Coronavirus Disease 2019 (COVID-19) in Kids

Yes. Children of all ages can get sick with COVID-19. Though fewer children overall have been sick with COVID-19 compared to adults, kids can be infected, get sick and spread the coronavirus to other people.

Yes. Just like adults, children without symptoms of COVID-19 can still spread the virus to others. This is called asymptomatic spread.

There is still a lot we do not know about COVID-19. Based on current medical research, babies under 1 year old might be more likely to have severe illness from COVID-19. Children with certain underlying medical conditions like asthma, chronic lung disease, diabetes, weakened immune systems, heart disease since birth and obesity might also be at increased risk compared to other children.

Current evidence from scientific studies shows that some people with underlying medical conditions are or could be at greater risk of severe illness from COVID-19.

Increased risk

When compared to other children, kids with the following conditions might be at an increased risk for severe illness from COVID-19:

• Multiple chronic conditions that affect several parts of the body
• Neurologic, genetic or metabolic conditions
• Congenital heart disease

People of all ages – including kids – with the following underlying medical conditions are at increased risk of severe illness from COVID-19:

• Cancer
• Chronic kidney disease
• Immunocompromised state (weakened immune system) from solid organ transplant
• Obesity
• Serious heart conditions, such as heart failure, coronary artery disease or cardiomyopathies
• Sickle cell disease
• Type 2 diabetes

Possible increased risk

People of all ages with the following conditions might be at an increased risk for severe illness from COVID-19:

• Asthma (moderate-to-severe)
• Chronic lung disease
• Cystic fibrosis
• High blood pressure
• Weakened immune system from blood or bone marrow transplant, immune deficiencies, HIV or use of immune-weakening medicines
• Neurologic conditions
• Liver disease
• Pregnancy
• Smoking
• Thalassemia (a type of blood disorder)
• Type 1 diabetes
• Vaping

Learn more about COVID-19 in children and teens from the CDC.

Scientists are learning more about how SARS-CoV-2 spreads between people. It spreads most commonly during close contact. The latest evidence shows that:

• COVID-19 can spread through respiratory droplets, such as saliva and mucus, when people cough, sneeze, breathe, talk, sing and shout. These droplets can land on others or on surfaces. The virus can infect others if it comes into contact with their eyes, nose or mouth.
• Less commonly, COVID-19 can also be spread through airborne transmission, which occurs when tiny respiratory droplets are able to linger in the air for minutes to hours due to poor ventilation. Current science shows that airborne transmission is less common than close contact, but it’s an important consideration for small or indoor public spaces with less air flow.

Learn more about how COVID-19 spreads from the CDC.

Remember, kids can spread the virus, even if they do not have symptoms. This is why it’s important for everyone – including children and teens – to follow public health guidelines like cleaning hands frequently, wearing cloth face coverings (with some exceptions like babies and toddlers), and physical distancing whenever possible. Each of these methods offers some but not complete protection. This is why it’s important for families to use these methods together to protect themselves and others from COVID-19.

There are several steps parents and families can take to help prevent children (and everyone) from getting COVID-19. Use all of the following methods to protect your family and decrease the spread of COVID-19:

1. Wash your hands frequently and thoroughly, especially after interacting with others.
2. Wear a cloth face covering when you are around others you don’t live with or when you’re out in public.
3. Keep a minimum of 6 feet away from others you don’t live with (referred to as social distancing or physical distancing).
4. Stay at home when you feel sick (and keep your kids home when they feel sick, too).
5. If you or your child gets sick, get tested.
6. Avoid large gatherings and, when possible, socialize outside, not inside.

Remember, there’s no way to eliminate all risk, but there are simple and effective steps we can all take to protect each other and limit the spread of COVID-19 within our neighborhoods and communities. Practicing these public health measures isn’t just about protecting yourself and your family – it’s about protecting the most vulnerable people in our community.

