COVID-19 in children

COVID-19, Corona-virus, SARS COV-2… these terms have been shouted from the rooftops the last few months. Our lives have all changed and there are many new things popping up on our worry-lists. One of the items on my list was the health of my children. As a pediatrician I decided to investigate the facts on COVID-19 in children and to my big relief I could scratch a few things from my worry-list. I would love to share my findings with you:

How does Covid-19 affect children?

  • Physically: children have the same risk as adults to become infected with COVID-19. The good news is that they are mostly not as severely affected. They are often asymptomatic or have a very mild disease. New research also show that they do not really spread the virus among other children.
  • Socially: Our kids cannot see their extended family or friends and this is tough on them. We can help them to cope by letting them write letters / draw pictures for grannies, video-calling with their friends and giving them a lot of extra hugs to make them feel loved and safe. As schools are reopening, they may need extra support to get used to the new routine and to catch up with school work.
  • Emotionally: Children are very sensitive to the emotions of adults around them. Add a lot of talk about illness and death and it is no wonder that a lot of children are “acting-up” or wetting their beds again. Be sensitive to what they listen to / watch and try to inform them about the facts in an age-appropriate way.  Children thrive on routine, so try to have some sort of routine at home that can help them feel safe. In the end they just need love, a place to feel safe and food to eat. (See the Resources at the bottom for some free online storybooks that can help you to explain the pandemic).

What symptoms do kids typically have?

Children often develop fever, a dry cough, a sore throat or can present with vomiting and diarrhoea. Most children do not develop any symptoms or have very mild flu-like symptoms. This means they rarely get tested and thus the statistics show only a few cases in children.

More severe cases usually develop pneumonia, so it is important to look out for signs of difficult breathing (fast breathing, nose flaring with every breath, chest wall pulling in under rib cage).


New research have associated an inflammatory syndrome called Multisystem Inflammatory Syndrome in Children (MIS-C) (similar to “Kawasaki-disease” ) with COVID 19. Children with this disease usually test negative for active COVID-19 but have antibodies proving previous infection. It seems as if the virus causes confusion in the immune system that triggers an inflammatory reaction in more than one system in the body.

Symptoms can include fever, vomiting, diarrhoea, stomach pain, red skin rash, red eyes, red/swollen lips and tongue. Children can also develop difficulty breathing, chest pain and changes in consciousness.

Luckily this new syndrome is VERY rare.

Phone your child’s health-care provider if you are worried that your child might have been exposed to someone with COVID-19, or if your child has any of the above-mentioned symptoms. They will be able to direct you in the next steps to take.

How do you protect your kids from Covid 19?

The WHO reminds us that it is the basic things that make the biggest difference in prevention:

  • Frequent hand washing (with soap and water or hand sanitizer). This is a very important life skill to teach your children from a young age. In babies under 1yr you can use 3 wash-cloths (one to wet hands, one with soap, one to “rinse”). In toddlers you need to model the different actions and help them to wash all surfaces of their hands.

Pick a song such as “Twinkle, Twinkle little star” that is at least 20seconds long to sing while you wash. You can use the “pepper-experiment” to teach your children the importance of hand washing: Fill a bowl with water and sprinkle grinded black-pepper on the surface. Let your child dip his finger in the bowl (there will be some pepper stuck to his finger, explain that the pepper is like the virus). Apply some handwash-soap to the finger and let him dip it in the bowl again. (The pepper will now move away from his finger due to the change in surface tension. This gives an illustration of how effective hand washing is!).

  • Teach your children to cough / sneeze in their elbows / a tissue which they should throw in a dustbin immediately. This prevents them from spreading COVID-19 containing droplets.
  • Let them stay at home. Do not take your children with you when you go to the shops. It is very hard for a toddler to not touch different surfaces and then touch their faces! It is also not safe to visit playgrounds as the virus can survive from hours to days on different surfaces. Explain the concept of physical distancing to your child so that they will be able to handle the new rules at school.
  • At home you should clean surfaces that are touched often (such as door-handles, light switches, remotes) daily with disinfectant. If you or your children were exposed to anybody that is ill / to public areas please wash your clothes and any blankets / soft toys with warm water and laundry detergent.
  • Wear a cloth facemask. Children above 2 years of age can wear facemasks to prevent them from coughing / sneezing and spreading droplets in public. Remember that they can spread Covid-19 even while they seem healthy! It does also provide an extra barrier of protection for them from the droplets that other people may spread and from putting their fingers in their mouths! Keedo are now making and selling the cutest facemasks for children in two sizes and different designs so that it will fit their faces snugly. See their website for more information or to order.

Make sure the mask fits over their nose and mouth, stretching from ear-to-ear and below the chin. Use elastic bands or velcro straps to make it easy to put on. Model good mask-wearing behaviour to your child and remember to make it part of a game / tell them they are a super-hero to encourage them to keep the masks on while in public places.

It seems like the latest regulations for the opening of the schools are that children above 6yrs of age have to wear masks at school, while the smaller children will only need a mask if they develop any symptoms that can be associated with COVID-19.

(Children under 2 years still have very small airways and adding a facemask might make it hard for them to breathe. They also cannot remove the mask by themselves if they are struggling).

Some schools might also require a face shield, this is also safe and may be easier for little kids to wear.

  • Spend time outdoors – physical exercise and the Vitamin D formed in your skin from exposure to the sun is very important to maintain a healthy immune system.
  • A healthy diet also ensures a healthy immune system. If you have a picky-eater it can help to give extra vitamins (Vitamin A, Vitamin C, Vitamin D and Zinc is especially important for immunity)
  • Stay up-to-date with their routine immunizations. Children under 5years of age should also get the flu-vaccine. Now is not the time for your child to get any serious, preventable diseases.

I hope I could set your mind at ease and empower you with some practical tips to keep your children and the rest of your family safe in this unsure, unprecedented times. May you know that you are not alone and may peace guard your heart and mind!

Love, Nické


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