At the beginning of the coronavirus pandemic back in 2020, many parents were terrified by the prospect of their children getting COVID-19. (Raise your hand if you cleaned all your groceries with disinfectant wipes and banned all playdates for, well, forever.)
We knew next to nothing about the virus at that time, but in the months that followed, a bit of hopeful news filtered out: The headlines said that kids were far less likely to get the coronavirus, and even if they did, it wouldn't make them as sick as it did adults.
Was that news untrue? Not entirely, researchers say: Children do have a propensity to handle the virus better than adults, and their symptoms do tend to be milder. But as new variants of the coronavirus have emerged, research suggests our kids aren’t entirely off the hook.
Here’s something else to consider: As of May 2022, over 13.2 million kids had tested positive for COVID-19 since the pandemic started, and more than 5 million of them did so in the first half of 2022. “These numbers are a chilling reminder of why we need to take this virus seriously,” Sally Goza, M.D., former American Academy of Pediatrics president, said in a press brief in 2021. “While much remains unknown about COVID-19, we do know that the spread among children reflects what is happening in the broader communities.”
Back in January 2022, the number of children being admitted to the ER with COVID-19 hit record highs in nine states. Children who live with conditions such as diabetes, obesity, and asthma are at greater risk of severe illness, but half of the children who have been hospitalized with COVID-19 had no underlying health issues, according to the Centers for Disease Control and Prevention (CDC).
Vaccines reduce the risk for children who get them, but breakthrough cases do occur and kids can still get sick, or pass the virus on to others. As one Toronto woman memorably noted to National Geographic, the symptoms may be milder for the vaccinated, but they’re still no fun. “When people say ‘mild,’ they mean you’re not dying, like you don’t end up in the ICU,” said Melinda Maldonado, a communications strategist who fell ill when Omicron hit the U.S. in December 2021. “For me, this was not mild.”
Kids under 6 months old are not yet able to get vaccinated, which can be nerve-wracking for parents. Here's what you need to know about what COVID-19 symptoms look like in toddlers and children, plus tips for preventing the illness.
COVID-19 Symptoms in Kids and Toddlers
The first thing to know is that COVID-19 doesn’t look the same for everyone, even among children. Many kids experience no symptoms whatsoever, while others have mild symptoms that resemble the common cold, flu, or even seasonal allergies. It’s scary to see pediatric hospitalization rates climb, but it still remains relatively rare for children to go into respiratory distress or die from COVID-19.
That said, it's important to know what the symptoms of COVID-19 can look like so you can not only care for your child but also protect others. In general, symptoms of COVID-19 in kids appear within two to 14 days of exposure, and may include:
- Fever
- Cough
- Runny nose or congestion
- Sore throat
- Gastrointestinal issues (such as nausea, vomiting, or stomachache)
- Diarrhea
- Fatigue
- Headache
- New loss of taste or smell
- Shortness of breath
- Body aches
- Poor appetite
Kids can also be asymptomatic, even if they are carrying a high viral load. Fortunately, that does not typically translate to them being sicker, but there’s still a downside: As a study in the Journal of Infectious Diseases points out, we might think they are doing fine until they infect us.
How long does COVID-19 last in kids? Every little one is different. Most symptomatic children will recover within two weeks, but if they have complications, it could take a little longer to get better. Long-haul COVID-19 that sticks around for weeks or months has also been reported in kids.
How Often Do Kids Have COVID-19 Complications?
Here’s some good news: State records suggest that children under 18 make up less than 1.5 percent of people who enter the hospital with COVID-19, and they comprise less than 0.30 percent of COVID-19 deaths. Kids can and do get very sick with COVID-19, and some experience serious complications, but it’s still very rare.
That said, unvaccinated children are most at risk for hospitalization (their odds tend to be at least twice that of vaccinated children), and with variants evolving so quickly, they still make up the bulk of those who go on to develop complications. Despite that, many parents have not gotten their 5- to 11-year-olds vaccinated even though they are eligible. (Fewer than 30 percent of kids aged 5 to 11 had their shots as of May 2022, compared to around 60 percent of kids aged 12 to 17.) Experts are expecting similarly low vaccination turnout for those ages 6 months to 5 years old.
There are also other factors at play. Tragically, Black and Hispanic children are disproportionately more likely to get the virus and to develop the rare, related condition known as multisystem inflammatory syndrome in children (MIS-C). In fact, they make up 57 percent of all MIS-C cases.
Babies under the age of 1 are typically at higher risk of developing severe symptoms when they contract the coronavirus, according to the Mayo Clinic. Parents with toddlers and young kids need to remember, though, that the virus does not discriminate, so it’s impossible to tell who will become really ill, or end up on a ventilator. COVID-19 prevention protocols should always be on your radar if your child has an underlying medical condition that puts them at higher risk such as congenital heart disease, obesity, chronic lung disease, diabetes, or sickle cell disease.
