Questions about COVID-19 and kids

All children are at risk of getting COVID-19. Symptoms in children are generally milder than what adults experience.

For many children, the symptoms look like any other respiratory viral infections: cough, fever and a runny nose. This means most children will be able to be looked after at home. The Omicron variant has seen more young children present with croup symptoms.  A barking cough or noisy breathing should get checked out by a doctor. A very small percentage of children become more unwell with COVID-19, such as a prolonged fever (5+ days), breathing difficulties, and abdominal pain.

Most children with COVID-19 completely recover and recover quickly. Children with COVID-19 are unwell for about 6 days, but this can vary.¹ For children who experience more severe COVID-19 symptoms, they tend to spend about 2 days in hospital, or 7 days if they require ICU care.²

Though COVID-19 is referred to as a “respiratory” viral infection, it can affect anywhere in the body, such as the lungs, heart, kidney, liver, and nervous system.³

As of the 11^th of January 2022, about 1 in 4 cases in Australia have been in people aged under 20 years.⁴

However, the vast majority of Australian children have not been exposed to or infected with COVID-19. In turn, this leaves them susceptible to the virus.

Both adults and children with underlying health conditions are at higher risk of experiencing more severe COVID-19 symptoms.

Recent data from New South Wales shows that infants (especially those born before 36 weeks gestation), adolescents, as well as children with certain conditions (e.g., obesity, asthma and chronic lung conditions) are at greater risk of hospitalisation from COVID-19.² Households with children who have underlying health conditions need to take greater care to ensure they are practising social distancing, maintaining good personal hygiene, and receiving COVID-19 vaccines if able to do so.

Global data also shows that some immunocompromised children are at greater risk of severe COVID-19, including children receiving chemotherapy for cancer.^{5, 6} Given immunocompromised people may not respond to the COVID-19 vaccine in the same way as people who don’t have compromised immune systems, it’s recommended that children aged 5 years and over with certain immunocompromising conditions receive 3 primary doses of a COVID-19 vaccine (compared to the general population receiving 2 primary doses).⁷

During the Delta wave in NSW infants aged younger than 6 months were more likely to require hospitalisation compared to older children,² consistent with data from the US.⁸

Although infant vaccination is not yet available, an increasing number of studies have shown very efficient transfer for protective antibodies from the mum to the baby, following COVID-19 vaccination during the second trimester of pregnancy, prior to conception or following a third-trimester booster.^9-11 

Worldwide, very few infants have died from COVID-19, with most cases also having serious underlying health issues. If your child has an underlying health issue and you are especially concerned, it is recommended that you contact your GP for further advice about managing their health.

For pregnant mothers and their unborn babies, catching COVID-19  increases the risk^{12, 13} of:

• premature birth
• fetal distress
• preeclampsia/eclampsia
• admission to a hospital newborn care unit
• admission to an intensive care unit.

Just as pregnant women protect themselves and their babies against whooping cough and influenza with vaccines, it is recommended they also get vaccinated at any stage of pregnancy against COVID-19. The Pfizer or Moderna vaccines are currently approved for pregnant women. For those who can breastfeed, emerging evidence suggests that those who were vaccinated in pregnancy are able to pass on some immunity to their baby through breastfeeding.^{14, 15} It is also safe to get the vaccine while breastfeeding.

Hospitalisation in children with COVID-19 occurs much less often compared to adults and the elderly.

This explains why the vaccination program targeted older people first – to keep them well and out of hospital. In Australia in 2021, less than 3% of children aged younger than 16 years with COVID-19 were hospitalised due to COVID-19, compared to more than 30% of people aged over 60 years with COVID-19.¹⁶ More severe outcomes can occur but are rare, with 1 in 1000 children with COVID-19 being admitted to an Intensive Care Unit (ICU).¹⁶

Many hospitalised children in Australia haven’t been hospitalised because they have been unwell, but because their carer’s were too ill to look after them.² These numbers show that, although children are getting infected with COVID-19, 97% don’t require hospitalisation,¹⁶ indicating a mild infection. And within the 3% of children who did need hospitalisation, two-thirds were for social admissions, and not for medical need. Across the globe, some children will need hospital level care to manage their infection, whilst many children are incidentally found to have a positive COVID test when they go to hospital for another reason due to widespread testing that is occurring. Sometimes this can make the case numbers of children in hospital seem worrying – but on the whole, there are few children who get seriously unwell.

