COVID in Kids- what you need to know

Yes, kids can and do and will get COVID-19.  There has been a lot of opinion, worry, and talk regarding what exactly COVID-19 “is” in our pediatric population.  I have put together some information gathered from articles, lectures, podcasts, etc. and laid it out below.  There are number of resources if you are interested in diving deeper, but this serves as a solid foundation of what you need to know as a parent as we navigate this novel virus (“novel” refers to a disease not previously identified in humans).

1. Yes, kids get COVID, but it is generally not nearly as severe as what we have seen in adults. This is especially true in school age and younger, meaning the teenagers may have  more severe symptons/courses.
2. In general, epidemiologist have noted even with high exposure kids tend to show few to no symptoms and are less likely to get infected (as compared to adults).
3. For the most part, kids COVID-19 symptoms present as typical upper respiratory tract viral infection.  Helping them navigate this “cold” is done in the same way as every other time your kid presents with cough and runny nose (and maybe fever).  Make sure to read-on as I will discuss other symptoms to pay closer attention to as a parent.
4. There are a few different hypotheses as to why kids are not presenting with the same severity of symptoms as adults.  Here are a few that have been floating around:
   1. Kids have few ACE-2 receptors [side note: the spike protein you have been hearing so much about…this is what the mRNA vaccine is modeled after….ok so the COVID-19 virus attaches to the spike protein which then attaches to an ACE 2 receptor.  This “opens the door” to the cell and allows the virus “in”.  So less ACE 2 receptors – potentially less “doors” to let the virus “in”]
   1. Kids have a ramped up immune response because they are young, exposed often to viruses in school/daycare settings.  They also get more sleep and are theoretically less stressed – creating a better chance at having a good immune system/response. With the increased ability to create an immune response the secondary cascade that is happening in adults causing massive tissue damage to lungs and other organs – is not happening in kids because it is being shut down by the immune system before this can happen.
5. MIS-C (Multisystem Inflammatory Syndrome in Children) is a scary and happening.  HOWEVER, only about 0.1% of kids with COVID will develop this syndrome (perhaps even less now).  The syndrome presents like Kawasaki disease (high fever, rash, bloodshot eyes) – but is notably different in that there are often if not always GI symptoms.  The younger kids (less than school age) seem to present more like Kawasaki than the older school age kids.  Either way, simple testing at any hospital can differentiate between Kawasaki and COVID-19.  WHAT YOU NEED TO KNOW: If your kid develops symptoms of belly pain, vomiting, diarrhea, AND it gets continually worse instead of better – go to the ER.  It is not uncommon for kids or adults to have these symptoms with COVID, but they should progressively get better not worse.  If you bring you kid to the hospital, they can easily assess for MIS-C and treatment early-on is VERY VERY VERY VERY successful.  Testing usually includes blood and urine sampling (looking for inflammatory markers) and possibly cardiac echo and abdominal ultrasound.  Once MIS-C is identified, kids are treated with a course of IVIg and steroids.  The IVIg (intravenous immunoglobulin) is used to treat the massive inflammatory response and the steroids work on the inflammatory pathways as well. In combination, this treatment for MIS-C is highly effective and kids return to baseline quickly.
6. “COVID toes” are a thing.  There have been many sequala noted after people have been infected with COVID-19, one is “COVID toes”.  This particular sequala presents as lesions on the toes. There have also been many reports of iritis, or an inflamed colored ring around the iris in eye.  These are aside from the many pulmonary sequala noted in adult patients, which are still being uncovered and investigated.
7. Breastfeeding is OK.  There have been NO reports of COVID-19 being passed in breast milk. The recommendation is to continue breastfeeding even if the mother is COVID-19+, but to wear a facemask and remain socially distance from the baby as much as possible (outside of feeding times- at which time a mask should be worn).
8. When can kids gets get the vaccine? At this point Moderna and Johnson & Johnson are approved for 18 years old and up.  Pfizer is approved for 16 years old and up.  Both Moderna and Pfizer are well underway with trialing the vaccines in kids 12 years old and up. If the trials are successful, the results will be presented the FDA for approval of use in the general population.  Johnson & Johnson has announced it will trial its vaccine in infants, they will also present findings to the FDA for approval and use in the general population.
9. Vaccines….while we are on this topic.  I will write a separate post regarding vaccines but as a plug for the newest kid on the block (J & J) – if it is the option offered to you – get it.  The trials showed if you received the J & J vaccine that NO ONE in the trial died of COVID-19 if they received the vaccine.  Again, this vaccine can and will save lives.  The same can be said of Pfizer and Moderna (but there seems to be a lot of skepticism around J & J for some reason).  Modern/Pfizer use mRNA and J & J uses DNA to deliver the vaccine – but the bottom line is that both are effective, and everyone should be lined up, shirt sleeve rolled-up, and ready to receive the vaccine the second they are eligible.