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Coronavirus and children

Symptoms, illness duration, and risk of transmission

1. The risk of infection in children

1.1. Frequency of infection

Children can also become infected with the coronavirus (SARS-CoV-2). Since 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 strain on their bodies in the event of a coronavirus infection. [1].

Because children potentially can carry the virus, yet are less able to comply with protection measures, and often have close contact with each other, there can be widespread transmission of the virus by and among children [2, 3].

Whether a child has symptoms or not is not the decisive factor: even children with only a few symptoms have a similar amount of virus in the nose and throat as symptomatic adults [4].

The bottom line is: children can catch the disease from adults as well as from other children – even if the person had no symptoms. [3, 4]. 

1.2. Transmission from children to others

Just as children can spread the coronavirus among themselves, transmission to adults is also possible – and this is independent of symptoms. Studies have shown that children spread the coronavirus in institutions such as daycare centers and schools, as well as at home among family members [4].

Nevertheless, contrary to what was assumed at the beginning of the pandemic, children are not "super-spreaders," as can be the case, for example, with flu epidemics. Accordingly, the spread of the disease is possible among children under the age of 14, but it is by no means more frequent than among adolescents or adults [5].

Also, area-wide school and daycare closures didn't have as much of an effect as general social distancing and hygiene regulations [5].

Furthermore, consistently sticking to protection plans such as wearing masks or separating groups in educational institutions showed positive effects [4].

The risk of transmission can therefore also be noticeably reduced in children with the help of measures adapted to their age [4].

1.3. Measures against infection in everyday life

Proper ventilation is one of the best ways to protect children from infection because tiny particles known as aerosols can linger for long periods in the air. You can significantly reduce the risk of infection by regularly opening the windows and airing out rooms every 20 minutes or so [6]. 

The amount of time you need to air out a room depends on the season. In summer, you should air out the room for 20 to 30 minutes. In winter, 5 to 10 minutes at a time may be enough. Children may need to put on warmer clothing while the room is being aired. If you can open windows on opposite sides of the room at the same time, this will speed up the ventilation process considerably. If many people are gathered together in a confined space, it may make sense to keep the windows open the whole time [7].

In schools and similar establishments, rooms should be aired out during every break between lessons or at least every 45 minutes if lessons last longer. It’s a good idea to air out rooms during lessons as well. The room should be aired immediately if somebody repeatedly needs to cough or sneeze. Other measures such as physical distancing, good hygiene, and face masks are much more effective when combined with measures to ensure that there is enough fresh air indoors [8].

The feasibility of some measures depends on the age of the child. Whenever possible, ensure that children comply with contact and hygiene rules. These include staying 1.5 meters away from other people, regularly washing hands, and wearing a mask that covers both the mouth and nose [4, 8].

Especially in the case of very young children, these measures can be difficult to implement and it is necessary to find a workable balance. Measures such as washing hands thoroughly with soap and water, carefully cleaning frequently touched surfaces, and minimizing contact with others are all advisable and often 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 applies if an infection is suspected prior to a negative test result [8, 9].

Since coronavirus infections in children are usually mild or even asymptomatic, it is often difficult to detect the disease early on and prevent transmission to others. In addition to observing the generally recommended measures (physical distancing, hygiene measures, and face masks) and ensuring adequate ventilation, you should also pay attention to the following [1]:

  • Look for the symptoms mentioned above every day (see 2.1).
  • Keep track of whom the child comes into contact with on a daily basis.
  • Keep a journal in which any gatherings held in confined spaces are listed. This can make it much easier for health authorities to trace the chain of infection later.
  • If relatives of a child or the child itself should fall ill, the school and the responsible health authority must be informed immediately.

Always reconsider whether or not to allow contact between children and people with pre-existing conditions, especially the elderly. If there is even the slightest suspicion that the child poses an infection risk, encounters of this type should not take place under any circumstances [1].

2. COVID-19 in children

2.1. Typical symptoms

As many as one-fifth to one-third of all children have no symptoms at all in a coronavirus infection. COVID-19 also tends to be milder in children, although there are also severe cases. Symptoms last an average of 6 days and usually disappear completely after 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]:

Overview of frequency of COVID-19 symptoms in children
Frequency of COVID-19 symptoms in children and adults compared

2.2. Signs of a severe infection

Most cases of coronavirus infection in children are asymptomatic or mild. The symptoms then usually subside again within 1 to 2 weeks [16].

If the clinical course is severe, this is often because the child also has an underlying disease that existed before the infection, such as lung disease, diabetes, a heart abnormality, a weakened immune system, a genetic condition, obesity, or another underlying condition [5, 16].

Pre-existing treatment that affects the child’s immune system may also be a reason for severe disease [16].

If a child shows clear symptoms of illness such as fever, cough, sore throat or ears, severe abdominal pain, vomiting, diarrhea, or an unexplained rash, they should not attend daycare or school under any circumstances and medical advice should be sought [5].

Symptoms such as increasing breathlessness, persistent chest pain or tightness, confusion, extreme and unusual drowsiness, bluish lips, and severe abdominal pain may be signs of a severe coronavirus infection and the child should be taken to an emergency room immediately [5].

Fortunately, severe illnesses and deaths from coronavirus infection in children are extremely rare [5, 16].

2.4 Complications and long-term consequences

COVID-19 complications in children are extremely rare. These include pronounced pneumonia, which – similar to adults – may require ventilation at some point during 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, the most frequent consequence of coronavirus infection in children is Long COVID. As this condition is fairly new, further research is needed to draw more precise conclusions in the future [5, 10].

The fact that more and more children are eligible for vaccination against COVID-19 is extremely good news and will further reduce the risk to children [17|.

The contents of this article reflect the current scientific status at the time of publication and were written to the best of our knowledge. Nevertheless, the article does not replace medical advice and diagnosis. If you have any questions, consult your general practitioner.

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