The Omicron variant was first reported in November 2021 and has spread globally with cases now in Australia.

We are quickly learning more about this variant including how easily it spreads, whether it is more or less severe than other variants, and whether our current vaccines provide effective protection. From what we currently know, most children who get Omicron will only experience a mild infection, much like other variants. Of the confirmed Omicron cases in NSW between 26^th November 2021 to 1^st January 2022, 2% were in children aged less than 10 years, and 17% were in children aged 10 – 19 years.¹⁷ Early data from the UK suggests that there may be a lower risk of hospitalisation among Omicron cases in children aged 5 to less than 17 years, compared to hospitalisation among Delta cases in children,¹⁸ which is what is being identified in NSW, too.¹⁷

While there’s no publicly available data as yet on how effective the vaccine is against Omicron specifically for children, the estimated vaccine effectiveness against severe disease due to Omicron six months after an adult has received the second Pfizer dose is 71%, which is raised to 98% after a booster.¹⁹ It is therefore likely that Pfizer and other mRNA vaccines are still effective at protecting against severe disease due to Omicron even six months after their second vaccine.

We do not yet completely understand the long-term effects of contracting COVID-19, and so “long COVID” in kids will be watched very carefully. Early data suggests some children with COVID-19 can have symptoms such as:

• Headache
• Fatigue
• Sleep disturbance
• concentration difficulties
• Abdominal pain

These symptoms can last for up to 12 weeks after COVID-19 symptoms first appear.²⁰ Some children are also developing a rare condition called ‘Multisystem Inflammatory Disease in Children (MIS-C), otherwise known as Paediatric Inflammatory Multisystem Syndrome (PIMS-TS). Between June – October 2021, about 1 in every 2,500 children in NSW with COVID-19 went on to develop MIS-C/PIMS-TS.² Symptoms include a persistent fever, abdominal pain, vomiting, diarrhoea, a rash, conjunctivitis (red eyes), and a headache appearing within 6 weeks of a COVID-19 infection. Most children who develop MIS-C/PIMS-TS after COVID-19 require treatment in hospital,^{21, 22} and the majority of these children are unvaccinated, particularly the cases requiring care in an ICU.^{22, 23}

COVID-19 is spready by:

• Breathing in the air when close to someone with COVID-19, or small droplets exhaled by the person with COVID-19 while talking, coughing, or sneezing near you landing on your eyes, nose or mouth
• Touching your eyes, nose or mouth with hands that have COVID-19 on them

There are therefore several ways to reduce the risk of contracting and/or spreading COVID-19, including:

• Physical distancing
• Frequent hand washing with soap, or using hand sanitiser
• Wearing well-fitted masks over mouth and nose
• Staying home when unwell
• Covering coughs and sneezes
• Vaccination (if aged 5 years or older)

It’s important to teach children these preventative measures. In the event of a COVID-19 outbreak, it’s also very important to follow the public health advice at the time to protect both children and adults. With the WA border opening, it’s likely we will see more COVID-19 cases than we have so far. WA Health provides up-to-date information on what you and your family should be doing to protect yourselves against COVID-19 here: https://www.healthywa.wa.gov.au/COVID19

In the 2020 outbreak, children were considered to have a small role in transmission.

In fact, it was young and mobile adults that were the biggest transmitters in the community. However, as new, more transmissible variants have emerged, and as more adults become vaccinated, young children are playing a larger role in transmission. As more children get vaccinated, they will be less likely to pass the virus on.

If your child becomes unwell with COVID-19, you can look after them by^{24, 25}:

• Ensuring they drink lots of fluids
• Providing pain relief medication (e.g. paracetamol) if they are in pain or have a fever
• Encouraging them to rest
• Ensuring they’re wearing comfortable clothing, so they don’t get too hot or too cold

Also keeping an eye on symptoms.²⁴ Children will need urgent medical attention if they:

• Have a fever for more than 5 days
• Have difficulty breathing or chest pain
• Have severe abdominal pain, vomiting and/or diarrhoea
• Are drinking less or passing less than half of the amount of urine they usually would
• Are sleepy or irritable

There are several ways to reduce spreading COVID-19 in the home.²⁶ It is a good idea to:

• Frequently wipe down commonly touched surfaces, such as benches, taps and door handles, with an alcohol-based sanitiser or soap and water
• All household members should wash hands often and for at least 20 seconds
• Reduce contact between individuals with COVID-19 in the household, and wear a mask when in the same room. WA Health currently recommends wearing single use surgical face masks, or fitted reusable fabric masks²⁷
• Thoroughly wash any common household items used by the person with COVID-19, such as cups, eating utensils, bedding, and towels.
• Where possible, for those infected to use separate toilets and sleep in a separate well-ventilated room

We acknowledge that this may be hard or impractical for some households, especially for parents of very young children who need greater care and supervision. It’s a good idea for any people aged 18 years and older to receive a booster vaccine as soon as they can, to reduce the chance of also becoming ill while living with someone with COVID-19.

