BACKGROUND AND PURPOSE:

• COVID-19 cases in children (<18 years old) appear to be less severe than adult cases, and may present with different symptoms
• The CDC response team (MMWR, 2020) describes COVID-19 cases in children in the US

METHODS:

• Data sources (February 12 to April 2, 2020)
  • 50 states, the District of Columbia, New York City, and four U.S territories
  • Cases were submitted through an electronic case-based COVID-19 surveillance database
• Participants
  • Laboratory confirmed COVID-19 cases in the US
  • Children: <18 years old
• There were limited data available for some important variables
  • Data on symptoms were available for 9.4% of cases
  • Underlying conditions: 13%
  • Hospitalization status: 33%
• Data analysis
  • Due to missing data and the fact that severe cases are more likely to have hospitalization status reported, percentages of patients hospitalized were estimated as a range
  • Severity of COVID-19 in pediatric group was compared to adults
  • No statistical comparisons were performed due to large amounts of missing data

RESULTS:

• 149,760 positive COVID-19 cases in the US
• <18 years: 2,572 (1.7%) | Median age of pediatric cases :11 years | 57% were males
  • New York City: 33%
  • Rest of New York state: 23%
  • New Jersey: 15%
  • Other jurisdictions: 29%
• Pediatric cases broken out by age
  • Age <1 year: 15%
  • Ages 1-4 years: 11%
  • Ages 5-9 years: 15%
  • Ages 10-14 years: 27%
  • Ages 15-17 years: 32%

Symptoms

• Children with COVID-19 might not report fever or cough compared to adults
  • 73% of pediatric patients had symptoms of fever, cough, or shortness of breath
    • Fever: 56% | Cough: 54% | Shortness of breath: 13%
  • 93% of adults aged 18–64 years had these same symptoms
    • Fever: 71% | Cough: 80% | Shortness of breath: 43%
• Additional symptoms in the pediatric population: Myalgia, sore throat, headache, and diarrhea were less commonly reported

Hospitalization Rates

• Overall
  • Pediatric patients: 5.7% hospitalized | 0.58% in ICU
  • Adult patients: 10% hospitalized | 1.4% in ICU
• Of patients whose hospitalization status was known
  • Pediatrics patients: 20% hospitalized | 2.0% in ICU
  • Adult patients: 33% hospitalized | 4.5% in ICU
• Children <1 year accounted for the highest percentage of hospitalization among pediatric patients
  • Among those <1 year with known hospitalization status, 62% were hospitalized (5 admitted to an ICU) vs 14% in those 1 to 17 years (with little variation among age groups)

Pediatric Underlying Conditions

• ≥1 underlying condition (with data on underlying conditions): 23%
  • Most common chronic lung disease (including asthma), cardiovascular disease, and immunosuppression
• ≥1 underlying condition among hospitalized patients: 77% | All 6 six patients admitted to an ICU had ≥1 underlying condition
• Pediatric Deaths
  • 3 deaths reported

CONCLUSION:

• Fewer cases of COVID-19 have been reported in children <18 years than in adults in the US
  • Few pediatric COVID-19 cases were hospitalized, supporting previous reports that the disease is less severe in children
  • Most pediatric hospitalizations occurred in children <1 years of age
• Pediatric patients may be less likely to report symptoms of fever, cough and shortness of breath
• Limitations on this analysis
  • Missing data
  • Final outcomes for many patients remain unknown
  • Many areas are prioritizing testing cases requiring hospitalization, which may lead to overestimation of hospitalization rates
  • Young adults (those closer to 18 than 65 years) may experience symptoms more similar to pediatric cases than cases in older adults
• Social distancing and everyday preventive behaviors remain important for all age groups
  • Children likely play an important role in disease transmission

Learn More – Primary Sources:

Coronavirus Disease 2019 in Children — United States, February 12 to April 2, 2020

Related ObG Topics:

MMWR Reports on Initial US COVID-19 Experience: Demographics, Mortality and Outcomes 

COVID-19 Case Series: Pregnancy and Infant Outcomes

COVID-19 in Newborns: What are the Clinical Features and Outcomes?

NEJM Correspondence: Clinical Course of COVID-19 in Children