Coronavirus in children

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Lisa Vogel studied departmental journalism with a focus on medicine and biosciences at Ansbach University and deepened her journalistic knowledge in the master's degree in multimedia information and communication. This was followed by a traineeship in the editorial team. Since September 2020 she has been writing as a freelance journalist for

More posts by Lisa Vogel All content is checked by medical journalists.

Children can also become infected with the Sars-CoV-2 coronavirus and contract Covid-19. The disease is usually symptom-free or mild - comparable to a cold. How dangerous is the coronavirus for children? Should I have my child vaccinated? And how often does Long Covid Syndrome occur in children? Read more!

Brief overview

Risk of contagion through children: Children seem to be just as contagious as adults.
Corona symptoms in children: cough, fever, runny nose, general feeling of illness, sore throat, shortness of breath, gastrointestinal complaints, pneumonia; Children with corona often show no symptoms or only one symptom.
Course of the disease: 43 percent of 0 to 5 year olds are infected without symptoms, 57 percent show only one symptom. The course of the disease is milder than in adults.
Possible consequences of the infection: Long Covid (Post-Covid Syndrome) with symptoms such as fatigue, pain, concentration disorders, cardiological and neurological disorders. Some children develop the multi-inflammatory disease PIMS.
Risk factors: heart and lung diseases, children under one month of age
Protection against infection: vaccination (approved in the EU from twelve years of age), AHA rules (keep your distance, hygiene measures such as correct and thorough hand washing, everyday life with a mask). Reduce contacts, meet in the fresh air or in well-ventilated rooms.

Vaccinate children or not?

In children and adolescents, a Sars-Cov-2 infection is usually very mild or even without a system. Very few are seriously ill with Covid-19. The question of vaccination for children is therefore currently the subject of controversy. In particular because it is unclear whether the benefits of vaccination for the children outweigh the extremely low but existing risks of vaccination.

Long Covid / Post Covid in Children

So far, very little is known about Long Covid (also: Post Covid) in children. But we know that the long-term consequences of a Sars-CoV-2 infection can affect you too. This even applies to infected people who have hardly noticed any symptoms of Covid-19.

How common is Long Covid in children?

The big question is how common is Long Covid in children. Because that could help decide whether the Standing Vaccination Commission (STIKO) will also recommend vaccination for children and adolescents aged 12 and over who are not at particular risk of developing the disease. This question would also arise in the event of a later approval of a vaccination for the younger ones.

Data from Switzerland now give an indication. Researchers at the University of Zurich tested blood samples from 1,355 schoolchildren for Sars-CoV-2 antibodies in October and November 2020 (mean age: 11 years). Six months later, they asked families online about typical Long Covid symptoms in the children.

The result: 4 percent of the 109 children in whom the researchers found antibodies in the blood had suffered from symptoms typical of corona for more than twelve weeks. However, such symptoms also affected 2 percent of the 1246 children and adolescents who had no antibodies in their blood.

The long covid risk for children is therefore low, but certainly there.

Long Covid Symptoms in Children

The possible Long Covid symptoms in children are the same as in adults:

Exhaustion
exhaustion
Difficulty concentrating
Muscle and limb pain
sleep disorders
shortness of breath
Palpitations
neurological disorders

Pediatric Inflammatory Multiorgan Syndrome (PIMS) also occurs as a late complication in some children (see next section).

For more information on the long-term effects of Covid-19, see the Post-Covid Syndrome article.

Multi-inflammatory disease: PIMS

In rare cases, children develop complications during coronavirus infection. One of them is PIMS (“pediatric inflammatory multisystem syndrome”). This is a multi-inflammatory disease that affects children.

Probably the immune system of the deceivers is directed against the body's own structures. People develop severe abdominal pain and persistent fever. Some also develop toxic shock syndrome (TSS).

If your child develops a high fever after a coronavirus infection, you should see a doctor or a clinic immediately.

The combination of PIMS and TSS is similar to Kawasaki syndrome. This has already been observed in children in connection with other infectious diseases. The majority of those affected require intensive medical care.

As a rule, the clinical picture is easy to treat. However, the condition can cause lasting damage. For example, heart disease or changes in the gastrointestinal tract, skin, mucous membranes and lower respiratory tract can occur.

