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.

Children represent about 19% of all reported COVID-19 cases in the U.S. since the pandemic began. About 7.6 million child cases have been reported since early September 2021.

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.

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 doctor 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.

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 doctor.
• 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., the doctor 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 The doctor 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.

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 doctor right away for advice.

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.

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.

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

• Ages 5 through 11. The U.S. Food and Drug Administration (FDA) has given emergency use authorization to a Pfizer-BioNTech COVID-19 vaccine for this age group. This vaccine involves two shots, given three weeks apart. It contains a lower dose 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.

• Ages 12 through 15. The FDA has given emergency use authorization to a Pfizer-BioNTech COVID-19 vaccine for this age group. This vaccine involves two shots. The second dose can be given three to eight weeks after the first dose. It contains the same dose as the Pfizer-BioNTech COVID-19 vaccine for people ages 16 and older. The second dose can be given up to six weeks after the first dose, if needed.

  This vaccine is 100% effective in preventing COVID-19 in children ages 12 through 15.

• Ages 16 and older. The FDA has approved a Pfizer-BioNTech COVID-19 vaccine, now called Comirnaty, for this age group. This vaccine involves two shots. The second dose can be given three to eight weeks after the first dose. The second dose can be given up to six weeks after the first dose, if needed.

  This vaccine is 91% effective in preventing severe illness with COVID-19 in people age 16 and older.

The shortest interval between the first and second doses of mRNA COVID-19 vaccines is still recommended for people who have weakened immune systems and others who need rapid protection due to concern about community transmission or risk of severe illness. An eight-week interval between the first and second doses might be best for some people age 12 and older, especially males ages 12 to 39.

Studies on the use of COVID-19 vaccines in younger children are also in progress.

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. This shot should be given at least four weeks after the second shot.

Booster doses can help people who are vaccinated and whose immune response weakened over time. Research suggests that getting a booster dose can decrease the risk of infection and severe illness with COVID-19. Kids ages 12 through 17 should get a Pfizer-BioNTech COVID-19 vaccine booster shot if they have been given both doses of the Pfizer-BioNTech COVID-19 vaccine and it's been at least at least five months.

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.