COVID-19 Resource Center

COVID-19 Resource Center

Issue: July 2021
Disclosures: Parcha reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
May 27, 2021
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Children with COVID-19 may not show typical symptoms

Issue: July 2021
Disclosures: Parcha reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Children infected with SARS-CoV-2 may not show typical symptoms such as fever, cough or dyspnea, according to a retrospective cohort study of more than 12,000 pediatric COVID-19 patients in the United States.

Vibhu Parcha

“We observed a high prevalence of non-specific symptoms at presentation, with frequent multi-organ involvement,” Vibhu Parcha, MD, a clinical research fellow at the University of Alabama in Birmingham, and colleagues wrote in Scientific Reports.

Source: Adobe Stock.
Source: Adobe Stock.

The study included 12,306 pediatric patients diagnosed with COVID-19 at 33 health care organizations. Almost half (43%) were from the South.

According to the study, 74.9% of children did not have any of the typical COVID-19 symptoms. Of the total, 16.5% presented with respiratory symptoms; 13.9% had gastrointestinal symptoms, such as nausea, vomiting, diarrhea and abdominal pain; 8.1% had dermatological symptoms with a rash; 4.8% had neurological symptoms with headaches; and 18.8% had nonspecific symptoms, such as malaise, myalgia and arthralgia.

“Children who have COVID-19 may not have typical symptoms, and they may be frequently missed in routine screening measures, such as temperature checks,” Parcha told Healio. “However, they can still be a source of spreading the infection to other children and adults. Children are still at risk for hospitalization, requiring critical care and ventilator support for breathing.”

Overall, 672 of the children (5.5%) were hospitalized as a result of COVID-19. Among the hospitalized patients, 118 (17.6%) required critical care services and 38 (4.1%) needed ventilation.

“While we have cautiously reopened in-person schools, the practice of using masks and physical distancing may still need to continue at schools,” Parcha said. “We need to have a low threshold for testing children for COVID-19 and we may need to expand sentinel surveillance measures to schools and in households with at-risk individuals. This study also emphasizes the need for parents to get their children vaccinated if they are eligible.”

The risk for hospitalization, illness requiring critical care and illness requiring ventilation was similar between male and female patients, Parcha.

Additionally, the risk for hospitalization was higher among Black children (6.5%) compared with non-Hispanic white children (3.3%), an RR of 1.97 (95% CI, 1.49-2.61). However, the risk for illness requiring critical care (RR = 1.71; 95% CI, 0.89-3.31) and the need for ventilation (RR = 1; 95% CI, 0.42-2.4) was similar between Black (1.2% and 0.5%) and non-Hispanic white (0.7% and 0.5%) children.

Similarly, the risk for hospitalizations was higher among Hispanic children (4.6%) compared with non-Hispanic white children (3.5%), for an RR of 1.31 (95% CI, 1.03-1.78). The risk for illness requiring critical care (RR = 1.18; 95% CI, 0.53-2.63) and ventilation (RR = 1; 95% CI, 0.41-2.39) was similar between Hispanic (0.7% and 0.5%) and non-Hispanic white (0.5% and 0.5%) children.

“Racial minorities were at a higher risk of hospitalization,” Parcha said. “This may be due to numerous social determinants of health disproportionately impacting minority populations starting at a very early age. Children from racial minority households may have a relatively higher risk of exposure of risk to the virus given that there is a higher prevalence of parents as frontline workers, a higher prevalence of multigenerational households, and clustered housing facilities making social distancing difficult.”