Coronavirus and children: The red flag symptoms to watch for

Children can contract the virus, but generally have milder symptoms and better outcomes

Any child with Covid-19 will need to be looked after at home and will be in isolation for 14 days. Photograph: Getty Images

Any child with Covid-19 will need to be looked after at home and will be in isolation for 14 days. Photograph: Getty Images

 

Like adults, children can of course contract coronavirus. However, the good news, if there is any to be gleaned from this global pandemic, is that children, generally, have much milder symptoms, much better prognosis, and deaths are extremely rare.

Covid-19 is, therefore, not an illness we need to fear in our children, and parents can be reassured that, while children can contract the virus, their symptoms tend to be very mild.

While data on the impact of Covid-19 on children is scarce, a recent systematic literature review of 45 scientific papers and letters on the virus – published up to March 18th, by researchers in Sweden, the UK and the US – showed that children have so far accounted for 1 to 5 per cent of diagnosed cases; they often “have milder disease than adults, and deaths have been extremely rare”.

The HSE website also has information and advice for parents on caring for children with Covid-19.

According to Prof Karina Butler, consultant paediatrician and infectious disease specialist at Children’s Health Ireland and clinical professor of paediatrics at UCD, 96 per cent of children who contract Covid-19 will have a very mild illness, some will have a more significant illness, and less than 0.2 per cent will have a critical illness.

The management of symptoms of Covid-19 in children was the same as for any other viral illness

The typical symptoms of the coronavirus in children are the same as in adults: a fever and cough. However, some children will also have more non-specific symptoms common in the more usual viral respiratory illnesses, such as a runny nose. Children may also have some gastrointestinal illnesses, such as diarrhoea and vomiting, but that is less frequent.

Prof Butler explained that, overall, children with the coronavirus “do very well”. And she advised that the management of symptoms of Covid-19 in children was the same as for any other viral illness and included paracetamol as the first-line treatment.

Red flag symptoms

Prof Butler also advised parents to watch out for red flag symptoms. These are signs that a child, for example, was having increased difficulty breathing, if they were having to work harder to breathe or were in-drawing their chest. Other signs to look out for would be lethargy and a child who is not drinking. Then they should seek medical advice. “All the usual things that they would normally think to ask a doctor about, those are the things that equally they should think to ask a doctor about in this era of Covid,” Prof Butler said.

“Not drinking more than eating because in a normal viral infection your appetite might go down a bit, but if you are not having good fluid intake, for the younger children always make sure they have liquids in and liquids out, so good, wet nappies as well. It’s really the same guidelines, the same principles as you would apply to any viral illness in children,” she added.

While Prof Butler said that there was some evidence from China suggesting that perhaps babies under the age of one were more susceptible to more severe symptoms of Covid-19 than older children, within that group in general it was very mild. “But the under-ones would be a group we probably pay a little bit more attention to,” she added.

“The management principles are the same as [with] any infant. If you are having persistent high fever, if you are coughing to the point where it is interfering with you being able to drink, if you are breathing so hard that you are in-drawing your chest, all of those things, if you are lethargic and not interested in doing things, they are all the things that we would always tell parents to get a medical opinion on a child who is suffering, and they should do it equally for those things in this time of Covid,” Prof Butler said.

Just because Covid is here doesn’t mean that all the other things that children normally get aren’t here

In relation to children who may be more susceptible to more severe illness if they contract Covid-19, Prof Butler said that while adults with type 2 diabetes were in the at-risk group, children with type 1 diabetes were not associated with any increased risk of severe disease if they contracted coronavirus.

“Type 1 diabetes isn’t associated with any higher risk of severe disease. That may be a reassurance for many parents,” she said.

The Ombudsman for Children has produced an informative guide on Coronavirus for children and young people, which is available at oco.ie.

Premature babies

The lack of data on Covid-19 in children makes it difficult to say for certain, but children with congenital heart disease and chronic lung disease, and premature babies with lung disease who are dependent on oxygen, would be among the groups of children that would be of concern.

Prof Butler said it was important to remind parents that children were still susceptible to all the usual childhood illnesses such as appendicitis, kidney infections and ordinary pneumonias, and the fear of Covid-19 should not deter them from seeking urgent medical care where appropriate.

“Just because Covid is here doesn’t mean that all the other things that children normally get aren’t here and so there is a little bit of concern that parents would be holding back from seeking medical attention when they would normally do it because they don’t want to bring their children to the emergency room. The emergency rooms are open for business in the sense that for all those normal things we don’t want to be missing things because people are holding back because they are afraid of Covid.”

There has been a lot of commentary online about young children being so called vectors of Covid-19; however, the evidence to date – albeit scant – suggests that children may not be the drivers of this disease.

While any parent will know that small children’s personal habits leave a lot to be desired, making them more prone to viral illnesses, Prof Butler advised that while household transmission rates of Covid-19 are high, it is more likely that a child will contract the coronavirus from a parent rather than the other way around.

So far it seems that while children get Covid-19, they may not transmit it as much as adults would do. This, however, may be subject to change as we learn more about this disease.

Still learning

According to Prof Butler, at present it is believed that children do not transmit Covid-19 as readily as adults, but, as coronavirus is such a new disease, there is so much more that we need to learn and are still learning about it. Therefore it is difficult to say this definitively.

This does not mean that a child will never transmit Covid-19 to an adult; therefore, adults who care for children with the coronavirus need to prevent further transmission within the household as much as they can. This includes regular hand-washing, deep cleaning of surfaces etc.

It is going to be very hard with toddlers to maintain the type of distance that one would need

Any child with Covid-19 will need to be looked after at home and will be in isolation for 14 days. All household contacts will also need to restrict their movements.

For older children, there are at least some ways to continue to connect with friends, through calls, messaging, video chats, and, perhaps, social media.
Even if they have symptoms of Covid-19, it is possibly for children to get outside and exercise if possible – while observing all the standard guidelines.
It’s important to remind them this will not last forever.

Prof Butler acknowledged that it was much easier to isolate a teenager than a toddler.

“It is going to be very hard with toddlers to maintain the type of distance that one would need, so you have to be practical,” she said.

While there are no guarantees, there are some practical ways of reducing the risk of transmission of Covid-19 with toddlers, such as giving cheek kisses rather than mouth kisses and not sharing any food utensils or cups etc with your child.

In conclusion, parents can be reassured that if their child contracts Covid-19, for the vast majority of cases it will be a very mild illness that can be managed at home. However, if your child is very unwell or displaying any of the red flag symptoms mentioned above or if you are worried about them in any way, it is important that you contact your GP or out-of-hours service. 

Read: How to keep children entertained at home

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