The Pandemic Pediatrician: What We Know Now

William T. Basco, Jr, MD, MS


December 04, 2020

Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Like all of you, I find the deluge of COVID-19 information difficult to keep up with. For that reason, I've scanned the recent pediatric literature and identified some interesting clinical reports that can inform practice and help answer patient questions.

What Have We Learned About COVID-19 in Kids?

A recent helpful and relatively brief review article summarizes what we have learned about this disease in children during the first wave of COVID-19. Here are some of the topics discussed:

Reasons why COVID-19 has a lesser effect on children than adults. Children may have other viruses in the respiratory tract that dampen the response to SARS-CoV-2, their immune system response may be different than the response of adults, and children may have had previous exposure to other coronaviruses — all of these might be factors.

Testing for COVID-19 in children. As with adults, the gold standard for diagnosis of acute infection is a reverse transcriptase polymerase chain reaction (RT-PCR) test, which is most accurate when performed on a nasopharyngeal sample. Viral replication likely stops 5-7 days after first symptoms, but children can remain RNA-positive for up to 2 weeks.

Clinical and radiologic features of COVID-19 in children. The most common acute presenting features are fever, cough, lethargy, coryzal symptoms, and shortness of breath. A significant proportion of infected children will have normal results of laboratory and radiologic investigations.

How COVID-19 affects neonates. Vertical transmission to neonates, whether intrauterine or perinatal, is possible but appears to be rare. The majority of the very few neonates who were reported to be infected have not required intensive care.

Children with comorbidities. A single observational study involving only 48 children found that the overwhelming majority requiring intensive care for COVID-19 (85%) had comorbidities. However, it is likely that parents of the most susceptible children have been diligent in protecting them, so it is hard to draw any firm conclusions from these early data.

Treatment options for children. Most children with COVID-19 will require only supportive therapy. Dexamethasone and remdesivir, both used to treat adults, are also available to treat children.

Certainly, it is reassuring to know that most children will get better — as children do — without much intervention. However, given that more than 1 million US children have already been infected with SARS-CoV-2, it is inevitable that some will have a very severe disease course.

In an analysis just published in The Journal of Pediatrics, investigators from Children's Hospital at Montefiore, Albert Einstein College of Medicine, and Yale School of Medicine, looked at factors that predicted a severe outcome from SARS-CoV-2 infection in children. Their conclusion, based on data from just under 300 children hospitalized early in the pandemic (March through May), underscored that the disease can present differently in children. Kids who, at the time of hospital admission, were obese, had lower lymphocyte counts, or who had hypoxia were more likely to have a very severe, potentially fatal course of illness.

The review article covers a number of other topics on COVID-19 in children, is well referenced, and is available in full text online. I recommend that you take a quick look at it.


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