Of course, life doesn’t stop, even during a pandemic. Going out and socializing with others is important for our economy and mental health. When you need to (or want to) leave your home, consult this helpful risk vs. benefit guide from the Colorado Department of Public Health and Environment (CDPHE) to help you understand the level of risk presented by different social activities, from camping to concerts.

The most common symptoms of COVID-19 in children are:

• Fever
• Dry cough
• Tiredness (fatigue)

Some patients with COVID-19 also experience the following symptoms:

• New loss of smell and/or taste
• Aches and pains
• Headache
• Sore throat
• Congestion or runny nose
• Nausea or vomiting
• Diarrhea
• Rash on the skin and/or discoloration of the fingers or toes
• Shortness of breath (feeling like you can’t take a full breath)

Most children with COVID-19 have mild symptoms and some have no symptoms at all. Some children can get severely sick from COVID-19. If your child has an underlying medical condition that may put them at higher risk, call their doctor as soon as you notice symptoms.

The symptoms of COVID-19 are similar in kids and adults. However, young children may have trouble explaining their symptoms. For example, it may be hard for a child to explain that they cannot taste or smell. Instead, they may say that their food doesn’t taste good or that it tastes funny.

People develop symptoms 2 to 14 days after they are exposed to COVID-19. The average time it takes to develop symptoms is 5 days. This is called the coronavirus incubation period, or the time from when a person is exposed to when they have symptoms.

Most children who have COVID-19 will not become seriously ill. However, whether or not you think it could be COVID-19, you should call 911 or go to the emergency room if you notice any of the following serious symptoms:

• Trouble breathing
• Persistent (ongoing) pain or pressure in the chest
• New confusion
• Inability to wake up or stay awake
• Bluish lips or face

Important: Do not delay getting emergency care for your child because you are worried about possible spread of COVID-19. Emergency departments, including at Children’s Colorado, have infection prevention plans to protect you and your child from getting sick with COVID-19 if your child needs emergency care.

There are several types of COVID-19 tests now available. A viral test called polymerase chain reaction (PCR) is considered the best method or “gold standard” for detecting an acute (active) COVID-19 infection. If your child receives a positive PCR test, it means your child has an active COVID-19 infection and can spread the virus to others.

What parents and caregivers should know about COVID-19 testing

Though there are several types of COVID-19 tests now available, such as rapid tests or saliva tests, each varies in terms of accuracy and its ability to detect negative and positive results. Some tests are faster, but they are also more likely to miss detecting the virus. This can create a false negative, meaning the person has the virus but received an incorrect result.

Use the table below to learn about the different types of COVID-19 tests, the pros and cons and what to do based on your child’s test result. If you have questions about the accuracy of a specific test, you should ask your doctor.

