Coronavirus Pediatric Care Plan

By David Shafran, MD
Medically reviewed
March 19, 2021

What is COVID-19?

Coronaviruses are a group of viruses that cause respiratory infections ranging from a mild cold to more severe pneumonia and less commonly, death. Coronaviruses are highly contagious.

In December 2019, a new human coronavirus, SARS-CoV-2, began causing a respiratory illness called Coronavirus Disease 2019, or COVID-19. The disease was first discovered affecting people in the Hubei province of mainland China but quickly became a global health threat, spreading to other countries including the United States. 

The most common symptoms in children include:

  • fever & chills
  • dry cough 
  • headache
  • diarrhea
  • sore throat
  • muscle aches
  • runny nose

How Does COVID-19 Affect Children?

While children tend to get similar symptoms to adults, they tend to be less severe. Children under the age of 18 are at especially low risk for severe disease.

Risk factors that increase the possibility for severe disease include:

  • asthma or chronic lung disease
  • diabetes
  • genetic, neurologic, or metabolic conditions
  • heart disease since birth
  • weakened immune system
  • obesity

Abdominal symptoms such as vomiting and diarrhea can occur without respiratory symptoms more frequently in children. Different types of rashes have been reported in children as well. “COVID toes” refers to reddish-purple bumps on the ends of the toes but this has not been proven definitively to be caused by COVID-19. 

Multisystem inflammatory syndrome (MIS-C) is an extremely rare but life threatening complication of COVID-19 in children. It is believed to show up 3 to 4 weeks after initial infection with COVID-19 though many children who developed MIS-C never had initial COVID symptoms. Symptoms of MIS-C might be due to dysfunction of the immune system caused by the COVID-19 virus. Since the two diseases can look similar, MIS-C can be mistaken for Kawasaki disease.

MIS-C can cause:

  • persistent fever
  • low blood pressure
  • stomach upset- abdominal pain, nausea, vomiting
  • headache and confusion
  • eye redness
  • swollen hands and feet
  • rash
  • inflammation of the heart muscle

Respiratory symptoms such as cough or shortness of breath are less prominent in MIS-C.

How is COVID-19-diagnosed?

There are two basic coronavirus test options:

  • A diagnostic (viral) test: A nasal swab, saliva test, or oral swab that tells you if you are currently suffering from an active COVID-19 infection. Viral tests can’t tell you if you’ve had an infection in the past.
  • An antibody (serology) test: A blood test that tells you if you have had a COVID-19 infection in the recent past. Serology tests can’t tell you if you have an active infection, only that you’ve already recovered from one. The medical community is still learning about what antibodies against COVID-19 means. Currently we don’t know if having antibodies against COVID-19 provides immunity against the virus in the future.

How is COVID-19 treated?

Children with mild symptoms can be treated at home with supportive care.

Aches and pains

Tylenol – dosed appropriately for age and weight – and ibuprofen can help treat aches and pains.

These medications should not be stopped if used regularly for chronic conditions such as juvenile idiopathic arthritis. 

Additionally, updated research indicates that ibuprofen is not associated with worse outcomes and can be used alongside Tylenol for Covid symptoms. 

Still, make sure you dose at the lowest possible effective dose.

Other Supportive Care

Keep your child hydrated, as hydration thins mucus and clears toxins.

Soothe a sore throat by:

  • Give hard candy or cough drops 
  • Sip warm chicken broth
  • Some children prefer cold foods such as popsicles or ice cream.
  • Warm salt water gargles

For a cough, try 1 teaspoon of honey, cough drops, or sucking candies.

Go to the emergency room if your child…

  • develops shortness of breath or chest pain
  • is not drinking and might be dehydrated
  • becomes less responsive or extremely weak

Check in with K if…

Your child’s symptoms are not improving within 3-4 days or are improving but do not totally resolve after 14 days

Frequently Asked Questions

What if a parent or caregiver has COVID-19?

If possible, having another family member or caregiver take care of the children to allow the sick parent to self-quarantine and self-care. If an ill parent leaves the quarantine room of the house, recommend wearing a mask and limit time in common household areas.  Good hand washing and frequent disinfection of the common surfaces in the home can help prevent transmission of the virus. See CDC for caregivers.

Should I get my child tested for COVID?

Children who have symptoms consistent with COVID-19 should be tested if:

  • Presence of an underlying condition that increases their risk for severe disease such as
    • asthma or chronic lung disease
    • diabetes
    • genetic, neurologic, or metabolic conditions
    • heart disease since birth
    • weakened immune system
    • obesity
  • There is a known exposure (being within 6 feet for more than 15min) to COVID-19 positive person within past 14 days
  • There are severe illness symptoms
  • Concerned for Multisystem Inflammatory Syndrome (MIS-C)
  • Clearance to return to school or sports is required
  • Clearance for a medical procedure is required

If your child does not have symptoms after an exposure to a confirmed COVID positive person, wait at least 4 days before taking your child to get tested to ensure most accurate results.

After an exposure to or having COVID-19 when can my child return to school or sports?

Exposure without symptoms:

  • Self isolate for 14 days because it can take that long for symptoms to appear
  • Stay home as much as possible and away from people with whom you share a living space,
  • Avoid sharing personal household items, and
  • Clean all “high-touch” surfaces daily

After having COVID-19:

  • Your child must isolate for ten days after the start of symptoms
  • Be fever-free for at least 24 hours without the use of anti-fever medications, and
  • Symptoms have improved before ending isolation

Should I and my child get the COVID vaccine?

The COVID vaccines are highly safe and effective at preventing symptomatic covid-19 infection. Other vaccines are in development as well. Studies in children have commenced but none of the vaccines are yet approved for children under the age of 16.

Target Population: The Pfizer emergency use authorization is for people aged 16 and older. Moderna’s is for people 18 and older.

Vaccine Efficacy: Both vaccines have shown astonishing — and essentially equivalent — degrees of efficacy at ~94%. 

Dosing: Both company’s COVID vaccines require two shots: a priming dose, followed by a booster shot. The interval between Moderna doses is 28 days; for the Pfizer vaccine, it’s 21 days. The two vaccines are not interchangeable. You are recommended to get both vaccine doses from the same manufacturer.

Side Effects:

The most common side effects are injection site pain, fatigue, headache, muscle pain, and joint pain.

To be clear: These side effects are a sign of an immune system kicking into gear. They do not signal that the vaccine is unsafe. To date there are no serious, long-term side effects associated with receipt of these vaccines.

If you have ever had a severe allergic reaction to any ingredient in a COVID-19 vaccine, CDC recommends that you should not get that specific vaccine. If you have had a severe allergic reaction to other vaccines or injectable therapies, you should ask your doctor if you should get a COVID-19 vaccine. 

CDC recommends that people with a history of severe allergic reactions not related to vaccines or injectable medications—such as allergies to food, pet, venom, environmental, or latex—may still get vaccinated.

If you have a severe allergic reaction after getting the first shot, you should not get the second shot.

For more frequently asked questions about the COVID vaccine in children visit the AAP’s website

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

David Shafran, MD

Dr. Shafran is a board-certified pediatrics physician. He joins K Health from the Cleveland Clinic, where he led a pediatrics practice and completed a fellowship in transplant ethics. He has completed multiple fellowships, including one in pediatric nephrology at Rainbow, Babies & Children's University Hospitals. He received his medical degree from the Sackler School of Medicine in Tel Aviv and completed his medical residency at the Jacobi Medical Center.