Revisions were made on August 14, 2020 to reflect new evidence about COVID-19 in children.
This guidance is intended to inform pediatric healthcare providers of up-to-date information about children with suspected or confirmed COVID-19 and about caring for children during the pandemic. Children are defined as age 1 month to 18 years for the purpose of this document.
For healthcare providers caring for neonates (≤28 days old) with suspected or confirmed COVID-19, including those born to a mother with suspected or confirmed COVID-19, please refer to CDC guidance for evaluating and managing neonates at risk for COVID-19.
Incidence of COVID-19 in Children
In the United States and globally, fewer cases of COVID-19 have been reported in children (age 0-17 years) compared with adults.1,2 While children comprise 22% of the US population,3 recent data show that 7.3% of all cases of COVID-19 in the United States reported to CDC were among children (as of August 3rd, 2020).4 The number and rate of cases in children in the United States have been steadily increasing from March to July 2020. The true incidence of SARS-CoV-2 infection in children is not known due to lack of widespread testing and the prioritization of testing for adults and those with severe illness. Hospitalization rates in children are significantly lower than hospitalization rates in adults with COVID-19, suggesting that children may have less severe illness from COVID-19 compared to adults.5, 6 Visit CDC’s Cases, Data, and Surveillance page for current CDC data.
Infections and Transmission Among Children
It is unclear whether children are as susceptible to infection by SARS-CoV-2 compared with adults and whether they can transmit the virus as effectively as adults. Recent evidence suggests that children likely have the same or higher viral loads in their nasopharynx compared with adults7 and that children can spread the virus effectively in households and camp settings.8,9
Due to community mitigation measures and school closures, transmission of SARS-CoV-2 to and among children may have been reduced in the United States during the pandemic in the spring and early summer of 2020. This may explain the low incidence in children compared with adults. Comparing trends in pediatric infections before and after the return to in-person school and other activities may provide additional understanding about infections in children.
The incubation period of SARS-CoV-2 appears to be about the same for children as in adults, at 2-14 days with an average of 6 days.10
Signs or symptoms of COVID-19 in children include:
- Nasal congestion or rhinorrhea
- New loss of taste or smell
- Sore throat
- Shortness of breath or difficulty breathing
- Abdominal pain
- Nausea or vomiting
- Poor appetite or poor feeding
Children infected with SARS-CoV-2 may have many of these non-specific symptoms, may only have a few (such as only upper respiratory symptoms or only gastrointestinal symptoms), or may be asymptomatic. The most common symptoms in children are cough and/or fever.11-15 A recent systematic review estimated that 16% of children with SARS-CoV-2 infection are asymptomatic,16 but evidence suggests that as many as 45% of pediatric infections are asymptomatic.17 The signs and symptoms of COVID-19 in children are similar to other infections and noninfectious processes, including influenza, streptococcal pharyngitis, and allergic rhinitis. The lack of specificity of signs or symptoms and the significant proportion of asymptomatic infections make symptom-based screening for identification of SARS-CoV-2 in children particularly challenging.17
Severity of Illness in Children
While children infected with SARS-CoV-2 are less likely to develop severe illness compared with adults, children are still at risk of developing severe illness and complications from COVID-19. Recent COVID-19 hospitalization surveillance data shows that the rate of hospitalization among children is low (8.0 per 100,000 population) compared with that in adults (164.5 per 100,000 population), but hospitalization rates in children are increasing. 5 While children have lower rates of mechanical ventilation and death than adults, 1 in 3 children hospitalized with COVID-19 in the United States were admitted to the intensive care unit, which is the same in adults.5
Current evidence suggests that children with certain underlying medical conditions and infants (age <1 year) might be at increased risk for severe illness from SARS-CoV-2 infection.1