1. Molteni E, Sudre CH, Canas LS, et al. Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2. The Lancet Child & Adolescent Health. 2021;5(10):708-718.
2. Williams P, Koirala A, Saravanos G, et al. COVID-19 in children in NSW, Australia, during the 2021 Delta outbreak: severity and disease spectrum. medRxiv. 2022.
3. Zaim S, Chong JH, Sankaranarayanan V, et al. COVID-19 and multiorgan response. Current problems in cardiology. 2020;45(8):100618.
4. Department of Health. Coronavirus (COVID-19) case numbers and statistics: Australian Government; 2022 [cited 2022 Jan]. Available from: https://www.health.gov.au/health-alerts/covid-19/case-numbers-and-statistics#cases-and-deaths-by-age-and-sex.
5. Mukkada S, Bhakta N, Chantada GL, et al. Global characteristics and outcomes of SARS-CoV-2 infection in children and adolescents with cancer (GRCCC): a cohort study. The Lancet Oncology. 2021;22(10):1416-1426.
6. Haeusler GM, Ammann RA, Carlesse F, et al. SARS-CoV-2 in children with cancer or after haematopoietic stem cell transplant: An analysis of 131 patients. European Journal of Cancer. 2021;159:78-86.
7. Australian Technical Advisory Group on Immunisation (ATAGI). ATAGI recommendations on the use of a third primary dose of COVID-19 vaccine in individuals who are severely immunocompromised: Australian Government; 2022 [cited 2022 Jan]. Available from: https://www.health.gov.au/resources/publications/atagi-recommendations-on-the-use-of-a-third-primary-dose-of-covid-19-vaccine-in-individuals-who-are-severely-immunocompromised.
8. Hobbs CV, Woodworth K, Young CC, et al. Frequency, characteristics and complications of COVID-19 in hospitalized Infants. The Pediatric Infectious Disease Journal. 2021.
9. Yang YJ, Murphy EA, Singh S, et al. Association of Gestational Age at Coronavirus Disease 2019 (COVID-19) Vaccination, History of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection, and a Vaccine Booster Dose With Maternal and Umbilical Cord Antibody Levels at Delivery. Obstetrics & Gynecology. 2021:10.1097.
10. Kugelman N, Nahshon C, Shaked-Mishan P, et al. Maternal and Neonatal SARS-CoV-2 Immunoglobulin G Antibody Levels at Delivery After Receipt of the BNT162b2 Messenger RNA COVID-19 Vaccine During the Second Trimester of Pregnancy. JAMA pediatrics. 2021.
11. Treger S, Shiloh SR, Ben-Valid T, et al. Transplacental transfer of SARS-CoV-2 antibodies in recovered and BNT162b2-vaccinated patients. American Journal of Obstetrics & Gynecology. 2021.
12. Allotey J, Stallings E, Bonet M, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. Bmj. 2020;370.
13. Villar J, Ariff S, Gunier RB, et al. Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection: The INTERCOVID Multinational Cohort Study. JAMA Pediatrics. 2021;175(8):817-826.
14. Perl SH, Uzan-Yulzari A, Klainer H, et al. SARS-CoV-2–Specific Antibodies in Breast Milk After COVID-19 Vaccination of Breastfeeding Women. JAMA. 2021;325(19):2013-2014.
15. Kelly JC, Carter EB, Raghuraman N, et al. Anti–severe acute respiratory syndrome coronavirus 2 antibodies induced in breast milk after Pfizer-BioNTech/BNT162b2 vaccination. American Journal of Obstetrics & Gynecology. 2021.
16. COVID-19 National Incident Room Surveillance Team. COVID-19 Australia: Epidemiology Report 55. Communicable Diseases Intelligence. 2021;45.
17. NSW Health. COVID-19 weekly surveillance in NSW: epidemiological week 52 ending 1 January 2022. 2022 [cited 2022 Jan]. Available from: https://www.health.nsw.gov.au/Infectious/covid-19/Documents/covid-19-surveillance-report-20220113.pdf.
