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Disclosures: Antoon reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
September 17, 2021
2 min read

Comorbidities in children linked to severe COVID-19

Disclosures: Antoon reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Comorbidities can factor into severe COVID-19 in children, according to a study published in the Journal of Hospital Medicine.

James W. Antoon, MD, PhD, an assistant professor of pediatrics and hospital medicine at Vanderbilt University, told Healio that throughout the pandemic most attention was paid to adults rather than children.

Source: Adobe Stock.
Children and adolescents with comorbidities are at a higher risk for severe COVID-19. Source: Adobe Stock

“When we started seeing more and more hospitalizations in children from COVID-19, we decided to take a deeper dive into which children are the most vulnerable for getting the sickest with COVID-19, in the hopes of then applying that to some of our mitigation efforts and school openings,” Antoon said.

Among 19,976 pediatric patients with COVID-19 examined by Antoon and colleagues, 4,063 (20.3%) were hospitalized, with the cases ranging from moderate (79.3%) to very severe (9.4%).

“We found that about 20% of children who are evaluated in the ED require hospitalization, and a little over 20% of children who are hospitalized require ICU care or mechanical ventilation,” Antoon said. “There’s been this myth circulating since the beginning of the pandemic that children don't get sick from COVID-19. And I think this study should put that to bed, that absolutely children can get very sick with COVID-19.”

The researchers found that several factors were associated with hospitalization in children, including obesity and type 2 diabetes (adjusted OR = 10.4; 95% CI, 8.9-13.3), asthma (aOR = 1.4; 95% CI, 1.3-1.6), cardiovascular disease (aOR = 5; 95% CI, 4.3-5.8), immunocompromised condition (aOR = 5.9; 95% CI, 5-6.7) pulmonary disease (aOR = 5.3; 95% CI, 3.4-8.2) and neurological disease (aOR = 3.2; 95% CI, 2.7-5.8).

Children aged older than 5 years, Antoon adds, also were more likely to have severe COVID-19.

“So one thing that was an interesting finding is that older children, children older than 5 years were at greater risk for more severe disease, and that's contrary to other viral illnesses. Typically, for influenza, or [respiratory syncytial virus], or other seasonal viruses, it's the younger children who have the more severe disease.”

James Antoon

Once a vaccine for children aged 5 years and older is authorized — the Pfizer-BioNTech vaccine expected to be the first — it would be crucial for patients with comorbidities to be among the first to receive it, Antoon said.

“Right now, 70% of children who are hospitalized with COVID-19 are not eligible for the vaccine,” he said. “They're [younger] than 12 years. And I think we can all agree that we want to protect those children. And so vaccinating everybody around them is very important in applying our mitigation efforts in schools, where COVID-19 is being transmitted now.”

According to the AAP, after declining in early summer, cases of COVID-19 have increased exponentially among children, who now comprise almost 30% of all new cases in the United States.

The AAP has recently ramped up efforts to convince parents to vaccinate eligible children, including through a CDC-backed advertising campaign. The academy also has discouraged providers from administering the Pfizer-BioNTech vaccine off-label to children aged younger than 12 years.