Coronavirus Disease 2019 in Children

Emily R. Levy; Jennifer Blumenthal; Kathleen Chiotos


Curr Opin Infect Dis. 2021;34(5):500-509. 

In This Article

Abstract and Introduction


Purpose of Review: Over the course of the coronavirus disease 2019 (COVID-19) pandemic, it has become clear that the clinical features, epidemiology, and outcomes of COVID-19 are distinct in children relative to adults. In this review, we will present recent pediatric studies informing our current understanding of COVID-19 in children, and review pediatric considerations surrounding disease transmission, currently available therapies, and vaccination.

Recent Findings: Recent studies have shed light on the clinical epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children, identifying a high prevalence of asymptomatic and mild infections, with severe COVID-19 infrequently reported. Several adult clinical trials have informed the use of remdesivir, anti-SARS-CoV-2 monoclonal antibodies, dexamethasone, and tocilizumab in the management of COVID-19. Associations between underlying comorbid medical conditions and severe outcomes, as well as transmission dynamics of SARS-CoV-2 in children, are complex and warrant further study. Finally, highly efficacious vaccines are available for adults and adolescents, with pediatric trials ongoing.

Summary: Children generally fare well with acute COVID-19 infection, though critical illness is possible. Future research should focus on clarifying the role of children in SARS-CoV-2 transmission and optimal prevention strategies, particularly in the school setting, as well as evaluating pediatric vaccine candidates.


In late 2019, the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, Hubei Province, China, as the causative agent of coronavirus disease 2019 (COVID-19). Since, over 148 million people have been infected worldwide, and over three million have died.[1] A striking feature of COVID-19 has been substantial differences in the clinical epidemiology and outcomes in children as compared with those observed in adults, with children experiencing severe manifestations of disease far less commonly,[2–4] In the United States (US), Centers for Disease Control and Prevention (CDC) surveillance data demonstrates that despite children under 18 years old accounting for 22% of the population, they account for just 12% of SARS-CoV-2 cases and 0.1% of deaths.[4] Herein, we review the unique clinical features of COVID-19 in children, and highlight pertinent pediatric considerations with regard to transmissibility, treatment, and prevention. Of note, this article will focus on acute COVID-19 with limited discussion of the multisystem inflammatory syndrome in children (MIS-C), but we refer the reader to other published reviews on this topic.[5–7]