You can read more about the symptoms and the consequences in the PIMS article.

How contagious is the coronavirus in children?

Children seem to be just as contagious as adults. This is shown by the data of a study. The virologist Christian Drosten from the Berlin Charité and his colleagues evaluated the data of 25,000 Covid-19 patients. They determined the viral load of all patients and thus the risk of infection.

Less viruses thanks to the type of testing

The younger the patient, the fewer viruses the scientists found in the test smears. In particular, in the samples of the youngest children between 0 and 5 years of age, the fewest viruses were found. But the researchers attribute this to the sampling.

According to the experts, the lower values in small children are mainly due to other test procedures for the youngest. For example, the cotton swab used to smear the swab is much smaller in children. The smaller swab absorbs less secretion - namely only about half the amount of secretion compared to a normal-sized swab. This also means that fewer viruses are in the smear. That could falsify the result.

The type of testing is also slightly different for children. For a meaningful corona test, a deep nasopharynx smear is necessary. This one is uncomfortable. That is why secretion is often taken from less deep layers of the mucous membrane in children and tested.

However, the viruses multiply more deeply in the airways. Samples of a nasal swab are less meaningful. Therefore, the rate of sub-optimal testing in younger children is higher than in older children, adolescents, or adults.

With increasing age, the viral load found in children and adolescents equals that of adults. In the age group of 20 to 65 year olds, there were no differences in viral load, according to the study results.

Effect of Corona Mutations on Children

How does the UK variant of coronavirus affect children? Since the corona mutants have also spread in Germany, more young people have become ill. In the third wave of the coronavirus pandemic, the under-15 age group was the second most affected. Most of the positive tests came from the 15- to 34-year-old age group.

A study from Great Britain compared the infection rate of the original Corona variant with the British beta mutation (type B.1.1.7) even before the population was protected by the vaccination. The result shows that overall more people are infected with the coronavirus - regardless of age.

However, children are also least affected by this corona mutant. Kindergarten and elementary school children have so far been less likely to fall ill than infants or older children.

Overall, even with the British mutation, children become less seriously ill - and only a few have to be hospitalized. A severe or even fatal course of the disease is also very rare with the British virus mutation.

Children with previous illnesses are at a higher risk of developing the disease more seriously - regardless of the type of mutation.

Corona: symptoms in children

Children with corona often have different symptoms than adults. This makes the infection harder to spot. Covid-19 causes the following symptoms in children:

cough
fever
sniffles
general feeling of illness
Sore throat
Shortness of breath (dyspnoea)
Gastrointestinal complaints
Inflammation of the lungs (pneumonia)

Coughs, runny nose and shortness of breath occur less often in children than in adults. On the other hand, children with corona suffer more often from gastrointestinal complaints.

A significant proportion of children and adolescents only show a single symptom of the coronavirus infection.

Depending on the age group, the symptoms of the disease vary in frequency. The following table shows the recorded corona symptoms in children and adolescents during the first wave in Germany:

symptom	0-4 years	5-19 years
cough	40%	42%
fever	48%	34%
sniffles	23%	30%
General signs of illness	18%	30%
Sore throat	8,5%	8,5%

Symptoms in children are harder to recognize than in adults. If your child shows the listed complaints, they should stay at home and neither go to school nor daycare. But not every child who has a cough has Covid-19. Let your pediatrician clarify the symptoms - preferably by phone first.

If your child shows strong coronavirus symptoms outside of normal opening hours, contact the medical on-call service on 116117.

Course of disease in children

Many children have Covid-19 with mild or no symptoms. According to the Corona-KiTa study, around 43 percent of 0 to 5-year-olds show no signs of illness.

More than half (57 percent) of children ages 0-5 experienced at least one symptom. The course of the disease in children is therefore less severe than in adult patients.

However, coronavirus infection in children can also be severe. In rare cases, children also need to be treated in hospital. Children with severe courses of Covid-19 usually suffer from fever and general symptoms.

In infants, a severe course of the disease is shown, for example, by loss of appetite. In addition, there may be an infection of the upper respiratory tract with coughing, runny nose or shortness of breath. In rare, severe cases, children develop severe diarrhea, pneumonia and even lung failure.

