COVID-19 in children: Age,

previous illness, and other

factors affect risk

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Superwoman on a wall in Hamm, western Germany, on April 8, 2020, referring to the spread of the novel
coronavirus COVID-19. INA FASSBENDER/Getty Images

 Severe outcomes among pediatric patients with SARS-CoV-2 infections are

poorly understood.
 A new study seeks to quantify severe outcome frequency and risk factors for
these patients.
 Clinicians should consider age, underlying chronic illness, and symptom
duration when treating pediatric patients.

While COVID-19 is generally mild in children, there are instances of serious outcomes
in some youths who test positive for the SARS-CoV-2 virus. A recent study in JAMA
Network OpenTrusted Source sought to clarify the impact of SARS-CoV-2 infection
and the risk of severe COVID-19 outcomes on young people worldwide.
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COVID-19’s impact on youth

At the onset of the COVID-19 pandemic, those under 18 years oldTrusted Source
represented 1.7% of all reported cases. Many believe these early estimates were
inaccurate due to early testing capacity and the usually mild, or even
asymptomaticTrusted Source, nature of the disease in children.

As of January 13, 2022, individuals under 18 years of age represented 17.8% of all
new COVID-19 cases. The number of children hospitalized for the disease increased
nearly fivefoldTrusted Source between June and August 2021.

The study, conducted through the Pediatric Emergency Research Network—COVID-

19, focused on answering the question: What proportion of SARS-CoV-2-positive
youths tested in emergency departments experience severe outcomes within 14
days?

Severe outcomes were categorized as cardiac events, such as myocarditis,

neurological issues, such as encephalitis, respiratory problems, such as pneumonia,
infectious issues, such as sepsis, and death.

Study participants were selected from emergency departments across eight

countries, including Argentina, Canada, Costa Rica, Italy, Paraguay, Singapore, Spain,
and the United States.
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Study results
Among the 10,300 participants, 3,222 tested positive for SARS-CoV-2 infection. Of
those, 23% were hospitalized, 3% experienced severe outcomes within 2 weeks after
their visit to the emergency department, and four of the children died.

The researchers identified the possible risk factors leading to severe outcomes.
These included a patient age between 5–18 years, a preexisting chronic illness, a
previous episode of pneumonia, and presenting to the hospital 4–7 days after
symptom onset.

While some of these same risk factors have been identified in other pediatric COVID-
19 studies, this study shows contrasting results in other areas. For example,
participants who were very young infantsTrusted Source did not appear to be at a
higher risk for severe outcomes. In addition, while asthmaTrusted Source has been
suggested as a risk factor for severe illness in those youths with COVID-19, the
study’s results did not support this association.

Dr. Stephen Freedman, pediatrician and professor at the Cumming School of

Medicine, University of Calgary, Canada, and study co-lead author told MNT, “It was
interesting and somewhat unexpected that we found that young children were at
the lowest risk of severe outcomes.”

Among the 2,500 SARS-CoV-2-positive youths discharged from the emergency

departments, only 0.5% experienced severe outcomes during the follow-up period.

The study also indicated that children deemed healthy at their initial emergency
department visit rarely deteriorated significantly after that first visit.

Dr. James Wood, assistant professor of clinical pediatrics at the Indiana University
School of Medicine and infectious disease physician at Riley Hospital for Children,
Indianapolis, was asked by MNT to comment on this study. He noted that very few
children who tested positive and were discharged developed severe outcomes.

“This is important as it shows the ability of emergency department clinicians to

appropriately recognize who is safe to be discharged home the majority of the time,”
said Wood. “Understanding these risk factors is important as clinicians have to make
decisions about who needs to be hospitalized and who would benefit from
treatment.”

Conclusions and future research

The researchers conclude by stressing risk factors such as age, underlying chronic
illness, and symptom duration should be considerations when making clinical care
decisions for children under 18 who test positive for SARS-CoV-2 infection.

When asked about future research needs regarding children and COVID-19,
Freedman said, “It will be important to explore outcomes within specific groups, for
example, young infants, and to evaluate whether laboratory parameters can also
assist in identifying children at increased risk of severe outcomes.”

Freedman stressed that the study does not imply that 3% of all children infected with
SARS-CoV-2 have severe outcomes since the participants did not represent the entire
population of children who had the infection.

“However, we did also find that when compared to children who were SARS-CoV-2
test negative, those who tested positive and were hospitalized were more likely to
have severe outcomes,” said Freedman.