By now, we know Coronavirus disease 2019 (COVID-19) is a respiratory illness that can spread from person to person. While the situation is swiftly evolving, and experts are learning more daily, concerns about the younger population may still be weighing on parents’ minds.
For reasons that nobody fully understands, COVID-19 does not appear to cause severe disease in previously healthy children. “The first, and most likely scenario, is that children are contracting COVID-19 but are getting a milder version of the disease,” says Thomas Murray, MD, PhD, a Yale Medicine pediatric infectious disease specialist and associate medical director for infection prevention at Yale New Haven Children's Hospital.
Other possibilities: they’re not being exposed, or they’re exposed and don’t contract infection. “Given how quickly it circulates and what we know about other respiratory viruses in children, this is unlikely,” says Dr. Murray. Based on what’s known, it appears children contract COVID-19 — but present a milder disease.
The disease seems to be more severe in older adults and those with underlying health problems and there are fewer hospitalizations in children compared with adults.
Still, parents want to be informed and take precautions where possible. Below are answers to questions parents might have about COVID-19 and how it affects children.
What preventative measures should parents practice with their kids?
"Wash your hands, wash your hands, and then wash your hands," says Dr. Murray. "Kids like to touch their face. Your nose, mouth, and eyes are all portals of entry for viruses into your body.” Frequent hand washing, especially with toddlers and kids who are in daycare, is important.
Keep kids away from people who are sick, especially if they have respiratory symptoms. For COVID-19, one of the most important things for containment is to isolate people who have the virus. And this is especially true for keeping sick kids away from elderly and people with underlying medical conditions. If you have a child with a respiratory illness who has frequent contact with elderly grandparents or caregivers, try to separate them until the child is feeling better — kids can be reservoirs for respiratory illness. This is important as older people and those with underlying diseases are at risk for more severe illness.
"Sometimes, younger healthy people can get sick enough to require hospitalization so if a child has respiratory symptoms, we should isolate them as best we can," says Dr. Murray. Keeping to groups of less than 10 is recommended across the board (the American Academy of Pediatrics has advised against playdates and close contact with other children).
While it’s not clear yet how much COVID-19 is transmitted from surfaces, we know other respiratory viruses can be. “We recommend cleaning surface areas with products that are documented disinfectants, like Lysol, or bleach-based products for surfaces that can handle bleach,” says Dr. Murray.
When should a parent call the doctor?
Call your provider, or the Yale COVID hot line at 203-688-1700, if you know you have been exposed to someone who has contracted COVID-19, or if you have symptoms of COVID-19 such as a fever, cough, respiratory symptoms, diarrhea, vomiting, sore throat, and shortness of breath.
“You don’t have to call your pediatrician for minor illness because it could be any number of viruses,” says Dr. Murray. “Again, the virus appears to be mild in children, and there are no available therapies today. Care for the infection is directed toward the symptoms: Tylenol, ibuprofen, and hydration with fluids, like chicken soup.”
Providers urge families to avoid the emergency room unless their child genuinely requires emergency care. Testing is still not widely available for COVID-19; coming to the hospital just to get tested is not recommended. This will also help keep emergency services available for the children who really need them and protect children who are most at-risk. Testing availability may increase and YNHH.org has the most updated information on testing availability.
Start with your regular pediatrician or PCP and only bring your child to the emergency room if they require emergency care.
Are there additional protective measures for children with chronic pulmonary or respiratory illness, like cystic fibrosis?
Based on the CDC’s guidance for people who are at higher risk, it's recommended that people with chronic respiratory illness and those who are immunocompromised not attend any large gathering and stay home as much as possible.
When in public, the six feet rule of social distancing is another way to avoid getting sick. If your child has an underlying health problem and has symptoms worrisome for COVID-19, please call your provider for additional recommendations.
What should we logically prepare for?
“It’s a moving target,” says Dr. Murray. If you do contract COVID-19 or are exposed to a diagnosed patient, be prepared to be quarantined for 14 days — so have enough household supplies to keep you stocked for two weeks. There is a possibility schools may be closed until the fall.
“Here [at YNHH], we have been preparing for this. We’re hopeful that our preparation can help contain the illness and provide outstanding care for any affected children that require hospitalization,” says Dr. Murray.
How can we reasonably practice social distancing with family?
"We understand social distancing is not realistic between a caregiver and a young child or young siblings," says. Dr. Murray. However, the family unit can social distance by limiting close interactions with anyone outside of those living in the house. And sick household members should try to isolate to one part of the house when possible (a sick child with one primary caregiver who also isolates with the child, for example).
Visiting extended family or at-risk grandparents after isolation of 14 days or more and without symptoms should be carefully considered — weighing the risks and the benefits.
"This is a great time for grandparents to learn about FaceTime and other video interfacing programs that allow for high quality remote social interactions," Dr. Murray says.
Getting out of the house when the weather permits and going for walks helps, and if you meet up with friends, ensure proper social distancing is maintained and the children stay apart.
Prepare, don’t panic. There is now widespread disease, and even if it’s mild in your child, we are trying to prevent the spread of disease so that our hospitals are not overwhelmed with sick patients who all require the same resources at the same time — like we’re starting to see in New York.
“Just be vigilant. Wash your hands. For children, it’s primarily about containment, not seriousness of disease,” says Dr. Murray. “The majority of healthy young people who are getting sick from this virus are experiencing a mild to moderate illness.”
Sick children should avoid older adults to prevent spread of disease to the most at risk population.
Information is rapidly changing. Please check back to the resources below frequently for up to date information about COVID-19.
For more information:
Yale COVID-19 Hotline 7AM-7PM 203-688-1700
5 Things Everyone Should Know About the Coronavirus Outbreak (YaleMedicine.org)
Coronavirus (COVID-19) vs. Influenza (Flu) (YNHHS.org)
Frequently Asked Questions and Answers: Coronavirus Disease-2019 (COVID-19) and Children (CDC)
People at Risk for Serious Illness from COVID-19 (CDC)
This article was updated on March 30, 2020