alt="Doctors at Data4Life" width="32" height="32" />Doctors at Data4Life 6. January 2022 Estimated Reading Time 9 min.
Children are not "little adults. Anyone who has children, works with children, or regularly encounters them in everyday life knows this all too well. Especially when living with Corona, this knowledge is more important than ever. Here we provide an overview of symptoms, progression and complications in children, as well as how best to manage everyday life at times of corona.
1. Risk of infection in children
1.1. Frequency of contagions
Children can also be infected with the coronavirus (SARS-CoV-2). Because young children and adolescents often develop milder symptoms than adults, the risk of infection is often underestimated. This is because children are less likely to have severe pre-existing conditions that put additional stress on their bodies when they are infected with Corona [1].
Nevertheless, because children carry the virus, are less able to adhere to the measures, and often have close contact with each other, there may be widespread spread of the virus by and among children [2, 3].
Whether a child has symptoms or not is not the issue: even children with few symptoms have a similar amount of virus in their nose and throat as symptomatic adults [4].
So the conclusion remains: children can catch the disease from adults as well as from other children – even if the person himself had no symptoms [3, 4].
1.2. Transmission from children to others
Just as children can spread coronavirus to each other, transmission to adults is also possible – and regardless of symptoms. Thus, studies have shown both that children spread the coronavirus in facilities such as daycare centers, daycare centers, or schools and at home among relatives [4].
Nevertheless, children are not "super-spreaders" – contrary to what was assumed at the beginning of the pandemic – as can be the case, for example, with flu outbreaks. According to this, especially in children under 14 years of age, onward transmission is possible but by no means more frequent than in adolescents or adults [5].
It has also been shown that area-wide school and daycare closures were of secondary importance compared with general distance and hygiene regulations [5].
In addition, consistently applied protection concepts such as the wearing of masks or clear subdivisions of individual groups in educational institutions showed effect [4].
The risk of transmission can thus also be noticeably reduced in children with the help of measures adapted to their age [4].
1.3. Measures against infection in everyday life
One of the best measures to protect oneself and children from infection is to ensure plenty of fresh air. This is because the virus can persist indoors for long periods in the form of tiny particles known as aerosols. Regular ventilation with windows wide open can significantly reduce the risk of infection. In doing so, shock ventilation should be performed approximately every 20 minutes [6].
How long one should carry out this "shock ventilation" depends on the time of year. In summer, shock ventilation should be carried out for 20 to 30 minutes. In winter, periods of 5 to 10 minutes of airing at a time are often sufficient. Children should wear sufficiently warm clothing. If it is possible to open several opposite windows at the same time, the air exchange can of course be accelerated considerably. If many people are staying in a confined space at the same time, consideration should be given to ventilating for the entire duration [7].
In schools and similar institutions, it is recommended to ventilate at every break – but in any case at least every 45 minutes. It is also advisable to ventilate during the lesson. In addition, all indoor rooms should generally be ventilated immediately if someone has to cough or sneeze repeatedly. All other measures – distance, hygiene and respiratory masks – work much better if sufficient fresh air has already been provided indoors [8].
How well further measures can be implemented depends, of course, strongly on the age and motivation of the child. Whenever possible, therefore, care should be taken to ensure that the "AHA rules" are observed in children as well. These consist of keeping a distance ("A") of at least 1.5 meters, regular hygiene measures ("H"), and wearing an everyday mask ("A") that covers the mouth and nose [4, 8].
However, especially in very young children, implementing these measures can be difficult and then requires consideration. However, regular and correct hand washing with soap, thorough cleaning of frequently used surfaces, and keeping contact with others to a minimum necessary for everyday life is highly advisable and usually easy to implement [8, 9].
1.4. Measures against transmission in case of infection
Children who have been infected should stay away from daycare, school or other appointments. The same also applies if an infection is suspected until testing has ruled it out [8, 9].
Due to the often mild or even asymptomatic course of corona infection in children, it is often difficult to detect the disease early and to prevent transmission to others. In addition to the generally sensible everyday measures such as the AHA rules and ventilation, you can pay attention to the following things [1]:
- Keep a daily eye out for the symptoms listed below (see 2.1) Lookout.
- Keep track of who a child comes into contact with on a daily basis.
- Keep a diary listing all encounters in a confined space. This may make it much easier for health departments to follow chains of infection later on.
- If a child’s relatives or the child itself becomes ill, school and the appropriate health department must be notified immediately.
In addition, contact between children and people with pre-existing diseases, especially the elderly, should always be reconsidered. As soon as there is even a slight suspicion of a possible risk of infection in the child, these encounters should absolutely be avoided [1].
2. COVID-19 course in children
2.1. Typical symptoms
After all, one fifth to one third of all children have no symptoms at all in corona infection. COVID-19 also tends to be milder in children, although severe cases do occur. Symptoms last an average of 6 days and usually resolve completely within 4 weeks at the latest [5, 10].
Similar to adults, fever and cough are among the most common symptoms. However, the frequency depends strongly on the age of the child [5, 10-15]:
Frequency of COVID-19 symptoms in children and adults comp.
2.2. Signs of a severe infection
Most cases of coronavirus infection in children are asymptomatic or mild. Symptoms usually resolve within 1 to 2 weeks [16].
If the course of the disease is severe, it is often due to the presence of an underlying disease in the child that existed before the infection. These may involve lung disease, diabetes, existing heart defects, a weakened immune system, pre-existing genetic conditions, severe obesity, and other underlying conditions [5, 16].
Pre-existing treatment that affects the child’s immune system may also be a reason for a severe course [16].
If a child shows clear signs of illness such as fever, cough, sore throat or earache, severe abdominal pain, vomiting, diarrhea, or an unclear skin rash, it is essential to avoid daycare or school and contact a physician instead [5].
Symptoms such as increasing difficulty breathing, persistent chest pain, or. -Tight, confusion, extreme and unusual sleepiness, bluish lips, and severe abdominal pain may be signs of severe corona infection and are reasons to bring the child to an emergency department immediately [5].
Fortunately, severe courses and deaths from corona infection in children are extremely rare [5, 16].
2.3. Delta variant in children
It is now known from analyses that with the prevalence of the delta variant (B.1.617.2) the number of infected children requiring hospitalization due to COVID-19 has increased [10].
This may be due to a greater spread and transmissibility of this viral mutation. It is currently uncertain whether the delta variant also leads to severe courses in children, such as that seen with Pregnant women has already been demonstrated [10].
2.4 Complications and long-term consequences
COVID-19 complications in children are extremely rare and are the absolute exception. These include, on the one hand, a pronounced pneumonia, which – similar to adults – may require ventilation in the course of the disease [5, 10].
Another extremely rare complication is the so-called "Multisystem inflammatory Syndrome in Children" or "MIS-C" for short. This is an overreaction of the immune system with fever and organ involvement 2 to 6 weeks after infection [5, 10].
However, probably the most common late sequelae of corona infection in children is Long COVID. As a completely new clinical picture, however, further research is needed in order to be able to make more precise statements in the future [5, 10].
A summary of the evidence base to date on Long COVID in children can be found here.
However, the fact that more and more children are being made eligible for vaccination against COVID-19 is decidedly good news, and will further reduce the risk to children in the future. For parents who are still ambivalent, offers following article an intellectual starting point [17|.
It may also be helpful to take a closer look at the psychological stress on children during the Corona pandemic. You can find more information about this here.
The contents of this article reflect the current, scientific status at the time of publication and were written to the best of our knowledge and belief. Nevertheless, the article cannot replace medical advice and diagnosis. If you have any questions, contact your general practitioner.