18. UK Health Security Agency. SARS-CoV-2 variants of concern and variants under investigation in England. Technical briefing: Update on hospitalisation and vaccine effectiveness for Omicron VOC-21NOV-01 (B.1.1.529) 2021 [cited 2022 Jan]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1045619/Technical-Briefing-31-Dec-2021-Omicron_severity_update.pdf.
19. Khoury DS, Steain M, Triccas J, et al. Analysis: A meta-analysis of Early Results to predict Vaccine efficacy against Omicron. medRxiv. 2021.
20. Zimmermann P, Pittet LF, Curtis N. How common is long COVID in children and adolescents? The Pediatric infectious disease journal. 2021;40(12):e482.
21. Rubens JH, Akindele NP, Tschudy MM, et al. Acute covid-19 and multisystem inflammatory syndrome in children. bmj. 2021;372.
22. Zambrano LD, Newhams MM, Olson SM, et al. Effectiveness of BNT162b2 (Pfizer-BioNTech) mRNA vaccination against multisystem inflammatory syndrome in children among persons aged 12–18 Years—United States, July–December 2021. 2022.
23. Levy M, Recher M, Hubert H, et al. Multisystem inflammatory syndrome in children by COVID-19 vaccination status of adolescents in France. JAMA. 2021.
24. Health Direct. Caring for someone with COVID-19: Australian Government Department of Health; 2021 [cited 2022 Jan]. Available from: https://www.healthdirect.gov.au/managing-covid-19/caring-for-someone-with-covid-19#child.
25. McMullan B, Britton P. Got a child with COVID at home? Here’s how to look after them: The Conversation; 2021 [cited 2022 Jan]. Available from: https://theconversation.com/got-a-child-with-covid-at-home-heres-how-to-look-after-them-166732.
26. Health Direct. Caring for people with COVID-19: Australian Government Department of Health; 2021 [cited 2022 Jan]. Available from: https://www.healthdirect.gov.au/coronavirus-covid-19-information-for-carers-faqs.
27. Department of Health. Preparing for COVID in the WA community: Government of Western Australia; 2022 [cited 2022 Jan]. Available from: https://www.healthywa.wa.gov.au/Articles/A_E/Coronavirus/Preparing-for-COVID-in-the-WA-community.
28. WA Department of Education, WA Department of Health, Telethon Kids Institute. DETECT schools study: understanding the impact of COVID-19 in Western Australian schools 2021 [cited 2022 Jan]. Available from: https://www.telethonkids.org.au/globalassets/media/documents/projects/detect-schools-study-final-report-and-appendices.pdf.
29. Racine N, McArthur BA, Cooke JE, et al. Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis. JAMA Pediatrics. 2021;175(11):1142-1150.
30. Juno J, Wheatley A. Are new COVID variants like Omicron linked to low vaccine coverage? Here’s what the science says: The Conversation; 2021 [cited 2022 Jan]. Available from: https://theconversation.com/are-new-covid-variants-like-omicron-linked-to-low-vaccine-coverage-heres-what-the-science-says-170262.
31. NSW Health. COVID-19 monitor: COVID-19 cases, variants, vaccines, hospitalisations and deaths 2022 [cited 2022 Jan]. Available from: https://aci.health.nsw.gov.au/__data/assets/pdf_file/0006/698388/20220104-COVID-19-Monitor.pdf?fbclid=IwAR0MP3YtaypZy3QNYyQHMEPgC-p02Bkz69byB3PMk-t5NtcUKsoi2W1zX_4.
32. Therapeutic Goods Administration. COVID-19 vaccine weekly safety report - 06-01-2022: Australian Government; 2022 [cited 2022 Jan]. Available from: https://www.tga.gov.au/periodic/covid-19-vaccine-weekly-safety-report-06-01-2022.
33. Singer ME, Taub IB, Kaelber DC. Risk of Myocarditis from COVID-19 Infection in People Under Age 20: A Population-Based Analysis. medRxiv. 2021.
34. Australian Technical Advisory Group on Immunisation (ATAGI), Cardiac Society of Australia and New Zealand (CSANZ), Royal Australian College of General Practitioners (RACGP), et al. Guidance on myocarditis and pericarditis after mRNA COVID-19 vaccines: Australian Government; 2021 [cited 2022 Jan]. Available from: https://www.health.gov.au/sites/default/files/documents/2021/11/covid-19-vaccination-guidance-on-myocarditis-and-pericarditis-after-mrna-covid-19-vaccines_1.pdf.
