COVID-19 and Children: What Parents Need to Know

As the medical community's understanding and scope of COVID-19 continues to rapidly evolve, it can be difficult for parents to keep track of how the virus impacts their families and children directly. Mark Pasternack, MD, chief of pediatric infectious disease at Mass General for Children, and colleagues are tracking the epidemiological records for children diagnosed with the novel coronavirus in the hopes to identify any distribution patterns and risk factors. Dr. Pasternack shares more about how COVID-19 impacts children and offers advice on how to keep children safe during the pandemic.

Q. How does COVID-19 affect children?

Pasternack: The illness is fundamentally the same as what we've observed in adult patients, although children are thought to have a higher rate of asymptomatic illness. Parents should be just as observant about their own symptoms as they are about their children's. Moderate symptoms of COVID-19 can include a significant fever and cough, while severe infection is indicated by shortness of breath that progressively worsens.

Access to testing has been limited and the medical community is continuing to gather information on rates of COVID-19 infection in children. However, early data from the pediatric department suggests that the rate of diagnosed infection is low in children.

We are estimating about 2% of COVID-19 infections at Mass General are in the pediatric age range and the rate of hospitalization for COVID-positive children is approximately 1-2% of that compared to adults. Most of those children have done well.

Q. What should parents be focused on to keep their children safe?

Pasternack: Know if your child is at risk. The data is developing, but we are seeing that certain pediatric patients with underlying conditions have more difficulty in recovery. Some at-risk medical conditions include:

• Chronic lung disease
• Cystic fibrosis
• Immunodeficiency
• Immunosuppression via medication
• Inflammatory bowel disease
• Organ transplantation
• Severe asthma
• Infants less than 1 year of life may have an increased risk of severe infection

Another important reminder for parents is to practice physical distancing within the household if a family member does get sick. This helps reduce intrafamilial spread, which is the primary way COVID-19 spreads among children when home from school.

In the case of a child who has contracted COVID-19, it's wise to quarantine them from the rest of the household in a separate room if possible.

Q. How to explain COVID-19 to your kids, particularly when it comes to playing outside?

Pasternack: A lot depends on the child's age and disposition, but overall parents should focus on honest communication and explaining the things within their and their child's control to help them stay safe—such as hand and home hygiene. Most children are surprisingly familiar with “germs” since they can remember having prior illnesses requiring them to remain at home and in bed.

Now that the weather is warming up, children will have the opportunity to go outside and play, if their neighborhoods are safe and they are wearing appropriate face coverings. Parents should continue to ardently communicate to their children the importance of not touching their faces and maintaining physical distance from playmates outside the home.

Younger children, in particular, may not have an easy time understanding why they can't go play with the neighbors. But parents can help their kids come up with creative ways to socialize at a safe distance, like:

• Online playdates
• Arts and crafts projects
• Bike rides
• Driving through the neighborhood

At the end of the day, it comes down to three rules of thumb: teaching good hand hygiene habits, emphasizing that children should not touch their faces and maintaining safe physical distance from others.