What to Know About COVID in Babies and Toddlers
The threat of COVID-19 is unfortunately a part of life and, as a parent, that can feel extra scary. After all, we want to do everything we can to protect our kids and our families. With so much information (and misinformation) out there, it’s hard to distinguish the facts from fiction. That’s why we’re sharing information straight from infectious disease experts. What are the COVID symptoms in babies and toddlers to look out for, and can young children even be tested for the virus? Moreover, when can kids get the COVID vaccine? Here’s what you need to know, plus tips to keep your kids safe.
In this article:
What is coronavirus?
Can babies get COVID?
Risks of COVID in babies and toddlers
COVID symptoms in babies and toddlers
When to test for COVID in babies and toddlers
How to treat COVID in babies and toddlers
When can kids get the COVID vaccine?
How to protect your child against COVID
Human coronaviruses are actually fairly common, according to the Centers for Disease Control and Prevention (CDC). There are seven different types of coronaviruses known to scientists, and most of them cause mild illness like colds, says William Schaffner, MD, an infectious disease specialist and professor at the Vanderbilt University School of Medicine in Nashville, Tennessee. However, three types of coronavirus can cause more severe illness. Those include MERS-CoV, SARS-CoV and SARS-CoV-2, which causes COVID-19.
While COVID-19 has been considered highly transmissible since its initial emergence, certain strains, including the Delta and Omicron variants, are especially contagious. “This virus is transmitted in a way that’s very similar to influenza or any of the seasonal common cold viruses,” says Juan Salazar, MD, a pediatric infectious disease specialist and physician in chief at Connecticut Children’s. “Exposure to someone who is coughing or has a runny nose will pose a risk of transmission.” It’s also possible to get COVID from touching surfaces with your hands and then touching your face, eyes or mouth with your hands, he says, although this is far less common.
Unfortunately, babies can get COVID-19. David Cennimo, MD, assistant professor of pediatric infectious disease at Rutgers New Jersey Medical School, says that, initially, young children weren’t getting the virus quite as much as adults, but the emergence of highly contagious variants changed the landscape.
Like everyone else, babies “usually get COVID from being around somebody else who is infected,” says Danelle Fisher, MD, FAAP, a pediatrician and chair of pediatrics at Providence Saint John’s Health Center in Santa Monica, California. It could be their parents, siblings or other family members. “Babies can also get COVID at places like daycare,” she says.
In general, babies and kids who contract COVID-19 tend to fare well. “Most children appear to only have very mild signs and symptoms when they get infected with the virus,” Salazar says. Some children can even be asymptomatic, meaning they show no symptoms at all when they become infected, says Richard Watkins, MD, an infectious disease physician in Akron, Ohio, and a professor of medicine at the Northeast Ohio Medical University. However, just as with adults, COVID in babies and children can potentially cause serious complications, like pneumonia and even death.
But acute illness isn’t the only potential danger. “The other concern is that they may have a mild initial course but can go on to develop Multisystem Inflammatory Syndrome in Children (MIS-C), and that can be life-threatening,” says Jennifer Schwab, MD, a pediatrician at Rocky Hill Pediatrics and Connecticut Children’s Medical Center. This is concerning, of course; still, it’s important to remember that MIS-C is rare, as emphasized by the American Academy of Pediatrics.
Multisystem Inflammatory Syndrome in children
While most kids recover well from COVID-19, a potential complication can lead to Multisystem Inflammatory Syndrome in children (MIS-C). This is a condition where different body parts and organs can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs, according to the CDC.
To date, there have been over 6,400 confirmed MIS-C cases diagnosed across the country, according to CDC data, and there’s still a lot that’s unknown about it. MIS-C is most likely to occur after a COVID infection, says John R. Schreiber, MD, MPH, interim chief of pediatric infectious diseases at Connecticut Children’s Medical Center. While children with MIS-C—usually above the age of 3—often test negative for COVID-19, “about 80 percent of the children who have MIS-C have antibodies for SARS-CoV-2, the virus that causes COVID-19,” he says. This, of course, suggests they had been infected with COVID at some point.
Kids with MIS-C develop what Schreiber calls an “abnormal immune response,” where a child’s immune system attacks their own organs. While MIS-C can be very serious, and has been fatal in some cases, with timely medical attention “most of the children who have developed it have done okay,” Schreiber says.
While it’s possible for your child to have COVID without you even knowing it, they’ll most likely present with the same symptoms as adults infected with the virus, Watkins says. According to the CDC, those symptoms include:
- Shortness of breath
- Repeated shaking with chills
- Muscle pain
- Sore throat
- New loss of taste or smell
Runny nose, vomiting and diarrhea have also been reported in children.
“Infants and toddlers may have more mild symptoms or be asymptomatic,” Cennimo says. “In those that do become ill, cough and fever are the most common, but not as prevalent as in adults.” Toddlers and children also “tend to have more gastrointestinal symptoms,” Fisher says, adding, “things like diarrhea and vomiting should be a trigger to get tested.”