As noted, the coronavirus can lead to MIS-C, which resembles Kawasaki disease. Symptoms include fever, rash, abdominal pain, vomiting, diarrhea, bloodshot eyes, fatigue, and neck pain. As of May 2022, 8,210 children had developed MIS-C, and of those, 68 had died. Beyond that, evidence that children will experience any aftereffects of COVID-19 (what’s known as long-haul COVID) is fairly limited.
Why Is COVID-19 Less Likely to Be Severe in Children and Toddlers?
Since COVID-19 is still a relatively new disease, experts still don't know many things about it—including why children tend to experience milder symptoms. "We don't definitively know the reason," says K.C. Rondello, M.D., MPH, CEM, clinical associate professor at the College of Nursing and Public Health at Adelphi University. There are, however, a few theories from within the medical community.
Kids may have a different immune response
In terms of how children have fared with COVID-19 since the original virus from Wuhan, China, one theory is that children have better immune responses than adults, which may help them fight off the coronavirus that causes COVID-19. "Children's immune systems are not fully functional until later in their development. As a result, they have a considerably stronger and more robust immune response to pathogens than adults," explains Dr. Rondello. Many experts tentatively support the hypothesis, but there's also a hitch: COVID-19 seems to spare most infants even though their immune systems aren't fully formed yet.
Kids have fewer preexisting conditions than adults
"The death rate for COVID-19 is higher among individuals with certain pre-existing conditions, such as cardiovascular disease, diabetes, and cancer," says Aimee Ferraro, Ph.D., a professor of public health at Walden University. "This may help explain why many children seem to be at lower risk, since they are less likely to have these types of preexisting conditions."
Experts might not be identifying all pediatric COVID-19 cases
Robert Frenck, M.D., director of The Gamble Vaccine Research Center at Cincinnati Children’s Hospital, says that a reporting bias might be to blame. For a long time, children with mild or asymptomatic cases weren’t being tested for COVID-19, and there’s a chance that’s still going on, which means the coronavirus may be affecting more children than is being reported. This underreporting could have skewed our perceptions a great deal.
Kids could have "immunological cross-protection"
Studies show that children are far better than adults at mounting “robust, cross-reactive and sustained immune responses” to the coronavirus. According to Dr. Rondello, a number of different viruses can give you the common cold—including other milder coronaviruses. “Children get colds a lot, so they’re already being exposed to more benign, less intense coronaviruses. They could have potentially built immunity to them,” he says. Dr. Rondello calls this “immunological cross-protection.”
Note: No matter what’s behind the seemingly lowered risk for kids, as a group, they may be even more protected since the emergence of the Omicron variant in late 2021. In an April 2022 study from CDC researchers, blood samples suggested that 68 percent of kids aged 1 through 4 already had COVID-19, along with 77 percent of kids aged 5 through 11 and 74 percent of those aged 12 to 17. Omicron was so transmissible, apparently, that infections doubled in the youngest age group from December 2021 to February 2021 alone. The antibodies from previous exposure may also help defend some children against future variants.
My Child Has COVID-19 Symptoms, Now What?
Does your child have fever, cough, sore throat, runny nose, nausea, or other symptoms of COVID-19? Get them tested for COVID-19. Testing is the only definitive way to determine whether their symptoms are a result of COVID-19 or another condition.
Your child (and other members of the household) will need to quarantine until you receive the test results, which could be as quick as 15 minutes with an at-home antigen “rapid” test or as long as a couple of days with a molecular test like polymerase chain reaction (PCR) tests.
Then, they’ll need to isolate at home away from well family members if the test comes back positive. Give the sick person their own bedroom and bathroom, if possible, and take other preventive measures to contain the illness.
Seek medical help immediately if your child has difficulty breathing, chest pain, confusion, inability to stay awake, changing skin color (especially if the skin looks pale, blue, or gray), or other worrisome symptoms.
How to Prevent COVID-19 in Children
Like the cold and flu, the coronavirus that causes COVID-19 is a respiratory illness that spreads through contaminated droplets. These droplets enter the body through the eyes, nose, and mouth, says Miryam Wahrman, Ph.D., biology professor and director of the microbiology research lab at William Paterson University in Wayne, New Jersey, and author of The Hand Book: Surviving in a Germ-Filled World. The CDC says that airborne transmission is also possible.
Getting vaccinated is one of the most effective ways to prevent serious illnesses related to COVID-19. Other layers of protection—such as hand-washing and mask-wearing—are also important for families with young kids.
The CDC advises that parents make sure they and their kids over age 2 are wearing masks indoors in public settings where COVID-19 transmission level is high. If the children are unvaccinated, it's wise to have them wear masks and socially distance in areas of moderate transmission, too, or when in a crowded, poorly ventilated area. Adults and children alike should wash their hands before eating or touching their eyes, nose, or mouth, especially when in public. Hand sanitizer made with at least 60 percent alcohol works in a pinch, too.
Check the Centers for Disease Control and Prevention (CDC) website for up-to-date information on coronavirus statistics, COVID-19 news, and travel advisories.
