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Home Health Library Articles COVID-19 in babies and children

COVID-19 in babies and children

Children of all ages can get the coronavirus disease 2019 (COVID-19) and experience its complications.

Know the possible symptoms of COVID-19 in children and what you can do to protect your child.

How likely is it for a child to become sick with coronavirus disease 2019 (COVID-19)?

Children represent about 19% of all reported COVID-19 cases in the U.S. since the pandemic began.

While children are as likely to get COVID-19 as adults, kids are less likely to become severely ill. Up to 50% of children and adolescents might have COVID-19 with no symptoms. However, some children with COVID-19 need to be hospitalized, treated in the intensive care unit or placed on a ventilator to help them breathe.

Certain medical conditions might increase a child's risk of serious illness with COVID-19, including:

  • Obesity
  • Diabetes
  • Asthma
  • Congenital heart disease
  • Genetic conditions
  • Conditions affecting the nervous system or metabolism

Research also suggests disproportionately higher rates of COVID-19 in Hispanic and non-Hispanic Black children than in non-Hispanic white children.

How are babies affected by COVID-19?

Babies under age 1 might be at higher risk of severe illness with COVID-19 than older children.

Newborns can get COVID-19 during childbirth or by exposure to sick caregivers after delivery. If you have COVID-19 or are waiting for test results due to symptoms during your stay in the hospital after childbirth, wear a well-fitting face mask and have clean hands when caring for your newborn. Keeping your newborn's crib by your bed while you are in the hospital is OK, but maintain a reasonable distance from your baby when possible. When these steps are taken, the risk of a newborn getting COVID-19 is low. However, if you are severely ill with COVID-19, you might need to be temporarily separated from your newborn.

Infants who have COVID-19 but no symptoms might be sent home from the hospital, depending on the circumstances. It's recommended that the baby's caregivers wear face masks and wash their hands to protect themselves. Frequent follow-up with the baby's health care provider is needed — by phone, virtual visits or in-office visits — for 14 days. Infants who test negative for COVID-19 can be sent home from the hospital.

What are the signs and symptoms of COVID-19 in children?

Children with COVID-19 might have many symptoms, only a few symptoms or no symptoms. The most common symptoms of COVID-19 in children are cough and fever. Possible signs and symptoms include:

  • Fever
  • Cough that becomes productive
  • Chest pain
  • New loss of taste or smell
  • Changes in the skin, such as discolored areas on the feet and hands
  • Sore throat
  • Nausea, vomiting, belly pain or diarrhea
  • Chills
  • Muscle aches and pain
  • Extreme fatigue
  • New severe headache
  • New nasal congestion

COVID-19 symptoms appear on average about 6 days after a COVID-19 exposure. It can be hard to tell if your child has COVID-19 or another illness with similar symptoms, such as the flu or hay fever.

If you think your child might have COVID-19:

  • Talk to your child's health care provider.
  • Keep your child at home and away from others, except to get medical care. If possible, have your child use a separate bedroom and bathroom.
  • Follow recommendations from the Centers for Disease Control and Prevention (CDC) and your government regarding quarantine and isolation measures, as needed.
  • Focus on symptom relief. This might include rest, plenty of fluids and use of pain relievers.
  • Call the doctor if your child keeps getting sicker. Emergency warning signs include trouble breathing, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, or pale, gray, or blue-colored skin, lips or nail beds — depending on your child's skin tone.

Factors used to decide whether to test your child for COVID-19 may differ depending on where you live. In the U.S., a health care provider will determine whether to conduct diagnostic tests for COVID-19 based on your child's symptoms, as well as whether your child has had close contact with someone diagnosed with COVID-19. A health care provider may also consider testing if your child is at higher risk of serious illness.

To test for COVID-19, a health care provider uses a long swab to take a sample from the back of the nose (nasopharyngeal swab). The sample is then sent to a lab for testing. If your child is coughing up phlegm (sputum), that may be sent for testing.

What is multisystem inflammatory syndrome in children (MIS-C)?

Multisystem inflammatory syndrome in children (MIS-C) is a serious condition in which some parts of the body — such as the heart, lungs, blood vessels, kidneys, digestive system, brain, skin or eyes — become severely inflamed. Evidence indicates that many of these children were infected with the COVID-19 virus in the past, as shown by positive antibody test results, suggesting that MIS-C is caused by an excessive immune response related to COVID-19.

