COVID-19 in the Paediatric Population

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Original Editor - User:Justin Bryan
Top Contributors - Justin Bryan and Lucinda hampton

Introduction

As the SARS-CoV-2 virus (COVID-19) has spread across the globe, it has presented unique challenges for every population it has impacted.  While the impacts, symptom, and long term implications have been variable, one thing is clear, the virus will continue to effect most every aspect of healthcare for years to come.  Given this, it is important for providers to recognize the unique ways that COVID-19 impacts the populations they work with.  The following page will focus on the impacts of COVID-19 in the pediatric population, exploring some of the unique aspects that the virus presents in this diverse group of patients.

Characteristics and Clinical Presentation

Generally speaking, COVID-19 has presented trends suggesting that it is less sever in the pediatric and adolescent populations (<19 years of age) when compared to the adult populations.  However, as new variants develop and spread through both developed and undeveloped countries, reports of complications such as multi-system inflammatory syndrome (MIS-C) and others have been reported.  Additionally, public response and restrictions presented by the virus itself has disrupted routine care including aspects such as vaccination and check-ups.

Data collected from the earlier periods of the pandemic (2020-2021) suggested of lower severity on illness and mortality among pediatric patients, with this subset accounting for between 1% and 10% of total cases.  The greatest distribution of cases in children tend to center around school-aged individuals. Worldwide, data from China, Korea, Spain, Italy, and the United States were supportive of this consensus for individuals <19 years of age during a similar time period.

Presentation of COVID-19 in children and adolescents has been variable, with he most common symptoms including fever and cough.  Other common symptoms reported include nausea/vomiting, diarrhea, nasal congestion, and shortness of breath. Pediatric and adolescent individuals also commonly present as asymptomatic. Development of severe cases was also lower among children in general, but those who developed these cases generally fell in the age groups of <1 year and 10-14 years of age.  Additionally, factors including viral load and comorbidities such as asthma, immune-suppression (i.e. cancer treatment), and congenital heart disease were predictive of increased risk of sever illness or hospitalization.

Given the increased virulence of SARS-CoV-2, the question has been raised as to why children and adolescents do not represent a higher percentage of cases given that their immune systems are relatively less developed than adults. Several explanations have been suggested for this trend. The first suggested hypothesis is based on the involvement of one specific cellular signaling process that the virus takes advantage of (ACE2 receptors and protease TMPRSS2), which are less developed in children and adolescents. Additional hypothesis suggests that due to the active development of the immune system at younger ages, the innate immune system is more active and thus provides additional protection. A third hypothesis posits that simply the presence of fewer comorbidities in these populations puts they at a reduced risk for infection.

Diagnostic Procedures

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Outcome Measures

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Management / Interventions

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Differential Diagnosis

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Resources

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