Test type	How the test is taken	What the test looks for	Pros	Cons	What a positive result means	What a negative result means
Polymerase chain reaction (PCR) test	Nasopharyngeal swab (or similar swab from the nose) to collect samples from the respiratory system	The PCR test looks for small amounts of genetic material (viral nucleic acid RNA) from SARS-CoV-2.	More sensitive, meaning it’s less likely to miss the virus and get a false-negative result	Slower results	A positive PCR test means your child has an active COVID-19 infection and can spread the virus to others. What to do: Isolate your child from others and follow isolation guidelines for 10 days after symptoms first appeared. Keep an eye on your child’s symptoms and consult with their doctor. Inform close contacts of your child’s positive test so they can quarantine for 14 days.	A negative PCR test means that it’s highly unlikely that your child currently has COVID-19. What to do: Continue taking steps to prevent the spread of COVID-19.
Rapid point-of-care testing (antigen test or PCR test)	Nasal or oral swabs or saliva to collect samples from the respiratory system	Rapid antigen tests look for proteins from the SARS-CoV-2 virus. Rapid PCR tests look for small amounts of genetic material (viral nucleic acid RNA) from SARS-CoV-2.	Quicker results Available in “point-of-care” settings, like the doctor’s office Rapid testing can help quickly screen a group to identify who should be isolated (though it may miss some cases of COVID-19).	Rapid tests are less sensitive, meaning there’s a higher chance of getting a false negative.	A positive rapid test means that your child has an active COVID-19 infection and can spread the virus to others. What to do: Isolate your child from others and follow isolation guidelines for 10 days after symptoms first appeared. Keep an eye on your child’s symptoms and consult with their doctor. Inform close contacts of your child’s positive test so they can quarantine for 14 days.	A negative rapid test means that it’s still possible your child has a COVID-19 infection and can spread the virus to others. What to do: If your child has symptoms, work with your doctor to get a PCR test to be sure. Continue taking steps to prevent the spread of COVID-19.
Antibody test	Blood test	This test looks for SARS-CoV-2 antibodies, proteins in your blood that your immune system makes when it is fighting off a COVID-19 infection.	This test can tell doctors whether your child had COVID-19 in the past, even if they did not show symptoms.	This test cannot determine whether your child has an active COVID-19 infection. This test is not 100% accurate, and a negative result does not necessarily mean they have not had a COVID-19 infection.	A positive antibody test means your child had a COVID-19 infection in the past. What to do: Continue taking steps to prevent the spread of COVID-19. Recent data suggest that it is possible to get a second infection; a positive antibody test does not mean your child is immune.	A negative antibody test could mean several things: Your child has not been infected with COVID-19 previously. Your child had COVID-19 in the past but did not develop or has not yet developed detectable antibodies. The result may be wrong, known as a false negative. What to do: Continue taking steps to prevent the spread of COVID-19.

Remember: We do not fully understand the new coronavirus. Having COVID-19 in the past does not mean your child is protected from another infection. Though rare, there have been several confirmed reports of reinfection. Scientists are still learning about the virus and how it affects people.

For the most accurate results, look for COVID-19 testing that meets the following criteria:

• Viral PCR testing
• Done in a hospital or public health department laboratory
• Tested on a sample collected via nasopharyngeal swab (where the nasal passages and throat meet)

Children’s Colorado performs PCR testing to diagnose COVID-19. A PCR test involves swabbing the inside of the nose where it meets the throat to determine whether the person has live virus in their body. Most coronavirus testing takes place at drive-through testing sites that allow lab workers to take samples with a swab through the car window. This helps keep everyone safe by limiting interactions between people who may be sick with the healthy workers.

In some cases, your child’s doctor may be able to take a sample in the doctor’s office. This is typically available when your child already has an appointment.

Children’s Colorado makes an extra effort to make coronavirus testing as comfortable and easy as possible for kids and families. Learn how and what to expect during coronavirus testing for kids.

If your child’s doctor suspects they may have COVID-19, they will order a viral test. Typically, this is the PCR test explained above, though rapid tests may also be available. At Children’s Colorado, our Pathology and Lab Services use the gold standard of PCR testing to diagnose an active COVID-19 infection.

We offer viral PCR testing and antibody testing for COVID-19 at multiple locations in the Denver Metro and Colorado Springs areas. Learn where and how to get a coronavirus test for your child and find more frequently asked questions about testing.

Coronavirus treatment depends on the severity of the illness. Most children who have COVID-19 tend to have mild symptoms that can be managed at home.

Treating kids with mild symptoms of COVID-19

If you or your child tests positive for COVID-19, treatment is focused on relieving symptoms. This includes:

• Getting lots of rest
• Taking acetaminophen (Tylenol) for any fever or achiness
• For children over 4, managing any cough or runny nose with cold medication
• Staying hydrated by drinking lots of clear fluids, like water

Call your child’s doctor if they experience any shortness of breath, seem to be getting worse or are not getting better within a few days.

Be sure to follow the CDC’s guidelines for caring for someone sick at home and when your child can be around others after they have had or likely had COVID-19.

Treating kids with more severe cases of COVID-19

Some children will develop more concerning cases of COVID-19, though this is relatively rare. Current science shows that approximately 1% to 2% of children who have COVID-19 will require hospitalization. Of those cases, about 1% of hospitalized kids will need critical care in an intensive care unit (ICU).

