-C include a fever that doesn’t go away, along with other symptoms:

• Vomiting.
• Diarrhea.
• Belly pain.
• Skin rash.
• Bloodshot eyes.
• Dizziness or lightheadedness.

Emergency warning signs of MIS-C include:

• Trouble staying awake or waking up.
• Difficulty breathing.
• New confusion.
• Gray or blue skin, lips or nail beds.
• Terrible belly pain.

If your child shows any emergency warning signs or is severely sick with other symptoms, take your child to the nearest emergency department or call 911 or your local emergency number. If your child isn’t seriously ill but shows other symptoms of MIS-C, contact your child’s healthcare professional right away for advice.

Most children get better quickly and don’t have any medical issues caused by MIS-C.

Staying up to date with COVID-19 vaccination offers protection against MIS-C. And most children who have had MIS-C can get a COVID-19 vaccine on schedule.

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Can children who get COVID-19 experience long-term effects?

Anyone who has had COVID-19 can develop a post-COVID-19 syndrome. New symptoms or conditions that develop after infection with the virus that causes COVID-19 is more often linked to serious COVID-19 illness. But anyone who catches the COVID-19 virus can develop a post-COVID-19 syndrome.

Symptoms often include a high level of tiredness that affects day-to-day life. And some symptoms may get worse after certain activities.

Symptoms may relate to trouble with:

• Breathing.
• Trouble with thinking.
• Fast heartbeat.
• Sleep problems
• Digestive issues.
• Pain in the joints or muscles.

Depending on their age, children may have trouble explaining some of these issues, which may be difficult for healthcare teams to diagnose.

These symptoms could affect your child’s ability to attend school or do typical activities. If your child has post-COVID-19 symptoms that aren’t getting better, talk with your healthcare professional. Working with your child’s school, it may be possible to compensate for these symptoms.

Staying up to date with COVID-19 vaccines offers protection against post-COVID-19 syndrome.

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What COVID-19 vaccines are available to kids in the U.S.?

The COVID-19 vaccines available in the United States are:

• Pfizer-BioNTech COVID-19 vaccine 2024-2025 formula, available for people age 6 months and older.
• Moderna COVID-19 vaccine 2024-2025 formula, available for people age 6 months and older.
• Novavax COVID-19 vaccine, adjuvanted 2024-2025 formula, available for people age 12 years and older.

In general, people older than age 4 with typical immune systems can get any vaccine that is approved or authorized for their age. And people usually don’t need to get vaccines from the same vaccine maker each time.

Some people should get all their vaccine doses from the same vaccine maker, including:

• Children age 6 months to 4 years.
• People age 5 years and older with weakened immune systems.
• People age 12 and older who have had one shot of the Novavax vaccine. They should get the second Novavax shot in the two-dose series.

Talk with your healthcare professional if you have any questions about the vaccines for you or your child. Your healthcare team can help you if:

• The vaccine you or your child got earlier isn’t available.
• You don’t know which vaccine you or your child received.
• You or your child started a vaccine series but couldn’t finish it due to side effects.

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What can I do to prevent my child from getting COVID-19?

There are many steps you can take to prevent your child from getting the COVID-19 virus and spreading it to others.

• Get vaccinated. If the timing works out, a COVID-19 vaccine can be given to eligible children on the same day as other vaccines.
• Keep hands clean. Encourage frequent hand-washing with soap and water for at least 20 seconds. Teach your kids to keep washing their hands until they have sung the entire “Happy Birthday” song twice, which takes about 20 seconds. Or use an alcohol-based hand sanitizer that contains at least 60% alcohol. Have your child cover the mouth and nose with an elbow or a tissue when coughing or sneezing. Remind your child to avoid touching the eyes, nose and mouth.
• Clean and disinfect your home. Clean high-touch surfaces and objects regularly and after you have visitors in your home. Also, regularly clean areas that easily get dirty, such as a baby’s changing table, and surfaces and items that your child often touches.
• Get the air flowing. Use fans, open windows or doors, and use filters to keep air and germs moving out of your indoor space.
• Keep some distance. If possible, avoid close contact with anyone who is sick or has symptoms. Spread out in crowded indoor places, especially in places with poor airflow.
• Wear face masks. If you are in an area with a high number of people in the hospital with COVID-19, the CDC recommends wearing a well-fitted mask indoors in public. Don’t place a face mask on a child younger than age 2 or a child with a disability who can’t safely wear a mask.

Keep up with well-child visits and your child’s other vaccines. COVID-19 is just one of many illnesses that can be prevented with vaccination. Vaccines for children are timed carefully. Vaccines are given when protection inherited from the mother fades and the child’s immune system is ready, but before kids are likely to come in contact with the germs that cause real infections.

Following guidelines to protect against the COVID-19 virus can be difficult for kids. Stay patient. Be a good role model and your child will be more likely to follow your lead.