35. AusVaxSafety. COVID-19 vaccines 2021 [cited 2022 Jan]. Available from: https://ausvaxsafety.org.au/safety-data/covid-19-vaccines.
36. Bentov Y, Beharier O, Moav-Zafrir A, et al. Ovarian follicular function is not altered by SARS–CoV-2 infection or BNT162b2 mRNA COVID-19 vaccination. Human Reproduction. 2021;36(9):2506-2513.
37. Orvieto R, Noach-Hirsh M, Segev-Zahav A, et al. Does mRNA SARS-CoV-2 vaccine influence patients' performance during IVF-ET cycle? Reproductive Biology and Endocrinology. 2021;19(1):69.
38. Morris RS. SARS-CoV-2 spike protein seropositivity from vaccination or infection does not cause sterility. F&s Reports. 2021.
39. Gonzalez DC, Nassau DE, Khodamoradi K, et al. Sperm Parameters Before and After COVID-19 mRNA Vaccination. JAMA. 2021;326(3):273-274.
40. Wise M. No, COVID-19 vaccines don’t affect women’s fertility The Conversation; 2021 [cited 2022 Jan]. Available from: https://theconversation.com/no-covid-19-vaccines-dont-affect-womens-fertility-168568.
41. Edelman A, Boniface ER, Benhar E, et al. Association between menstrual cycle length and coronavirus disease 2019 (COVID-19) vaccination: a U.S. cohort. Obstetrics & Gynecology. 2022:10.1097/AOG.0000000000004695.
42. Department of Health. Clinical recommendations for COVID-19 vaccines: Australian Government; 2022 [cited 2022 Jan]. Available from: https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/advice-for-providers/clinical-guidance/clinical-recommendations.
43. Australian Technical Advisory Group on Immunisation (ATAGI). ATAGI recommendations on the use of the paediatric Pfizer COVID-19 vaccine in children aged 5 to 11 years in Australia: Australian Government; 2021 [cited 2022 Jan]. Available from: https://www.health.gov.au/sites/default/files/documents/2021/12/atagi-recommendations-on-pfizer-covid-19-vaccine-use-in-children-aged-5-to-11-years_0.pdf.
44. Debes AK, Xiao S, Colantuoni E, et al. Association of vaccine type and prior SARS-CoV-2 infection with symptoms and antibody measurements following vaccination among health care workers. JAMA internal medicine. 2021;181(12):1660-1662.
45. Olson SM, Newhams MM, Halasa NB, et al. Effectiveness of Pfizer-BioNTech mRNA Vaccination Against COVID-19 Hospitalization Among Persons Aged 12-18 Years-United States, June-September 2021. MMWR Morbidity and mortality weekly report. 2021;70(42):1483.
46. Olson SM, Newhams MM, Halasa NB, et al. Effectiveness of BNT162b2 Vaccine against Critical Covid-19 in Adolescents. New England Journal of Medicine. 2022.
47. Ali K, Berman G, Zhou H, et al. Evaluation of mRNA-1273 SARS-CoV-2 vaccine in adolescents. New England Journal of Medicine. 2021;385(24):2241-2251.
48. Pfizer. Pfizer and BioNTech provide update on ongoing studies of COVID-19 vaccine 2021 [cited 2022 Jan]. Available from: https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-provide-update-ongoing-studies-covid-19.
49. Moderna. A clinical trial of a COVID-19 vaccine in children (ages 6 months to 12 years) 2022 [cited 2022 Jan]. Available from: https://trials.modernatx.com/study/?id=mRNA-1273-P204.
50. Hause A, Baggs J, Marquez P, et al. COVID-19 Vaccine Safety in Children Aged 5–11 Years—United States, November 3–December 19, 2021. MMWR Morbidity and mortality weekly report. 2021;70:1755-1760.
51. Walter EB, Talaat KR, Sabharwal C, et al. Evaluation of the BNT162b2 Covid-19 vaccine in children 5 to 11 years of age. New England Journal of Medicine. 2021;386:35-46.