Treatment is available for kids and teens who have more serious cases of COVID-19. Treatment options include:

• Dexamethasone (a drug called a corticosteroid that can help decrease inflammation or swelling in the body)
• Remdesivir (a new antiviral)

Though pediatric studies on these treatments are not yet available, dexamethasone and remdesivir have helped adults with COVID-19. Doctors are also studying convalescent serum, a blood product from plasma donors who have recovered from COVID-19, as a potential promising treatment for COVID-19.

A small number of children who had COVID-19 have gone on to develop a new inflammatory syndrome. This is called multisystem inflammatory syndrome in children associated with COVID-19, or MIS-C. Though MIS-C is rare, it is serious.

Yes. Children’s Colorado is here for all kids. That was true before the COVID-19 pandemic and it’s true today. Doctors in our Infectious Disease Program are experts in treating infectious conditions in children, including COVID-19.

Non-urgent care

If you believe your child needs attention for possible COVID-19, first call their pediatrician. If you do not have a pediatrician, you can call our ParentSmart Healthline at 720-777-0123 for advice from a pediatric nurse. This service is free and available 24/7.

Urgent or emergency care

Children’s Colorado also offers pediatric urgent and emergency care at several locations. Learn more about our urgent and emergency care and how to decide when to go where. If you believe your child is experiencing a life-threatening emergency, always call 911.

If you do go to urgent care or an emergency room for possible COVID-19, remember to:

• Call ahead;
• Tell the team about your symptoms as soon as you arrive; or
• Share your test results (if known)

This will help keep all patients and health workers safe.

Getting medical care during the pandemic

At Children’s Colorado, keeping patients safe is our top priority. Learn about the many precautions we’ve put in place to keep patients and families safe during the pandemic. Or find our coronavirus resources for families, all in one place.

In May 2020, many countries that had an outbreak of COVID-19 began reporting an inflammatory syndrome in some children. This is now called multisystem inflammatory syndrome in children, or MIS-C for short.

MIS-C is a condition in which different body parts can become inflamed (swollen) including the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs. MIS-C shares some clinical symptoms seen in Kawasaki disease, an illness that is most common in young children.

The most prominent symptoms of this inflammatory syndrome associated with the coronavirus are prolonged high fever and gastrointestinal symptoms such as abdominal pain, diarrhea and vomiting. Children may also develop a rash or red eyes.

We do not yet know what causes MIS-C. However, we know that many children with MIS-C had the virus that causes COVID-19, or had been around someone with COVID-19.

MIS-C can be serious, even deadly, but most children who were diagnosed with this condition have gotten better with medical care.

Children’s Colorado has seen several cases of MIS-C. Fortunately, parents can be reassured that MIS-C is rare in kids and there are existing treatments that have been successful in making kids better.

Common symptoms of MIS-C include:

• Fever
• Severe abdominal pain
• Vomiting
• Diarrhea
• Rash
• Red eyes, red lips
• Trouble breathing
• Seeming confused/sleepy

Doctors may do certain tests to look for signs of inflammation or other health problems. These tests could include:

• Blood tests
• Chest X-ray
• Heart ultrasound (echocardiogram)
• Abdominal imaging, like an ultrasound or computed tomography (CT) scan

Doctors may provide supportive care for symptoms (medicine and/or fluids to make your child feel better) and may use immune globulin (IVIG), steroids or other medications that strengthen the immune system that are used for Kawasaki disease and toxic shock syndrome. Fortunately, most children have responded well to those treatments.

Most children who become ill with MIS-C will need to be treated in the hospital. Some will need to be treated in the Pediatric Intensive Care Unit (PICU).

The best way to prevent MIS-C is to avoid exposure to COVID-19. If your child has had a COVID-19 infection or been around someone who has, keep in mind that this inflammatory syndrome is rare and there is no need to panic. Keep an eye out for symptoms and call your child’s doctor if you have concerns.

Stay in touch with your child’s doctor and contact them right away if your child is showing symptoms of MIS-C.