Possible signs and symptoms of MIS-C include:

  • Fever that lasts 24 hours or longer
  • Vomiting
  • Diarrhea
  • Pain in the stomach
  • Skin rash
  • Fast heartbeat
  • Rapid breathing
  • Red eyes
  • Redness or swelling of the lips and tongue
  • Feeling unusually tired
  • Redness or swelling of the hands or feet
  • Headache, dizziness or lightheadedness
  • Enlarged lymph nodes

Emergency warning signs of MIS-C include:

  • Inability to wake up or stay awake
  • Difficulty breathing
  • New confusion
  • Pale, gray or blue-colored skin, lips or nail beds — depending on skin tone
  • Severe stomach pain

If your child shows any emergency warning signs or is severely sick with other signs and symptoms, take your child to the nearest emergency department or call 911 or your local emergency number. If your child isn't severely ill but shows other signs or symptoms of MIS-C, contact your child's health care provider right away for advice.

Can children who get COVID-19 experience long-term effects?

Anyone who has had COVID-19 can develop a post-COVID-19 condition. Research suggests that children with both mild and severe COVID-19 have experienced long-term symptoms. The most common symptoms in children include:

  • Tiredness or fatigue
  • Headache
  • Trouble sleeping
  • Trouble concentrating
  • Muscle and joint pain
  • Cough

These symptoms could affect your child's ability to attend school or do his or her usual activities. If your child is experiencing long-term symptoms, consider talking to your child's teachers about his or her needs.

If children don't frequently experience severe illness with COVID-19, why do they need a COVID-19 vaccine?

A COVID-19 vaccine can prevent your child from getting COVID-19 and spreading it at home and in school.

If your child gets COVID-19, a COVID-19 vaccine could prevent severe illness.

Getting a COVID-19 vaccine can also help keep your child in school and more safely have playdates and participate in sports and other group activities.

What COVID-19 vaccines, additional primary shots and booster shots are available to kids in the U.S.?

In the U.S., COVID-19 vaccines are available to children by age group:

  • Ages 6 months through 4 or 5 years old. The U.S. Food and Drug Administration (FDA) has given emergency use authorization to a Pfizer-BioNTech COVID-19 vaccine for children ages 6 months through 4 years old. This vaccine requires three shots. The first two shots are given three to eight weeks apart. The third shot is given at least eight weeks after the second shot. Research shows that the three shots have produced antibody levels similar to those in young adults after getting the Pfizer-BioNTech vaccine.

     

    The FDA has also given emergency use authorization to a Moderna COVID-19 vaccine for children ages 6 months through 5 years old. This vaccine requires two shots, given four to eight weeks apart. It’s estimated that this vaccine is about 51% effective in preventing COVID-19 in babies ages 6 months through 23 months. For kids ages 2 through 5 years old, the vaccine is estimated to be 37% effective in preventing COVID-19.

    Both vaccines contain lower amounts of mRNA than the mRNA COVID-19 vaccines for older children and adults.

  • Ages 5 or 6 through 11. The FDA has given emergency use authorization to a Pfizer-BioNTech COVID-19 vaccine for children ages 5 through 11. This vaccine involves two shots, given three to eight weeks apart. It contains a lower amount of mRNA than the Pfizer-BioNTech COVID-19 vaccine used for people age 12 and older. This vaccine is about 91% effective in preventing COVID-19 in children ages 5 through 11.

    The FDA has also given emergency use authorization to a Moderna COVID-19 vaccine for children ages 6 through 11. This vaccine requires two shots, given four to eight weeks apart. For kids in this age group, the Moderna vaccine causes an immune response similar to that seen in adults.

    Both vaccines contain lower amounts of mRNA than the COVID-19 vaccines for people age 12 and older.

  • Ages 12 through 17. The FDA has approved the Pfizer-BioNTech COVID-19 vaccine, now called Comirnaty, for people age 12 through 17. This vaccine involves three shots. The first two are given three to eight weeks apart. The third shot, a booster, is given at least two months after the second shot. It contains the same amount of mRNA as the Pfizer-BioNTech COVID-19 vaccine for people age 16 and older. Research has shown that this vaccine is 100% effective in preventing COVID-19 in children ages 12 through 15.

    The FDA has approved a Pfizer-BioNTech COVID-19 vaccine, now called Comirnaty, for people age 16 and older. This vaccine involves two shots. The second shot can be given three to eight weeks after the first shot. This vaccine is 91% effective in preventing severe illness with COVID-19 in people age 16 and older.

    The FDA has also given emergency use authorization to a Moderna COVID-19 vaccine for children ages 12 through 17. This vaccine requires two shots, given four to eight weeks apart. It contains the same amount of mRNA as the Moderna COVID-19 vaccine for people age 18 and older. For kids ages 12 through 17, the Moderna COVID-19 vaccine causes an immune response similar to that seen in adults.

    The FDA has also given emergency use authorization to Novavax COVID-19 vaccine for children ages 12 through 17. This vaccine is also a series of two shots. The second shot is given three weeks after the first shot. Based on research submitted to the FDA, in children age 12 through 17, this vaccine is about 78% effective in preventing symptomatic COVID-19 illness.

