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COVID-19 in Child
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COVID-19 in Child

Contributors: Paritosh Prasad MD, Eric Ingerowski MD, FAAP, David Peritz MD, Susan Burgin MD
Other Resources UpToDate PubMed


Refer to the US Centers for Disease Control and Prevention (CDC) (Information for Healthcare Professionals) for the most current information.

Coronavirus disease 2019 (COVID-19), previously known as 2019 novel coronavirus (2019-nCoV), is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Clinical features:

Clinical features primarily include fever and upper respiratory tract symptoms with rhinorrhea, congestion, and pharyngitis that can progress to include symptoms of lower respiratory tract illness (eg, cough, shortness of breath), although many patients also report associated gastrointestinal complaints (nausea, vomiting). Reported cases have ranged from asymptomatic to severe; the case fatality rate varies worldwide, ranging from 0.1%-4.9% based on data compiled by Johns Hopkins. Clinical presentation can vary significantly, particularly with respect to vaccination and boosting status and time from last COVID infection.

Illness can range from mild to critical:
  • Mild to moderate (mild symptoms up to mild pneumonia)
  • Severe (dyspnea, hypoxia, or > 50% lung involvement on imaging)
  • Critical (respiratory failure, shock, or multiorgan system dysfunction)

SARS-CoV-2 spreads from person to person easily. The incubation period is estimated to be between 2 and 14 days after exposure, with an estimated median incubation period of about 3-5 days. This incubation period appears to vary slightly with respect to different variants.
  • The virus is transmitted primarily via infectious secretions (respiratory droplets and sputum) between individuals in close contact (within 6 feet).
  • Airborne transmission can occur, particularly within enclosed spaces (even those with adequate ventilation) or under circumstances where the infectious individual is breathing heavily, such as while exercising or singing.
  • Transmission of SARS-CoV-2 from asymptomatic or presymptomatic persons can occur.
  • It is not determined whether the virus can be transmitted by blood, vomit, urine, breast milk, or semen.

Multiple variants of the virus have circulated globally, including in the United States, and new variants are expected to occur. Omicron continues to be the dominant variant in the United States, with HV.1 the dominant strain as of November 2023. Other circulating subvariants include EG.5, FL.1.5.1, XBB.1.16.6, and XBB.1.16.11 among others. Subvariants may be less sensitive to neutralizing antibodies from prior COVID-19 vaccines and prior COVID infections and cause higher rates of reinfection.


Individuals previously diagnosed with COVID-19 may become infected again due to waning immunity from prior infection and/or waning vaccine effectiveness that occurs over time.

Breakthrough infection:

Breakthrough infections may occur in individuals who are up to date with COVID-19 vaccinations. However, vaccinated individuals are much less likely to experience severe symptoms than unvaccinated people.

Infection prevention and control in health care settings:

The CDC has provided updated guidance (updated May 8, 2023) on infection prevention and control to reduce facility risk, isolate symptomatic patients as soon as possible, and protect health care personnel.

About COVID-19
Coronaviruses are a family of viruses, some of which cause infection in humans and in animals such as camels, cats, and bats. When animal coronaviruses evolve, on rare occasions they can become infectious to and spread between humans (a zoonotic infection) as has occurred with Middle East respiratory syndrome (MERS) and SARS. This animal-to-human spread has been postulated to have occurred with SARS-CoV-2 with subsequent person-to-person transmission.

Related topics: multisystem inflammatory syndrome in adults, multisystem inflammatory syndrome in childrenpost-COVID conditions, skin and oral mucosal manifestations of COVID-19


U07.1 – COVID-19

840539006 – Disease caused by 2019 novel coronavirus

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Differential Diagnosis & Pitfalls

The differential diagnosis includes other etiologies of lower respiratory tract infection (depending on season).

Note: Viral coinfections (eg, influenza) have been reported in patients with COVID-19; thus, diagnosis of an alternative respiratory virus does not exclude SARS-CoV-2 virus infection.

Data have demonstrated that the majority of patients presenting with COVID-19 do not have concurrent bacterial infection, although those with COVID-19 and prolonged hospitalization often develop complicating bacterial infection.

Viral infection:
  • Influenza
  • Respiratory syncytial virus infection
  • Parainfluenza virus infection
  • Human metapneumovirus infection
  • Adenovirus infection
  • Common cold
  • Hantavirus pulmonary syndrome
Bacterial pneumonia, eg:
  • Streptococcus pneumoniae pneumonia
  • Haemophilus influenzae pneumonia
  • Moraxella catarrhalis pneumonia
Atypical bacterial pneumonia, eg:
  • Mycoplasma pneumonia
  • Legionellosis
Fungal pneumonia:
  • Coccidioidomycosis
  • Histoplasmosis
  • Blastomycosis
  • Congestive heart failure
  • Pulmonary embolism
  • Salicylate poisoning (Acute salicylate poisoning, Chronic salicylate poisoning)

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Last Reviewed:06/03/2023
Last Updated:12/10/2023
Copyright © 2024 VisualDx®. All rights reserved.
COVID-19 in Child
Imaging Studies image of COVID-19 - imageId=9733688. Click to open in gallery.  caption: 'Multifocal areas of airspace disease predominantly involving the lower lobes, compatible with multifocal pneumonia. SARS-CoV-2+.'
Multifocal areas of airspace disease predominantly involving the lower lobes, compatible with multifocal pneumonia. SARS-CoV-2+.
Copyright © 2024 VisualDx®. All rights reserved.