When to go to the emergency room

Get emergency care right away if your child is showing any of these emergency warning signs, which could signal MIS-C or another serious condition:

• Trouble breathing
• Pain or pressure in the chest that does not go away
• New confusion
• Inability to wake or stay awake
• Bluish lips or face
• Severe abdominal pain

COVID-19 is a new condition, and we’re learning more about it as additional scientific evidence becomes available every day. This means that health guidance may change as we learn more about how the coronavirus spreads and how to treat it.

We will update this webpage regularly as we learn more about COVID-19 and its impact on children and teens. We also recommend the following trusted resources for additional information on the COVID-19 pandemic.

• Centers for Disease Control and Prevention (CDC): Information and resources from the public health authority in the U.S.
• Colorado Department of Public Health and Environment (CDPHE): COVID-19 resources from Colorado’s health department
• HealthyChildren.org: Resources for parents from the from the American Academy of Pediatrics (AAP)
• World Health Organization (WHO): Information for the public from the global health authority

Though influenza (flu) and COVID-19 are both contagious respiratory illnesses, they are caused by different viruses. COVID-19 is caused by infection with a new coronavirus (SARS-CoV-2) and the flu is caused by infection with influenza viruses. There are several seasonal influenza viruses, and they circulate each year during what we call flu season.

Because some of the symptoms of the flu and COVID-19 are similar, it may be hard to tell the difference between them based on symptoms alone, and testing may be needed to help confirm a diagnosis. If you think your child has the flu or COVID-19, the best thing to do is call your child’s doctor to ask whether your child should be tested.

The CDC explains the key differences between COVID-19 and the flu.

Fortunately, most kids and teens who have COVID-19 fully recover from it within 14 days of their first symptoms.

Though there have been some reports of cases where symptoms last for several weeks or months following infection, this is uncommon. Doctors and scientists are beginning to study this.

If your child had a suspected or confirmed case of COVID-19, you should keep an eye on them for several weeks to make sure they are feeling better and that their symptoms improve and go away over time. Be sure to watch for any symptoms of MIS-C. Though MIS-C is rare, you should be aware of it and keep in touch with your child’s doctor if you have concerns.

In general, your child should remain in isolation until 10 days after their positive COVID-19 test.

Advice for parents of young athletes

If your child participates in competitive sports or vigorous exercise, we recommend checking in with their doctor before they return to sports and play. Their pediatrician can give them an exam to ensure that your child does not have lingering symptoms and is ready for exercise.

Generally, if your child has had confirmed or suspected COVID-19 they should wait at least 14 days after their symptoms appeared before returning to sports or vigorous exercise. This is because your child could still be contagious and may spread the coronavirus to teammates or others. It may also take up to two weeks for some symptoms to appear.

There have been reports of myocarditis (the swelling of the heart muscle) and sudden cardiac arrest in some competitive athletes who have had COVID-19. When the heart muscle is inflamed, there is a higher risk for the heart to work abnormally and to have an irregular heartbeat. Though this is unsettling, parents should not panic.

We are still learning about COVID-19 in kids and its potential effects on the heart. While there is evidence that COVID-19 impacts the heart in some adults, we need additional studies and data before we understand how the disease may affect the cardiovascular system in children and teens.

We recommend having your child checked out by their pediatrician before returning to sports if they are a competitive athlete and meet any of the following criteria:

• Over age 12
• Have a history of heart problems, including heart murmurs or high blood pressure
• Had a severe case of COVID-19 or had to be hospitalized
• Had MIS-C
• Have symptoms of pain or tightness in their chest, fainting or tiring very easily during exercise

Their pediatrician will perform a sports physical and can refer them to a pediatric cardiologist, if needed.

There is some disagreement between pediatricians about whether the return-to-play guidelines following COVID-19 infection are overly cautious. At Children’s Colorado, pediatric cardiologists in our Heart Institute recommend remaining cautious until additional scientific studies are available and we know more about the risks. Please speak with your child’s pediatrician to learn about your child’s individual risk and if they should receive a checkup.