An eight-week interval between the first and second doses might be best for some people, especially males ages 12 to 39. A longer interval might increase protection against COVID-19 and reduce the risk of rare heart problems, such as myocarditis and pericarditis.

An additional primary shot of a COVID-19 vaccine can help people who are vaccinated and might not have had a strong enough immune response. The CDC recommends that children ages 5 and older who have moderately or severely weakened immune systems should get an additional dose of the Pfizer-BioNTech COVID-19 vaccine or the Moderna COVID-19 vaccine. This shot should be given at least four weeks after the second shot.

The CDC now recommends that children age 6 months to 5 years who have a weakened immune system get at additional dose of the Moderna COVID-19 vaccine at least four weeks after their second shot. Children ages 5 and older who have moderately or severely weakened immune systems should get additional doses of the Pfizer-BioNTech COVID-19 vaccine or the Moderna COVID-19 vaccine. This shot should be given at least four weeks after the second shot for kids ages 5 through 11 for the Pfizer-BioNTech COVID-19 vaccine and the Moderna COVID-19 vaccine. For kids ages 12 and older the additional shot should be given at least four weeks after the second shot for the Pfizer BioNTech COVID-19 vaccine and Moderna COVID-19 vaccine.

A booster dose is recommended for people who are vaccinated and whose immune response weakened over time. Immune response fades naturally over time. It can also happen when the virus that causes COVID-19 changes so the immune system doesn't recognize it as well. Research suggests that getting a booster dose can decrease your risk of infection and severe illness with COVID-19.

These recommendations differ by age, what vaccines you have been given and the state of your immune system. But in general, people can get the booster shot at least two months after their last shot. People who recently had a positive COVID-19 test may think about waiting three months after their symptoms started to get the booster.

  • Ages 6 months to 5 years. Kids ages 6 months through 5 years who got the Moderna COVID-19 vaccine can get an updated, called bivalent, Moderna COVID-19 vaccine booster. The booster is based on the original virus strain and two omicron strains.
  • Age 5 and older. Kids age 5 who got the Pfizer-BioNTech COVID-19 vaccine can only get the updated Pfizer-BioNTech COVID-19 bivalent vaccine booster. Kids age 6 and older can choose between the updated Pfizer-BioNTech and the Moderna COVID-19 bivalent vaccine boosters.
  • Booster doses for people with weakened immune systems. People age 5 and older who have a weakened immune system and have had all recommended doses of the Moderna, Pfizer-BioNTech or Novavax COVID-19 vaccines can get a booster dose of the updated Pfizer-BioNTech or Moderna COVID-19 bivalent vaccines.

What can I do to prevent my child from getting COVID-19?

There are many steps you can take to prevent your child from getting the COVID-19 virus and spreading it to others. The CDC recommends:

  • Getting vaccinated. COVID-19 vaccines reduce the risk of getting and spreading COVID-19. A COVID-19 vaccine can be given to eligible children on the same day as other vaccines.
  • Wearing face masks. If you are in an area with a high number of people with COVID-19 in the hospital or new COVID-19 cases, the CDC recommends wearing a well-fitted mask indoors in public, whether or not you're vaccinated. Don't place a face mask on a child younger than age 2 or a child with a disability who can't safely wear a mask.
  • Keeping hands clean. Encourage frequent handwashing with soap and water for at least 20 seconds, or using an alcohol-based hand sanitizer that contains at least 60% alcohol. Have your child cover his or her mouth and nose with an elbow or a tissue when coughing or sneezing. Remind your child to avoid touching his or her eyes, nose and mouth. Teach your kids to keep washing their hands until they have sung the entire "Happy Birthday" song twice (about 20 seconds).
  • Cleaning and disinfecting your home. Clean high-touch surfaces and objects regularly and after you have visitors in your home. Also, regularly clean areas that easily get dirty, such as a baby's changing table, and surfaces and items that your child often touches.
  • Choosing safer activities. Choose outdoor activities when possible or indoor activities in well-ventilated spaces. Avoid activities that make it hard to stay 6 feet, or 2 meters, away from others. Limit visits with people who are unvaccinated or whose vaccination status is unknown. Keep distance between your child and others when in public. Avoid close contact with people who are sick, if possible.

In addition, keep up with well-child visits and your child's other vaccines — especially if your child is under age 2. If your child is due for a checkup and you're concerned about exposure to COVID-19, talk to your child's doctor about safety steps being taken. Don't let fear of getting COVID-19 prevent your child from getting vaccines to prevent other serious illnesses.

Following guidelines to protect against the COVID-19 virus can be difficult for kids. Stay patient. Be a good role model and your child will be more likely to follow your lead.

Last Updated: December 17th, 2022