If your baby or toddler has been shown to be infected with the coronavirus and is showing severe symptoms, see a doctor or hospital straight away.

Corona: risk factors in children

Most of the children who had such severe illnesses that they had to be hospitalized as an inpatient had previous illnesses. This includes

severe overweight (obesity)
severe heart disease
congenital or acquired immunodeficiency or relevant immunosuppression
severe nervous system disorders
chronic lung diseases with impaired lung function (with the exception of well-controlled asthma) or
chronic kidney failure
Trisomy 21
poorly controlled diabetes
Cancers

The age of the sick also plays a role: A Europe-wide study has shown that children under one month of age also have an increased risk of a serious course of the disease.

Corona vaccination for children

Although children get sick less often than adults, vaccination can be useful in many cases.

The vaccine “Comirnaty” from Biontech / Pfizer for children and adolescents from the age of twelve has been approved in Europe since May 2021, followed by the vaccine Spikevax from Moderna. The European Medicines Agency (EMA) has given the go-ahead for immunization, as it also safely protects 12 to 17-year-olds from Covid-19 disease.

More than 1,000 children and adolescents vaccinated had no Covid-19 disease, according to a study in the New England Journal of Medicine. For comparison: In the unvaccinated and roughly the same size control group, there were 16 Covid 19 diseases. After the vaccination, mostly minor side effects such as tiredness and headache occurred.

To weigh up the risks and benefits of vaccinations, the Standing Vaccination Commission (STIKO) does not currently have sufficient data to make a general vaccination recommendation for children and adolescents. The STIKO recommends vaccinations for 12 to 17 year-olds only for adolescents with previous illnesses that increase the risk of severe disease that endangered people have in their close environment, or who work in an area that is associated with an increased risk.

You can read more about the arguments for and against corona vaccinations for younger age groups in the article "Corona vaccinations for children and adolescents".

Previous illnesses for which the STIKO recommends vaccinations

The STIKO recommends vaccination from 12 years of age for the following pre-existing conditions:

severe overweight (obesity)
severe heart disease
congenital or acquired immunodeficiency or relevant immunosuppression
severe nervous system disorders
chronic lung diseases with impaired lung function (with the exception of well-controlled asthma) or
chronic kidney failure
Trisomy 21
poorly controlled diabetes
Cancers

A free vaccination is also possible for children and adolescents from the age of 12 who have no previous illness. There is not yet an approved vaccine for children under the age of twelve.

Influenza protection for the sick

Children with a chronic illness, such as bronchial asthma, can get a preventive flu vaccination. The STIKO recommends an annual vaccination against influenza.

The vaccination does not offer any protection against Sars-CoV-2, but it can prevent a dangerous double infection. For risk groups in particular, a simultaneous infection can quickly endanger their lives.

The RKI therefore recommends the annual flu vaccination in autumn and winter for all risk groups. Immunity to influenza can prevent the flu or weaken its course. The immune system can then concentrate on defending itself against the coronavirus.

Observe AHA rules

The so-called AHA rule protects young and old from infection - with Sars-CoV-2, but also with cold or flu viruses. It comprises the three most important basic rules:

keep distance

Children should also keep a distance of at least 1.5 meters from other people - even when playing with friends. While this is easier said than done, it is a great way to reduce the risk of infection

Observe hygiene rules

Regular and thorough hand washing protects against infections. Real sneezing and coughing - namely in the crook of your arm or in a handkerchief - also protects other people from viruses. A hand disinfectant also kills pathogens effectively.

Everyday life with a mask

Children and adolescents from six to 16 years of age have to wear a medical mask in public spaces such as in school, in the supermarket or in local public transport. Surgical masks and FFP2 masks are permitted. The mouth and nose cover prevents the viruses from spreading further.

Less contacts

Apart from the AHA rule, it is advisable to limit the number of contacts with other people.For example, reduce your child's meetings to one or two friends. It is best to let your child decide which contacts are most important to them. Your offspring can talk to other friends over the phone or virtually so that contact is not lost.

Playing in the fresh air

And when a meeting with friends is due, it is best in the fresh air. Because indoors, the finest breath droplets (aerosols) of all people in the room spread. This increases the risk of infection. The risk of infection is 19 times lower when outdoors. Regular ventilation of the interior also reduces the risk of infection.

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