If your child is exposed to COVID-19, they might not necessarily develop symptoms right away. The coronavirus incubation period can be anywhere between two and 14 days, Watkins says. If you suspect that your child has been infected, give your pediatrician a call before seeking care—that way, if your little one has, in fact, contracted COVID-19, you won’t risk infecting others. Your doctor can talk you through next steps about testing and ways to limit exposure.
Cold vs. COVID in kids
Other viruses are still circulating too, and that can make it tricky to know if your child has a case of COVID-19 or a simple cold. The truth is that even doctors aren’t readily able to detect the difference without a COVID-19 test to confirm one way or the other. “You can’t tell—that’s the bottom line,” Fisher says. Cennimo agrees. “It would be very difficult to determine if the child is infected with COVID-19 or another seasonal respiratory virus.” To that end, Fisher says, parents and caregivers shouldn’t hesitate to get their child tested for COVID-19 if they have symptoms.
Symptoms of MIS-C
In addition to being on the lookout for COVID symptoms in children, the CDC says to call your child’s doctor if they develop any of the following symptoms related to MIS-C:
- Abdominal pain
- Neck pain
- Bloodshot eyes
- Feeling extra tired
The CDC also urges parents to seek immediate emergency care if your child develops any of these symptoms:
- Trouble breathing
- Pain or pressure in the chest that doesn’t go away
- New confusion
- Inability to wake or stay awake
- Bluish lips or face
- Severe abdominal pain
Wondering if it’s time to head to your local testing site or snag an appointment online? It can be hard to decide, especially if your little one has a perpetual sniffle. “Just a runny nose is probably not COVID,” Schwab says. But if a child has two or three symptoms, like a runny nose and cough, “even if you think it’s just a cold, you should test for COVID,” she adds. It’s better to be safe than sorry and proactively have your child tested to prevent community spread. What’s more, if your child goes to a daycare center or preschool, you’ll want to be mindful of their policies around illness and COVID testing.
If you do decide that it’s time to test, you may be confused by all the current options. A PCR test is considered the gold standard in terms of accuracy. You can get one for your child at the doctor’s office as well as pop-up testing centers and some pharmacies (just make sure the location provides testing services for babies and toddlers; some do and some don’t). Some pediatricians will also do testing right from your car, Schwab says, so you don’t need to worry about moving baby or possibly infecting someone else. The downside to a PCR test is that, as Fisher points out, it can take some time to get results back.
Many doctor’s offices also offer rapid antigen tests, which give results in minutes, but aren’t always as accurate. There are also at-home rapid COVID tests you can take, but Cennimo points out that many are not approved for use in infants and younger children.
Antibody tests won’t tell you if you or your child are currently sick with COVID-19; rather, the test checks your blood for signs of past infection by looking for proteins that the body produces to fight off the disease. Typically, when your body creates antibodies, they provide protection against getting that disease again. However, with COVID-19, that’s not necessarily the case.
As of now, it’s not entirely clear when antibody testing should be used, and the tests themselves come with challenges, says Schreiber. “We only use it in very targeted circumstances, like when a child comes in with symptoms resembling MIS-C,” he says. It hasn’t been thought to be helpful for the general population so far because experts aren’t sure whether a positive result means you’re actually immune to the virus or for how long.
In general, doctors aren’t a huge fan of doing a lot of antibody testing. “I am discouraging of this,” Fisher says, noting that she typically will only do it if there’s a need to check and see what level of protection a child has. “Those antibodies don’t last if you had COVID last year,” she adds. Cennimo agrees: “I don’t like antibody testing because it hasn’t been correlated to immunity—we really don’t know how to interpret it.”
According to the CDC, even if you test positive for COVID-19 antibodies, you should still take proactive measures to protect yourself and others, since the results don’t confirm whether you’re able to transmit the virus.
There aren’t any specific treatments for COVID-19 in babies, toddlers and young children. Instead, doctors aim to treat symptoms. That includes having patients drink fluids, rest and take fever-reducing medications like acetaminophen (Tylenol), Watkins says. In more severe cases, a patient might require supplemental oxygen, he adds. Don’t hesitate to reach out to your doctor if you’re concerned about your child’s escalating symptoms.
The recovery time for a mild case of COVID-19 can take up to two weeks; it could be shorter though. “I’ve seen a lot of kids with very mild infections who only have symptoms for one or two days,” Fisher says. Severe cases, on the other hand, can last three to six weeks or longer for those requiring intensive care, according to the World Health Organization.
