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Covid-19 Primary Care Resources


Evidence on Covid in children



An updated summary on infection rates, common presentations and transmission

This information is sourced from the The UK Research and Innovation (UKRI), the Royal College of Paediatric and Child Health (RCPCH), the Lancet and the RCGP:

How does the new variant affect children?

  • Early population data suggests that the SARS-CoV-2 variant is more infectious to the general population
  • However, there is as yet no evidence of children being at increased susceptibility to this variant compared to adults, or to be more severely affected by this new variant, nor of any associated risk of developing PIMS-TS
  • The evidence base around this is rapidly growing

Infection rates in children

  • Infection with Covid-19 has been reported in all age groups, including infants, children and young adults
  • Evidence suggests that children may be less likely to acquire the disease
  • This is supported in countries that have undertaken widespread community testing, where lower case numbers in children than adults have been found
  • Teenagers are more susceptible to Covid-19 disease than younger children

What role do children play in transmission?

  • The importance of children in transmitting the virus is difficult to establish, particularly because of the number of asymptomatic cases
  • There is some evidence that their role in transmitting the virus is limited

Symptoms in children

  • Most infected children present with mild symptoms or are asymptomatic
  • Children’s symptoms vary slightly from those seen in adults and tend to be milder
  • Cough or fever are observed in around half of symptomatic children, which is less often than in adults
  • In contrast, upper respiratory symptoms such as a runny nose or sore throat occur in 30-40% and diarrhoea and/or vomiting are found in around 10% (sometimes this is the only symptom); this is more often than in adults

Are there any signs that could help differentiate Covid-19 from other childhood respiratory viral infections?

  • There appears to be little in the way of clinical signs in children to differentiate Covid-19 from other childhood respiratory virus infections
  • Covid-19 has been detected in combination with other viral and bacterial infections
  • There are some cases indicating possible association with skin manifestations which may persist for some time once other symptoms have resolved

Atypical Kawasaki disease, now called paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS)

  • In April 2020 the UK s Paediatric Intensive Care Society issued an urgent alert to GPs following a small rise in the number of critically ill children with overlapping features of toxic shock syndrome and atypical Kawasaki disease
  • On 1st May 2020 the RCPCH published guidance on this syndrome, now called PIMS-TS
    The symptoms are: persistent fever >38.5 C, evidence of single or multi-organ dysfunction (shock, cardiac, respiratory, renal, gastrointestinal or neurological disorder) with signs of inflammation (neutrophilia, elevated CRP and lymphopaenia) (See clinical and laboratory features page 4)
    Some but not all of these children tested positive for Covid-19 at the time of diagnosis of this syndrome
    The recognition of this disease late in the first pandemic wave might relate to its rarity
    Alternatively PIMS-TS might represent a post-infectious inflammatory syndrome

See also:

Management and guidance for febrile children during the pandemic

How should we approach common childhood illnesses in the context of Covid-19?

11 primary care pathways for remotely assessing children

Tonsillar examination

Covid vaccinations in children