Amongst the rising cases of the novel Coronavirus (SARS-CoV-2), infection rates in children also seems to be on the rise. In this article we will be discussing about the clinical manifestation of the COVID-19 infection in newborns and toddlers and the vaccines authorized for use in children and the ones that are currently under study for use in children aged 2-18 years old.

Studies show that the severity of the symptoms observed in children are comparatively milder as compared to affected adults. A study by the American academy of Pediatrics suggests that the children aged 10-14 are at a lesser risk for infection compared to people over age 20. Experts suggest that affected children displaying milder symptoms can be attributed to the fact that regular infections like the common cold, flu etc., caused by other viruses of the Coronavirus family might have primed their immune system for infection against most variants of Coronaviruses.

In recent times the possibility of milder symptoms in kids has also been attributed to the emergency use of the Pfizer-BioNTech vaccine for children over the age of 12 years old in some countries around the globe. In India, there are two vaccine candidates – Bharat Biotech’s Covaxin & Zydus Cadila’s ZyCoV-D – waiting for approval by the health authorities for use in children aged 12-18 years.

Although most children seem to be mildly affected by the disease, some have also been hospitalized and require ventilators for respiratory support. These severe cases of pediatric COVID-19 have been observed in children who have underlying conditions like asthma, obesity, genetic disorders, congenital heart defects and metabolic or nervous system disorders. Newborns and children under the age of 1 year are also said to have developed severe symptoms on exposure due to immature immune systems.

Most common symptoms of COVID-19 in newborns and toddlers include-

  • Cough, sore throat, runny nose & sneezing which indicate an upper respiratory tract infection
  • Fever causing
    • Changes in sleeping pattern
    • Difficulty feeding
    • Increased tantrums
  • Muscular pains which cause the babies to cry incessantly & become fussy
  • Diarrhea, nausea, vomiting and stomachache
  • Loss of sense of smell which can manifest as changes in eating habits in toddlers
  • Dry cough, rapid breathing or shortness of breath indicating mild pneumonia

In cases where babies develop severe symptoms, the differences can be observed within a week of appearance of the milder symptoms. These severe symptoms can be-

  • Respiratory distress which can cause
    • Intense shortness of breath that can cause the baby to gasp for breath
    • Snoring while sleeping
    • Very rapid breathing (more than 60 breaths per minute in newborns)
    • Grunting
    • Muscles surrounding the rib cage seem to suck-in while breathing
    • Flaring of the nostrils in newborns
  • Physical signs of reduced intake of oxygen can be observed in the form of
    • Blue lips or tongue
    • White fingernails
    • Rapid heart rate
  • Oxygen saturation less than 92%
  • Severe organ failure
  • Multisystem Inflammatory Syndrome in Children (MIS-C)

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