If your child (or anyone in your family) is mildly ill with COVID-19, they can likely recover at home. As much as possible, keep them isolated in a specific room in the house (away from other siblings and family members) and, if possible, have them use a separate bathroom. Don’t let them share food, drinking cups, utensils or bedding with others in your house. When caring for a sick child, parents and caregivers should wear a face mask and practice good hand hygiene. (Note, though, that it’s not recommended for children under 2 to wear face coverings.) Monitor your child’s symptoms, and let your pediatrician know if they worsen or if they have any trouble breathing.
Updated CDC guidelines allow asymptomatic individuals or those with resolving symptoms to leave isolation after five days. (They’re advised to wear a mask for an additional five days when around others.) Talk to your family’s pediatrician for personalized advice, and check your local health department’s guidance for more information; since children under 2 can’t wear a mask, babies and toddlers may need to quarantine for longer.
Currently, children ages 5 and up are eligible to get the COVID-19 vaccine in the US. Clinical trials are still in the works for children as young as 6 months old.
In December of 2021, Pfizer and BioNTech released a statement noting that its 3 microgram pediatric dose didn’t provide an adequate immune response in children ages 2 to 5 years old. The pharmaceutical companies plan to continue evaluating and will test a three-dose regimen for 6-month- to 5-year-olds. Unfortunately, this means that vaccines for children under the age of 5 likely won’t be available for some time.
We get it–trying to protect your kids against COVID-19 can be stressful. But there are certain things you can do to keep the virus at bay. The CDC currently recommends doing the following:
Get vaccinated and boosted to reduce your risk of contracting COVID-19 and passing it on to your child.
Get everyone in your family who is over the age of 5 vaccinated against COVID-19.
Wear a protective, well-fitted mask indoors in public places.
Limit visits with people who are not vaccinated.
Try to choose outdoor activities vs. indoor ones whenever possible.
Children 2 and older should wear a face mask that covers their nose and mouth when in a community setting.
Avoid touching your eyes, nose and mouth.
Clean and disinfect frequently touched objects (including toys) and surfaces.
Wash your and your kids’ hands often with soap and water for at least 20 seconds (which is how long it takes to sing “Happy Birthday” twice), especially after going to the bathroom, before eating and after blowing your nose, coughing or sneezing.
If soap and water aren’t available, use an alcohol-based hand sanitizer with at least 60 percent alcohol (but keep in mind that alcohol-based hand sanitizer isn’t recommended for children under the age of 2, according to the AAP.
Masks aren’t recommended for children under the age of 2, but older kids should be wearing a face covering when out in public settings. The risk of coronavirus in young children is real, and masks are a key form of protection. Of course, getting a toddler to wear a mask is easier said than done. Schreiber recommends turning mask-wearing into a game. “Have them pretend to be a mask-wearing superhero,” he suggests. You can also reframe thinking about masks by trying to have your child view it as a reward. “It’s not going to be reliable 100 percent of the time,” Schreiber says. “Some kids are just not going to do it and there’s nothing you can do about it.” But modeling how to wear a mask properly for your child will go a long way—toddlers love mimicking the adults around them.
If you have any questions about COVID in babies and toddlers, talk to your child’s pediatrician. They can offer personalized advice for you and your family.
About the experts:
David Cennimo, MD, is an assistant professor of pediatric-infectious disease at Rutgers New Jersey Medical School, where he also received his medical degree.
Danelle Fisher, MD, FAAP, a pediatrician and chair of pediatrics at Providence Saint John’s Health Center in Santa Monica, California. She earned her medical degree from the Albert Einstein College of Medicine of Yeshiva University in New York.
Juan Salazar, MD, MPH, FAAP, is a pediatric infectious disease specialist and physician in chief at Connecticut Children’s. He also serves as the chair of the department of pediatrics at the UConn School of Medicine. Salazar earned his medical degree from Pontificia Universidad Javeriana in Bogotá, Colombia, in 1986.
William Schaffner, MD, is an infectious disease specialist and professor of preventive medicine at the Vanderbilt University School of Medicine in Nashville, Tennessee. He was a Fulbright scholar and graduated from Cornell University Medical College in 1962. Schaffner is past president of the National Foundation for Infectious Diseases and has served on the executive board for the Infectious Diseases Society of America.
John R. Schreiber, MD, MPH, is the interim chief of pediatric infectious diseases at Connecticut Children’s Medical Center. He also serves as a professor of pediatrics at the University of Connecticut School of Medicine. He earned his medical degree from Tulane University School of Medicine in 1980 and is double board certified in pediatrics and pediatric infectious diseases.
Jennifer Schwab, MD, is a pediatrician at Rocky Hill Pediatrics and Connecticut Children’s Medical Center. She also serves as the division chief of community pediatrics at the University of Connecticut School of Medicine. She earned her medical degree from the University of Massachusetts Medical School.
Richard Watkins, MD, is an infectious disease physician in Akron, Ohio, and a professor of medicine at the Northeast Ohio Medical University. He received his medical degree from American University of the Caribbean School of Medicine.
Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.
Plus, more from The Bump: