Experts have found that fewer children have contracted coronavirus—and kids who have gotten it display milder cold-like symptoms. Find out some of the theories behind this baffling trend.

By Nicole Harris
Updated March 10, 2020
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The novel coronavirus SARS-CoV-2 (and the illness it causes, COVID-19) has the entire world on edge, but perhaps nobody is as concerned as parents. It can seem impossible to shield children from illnesses when germs are unpredictable and omnipresent. And the fact that coronavirus is spreading in America—where it’s caused 163 illnesses and 11 deaths so far—also doesn’t help parental anxiety.

But here’s a bit of optimistic news for moms and dads: Coronavirus doesn’t seem to impact children as severely. A World Health Organization (WHO) - China Joint Mission report on coronavirus, published in mid-February 2020, found that children aged 18 or younger accounted for only 2.4 percent of all coronavirus cases in China.

And the limited research suggests “that children with confirmed COVID-19 have generally presented with mild symptoms,” says the Centers of Disease Control and Prevention (CDC). Severe complications are exceptionally rare in kids. Here's what parents need to know about coronavirus and children, plus tips for preventing the respiratory illness that originated in Wuhan, China.

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What are Coronavirus Symptoms in Children?

Most children with coronavirus have mild cold-like symptoms, such as fever, runny nose, and cough, according to the CDC. Gastrointestinal issues, like vomiting and diarrhea, may also occur. Some children have no symptoms whatsoever.

Coronavirus complications appear to be uncommon for those under 18 years old—even in small infants. In fact, the WHO-China Joint Mission report states that only 2.5 percent of children diagnosed with coronavirus had “severe” symptoms, and 0.2 percent were considered "critical." The recorded complications include acute respiratory distress syndrome and septic shock, according to the CDC.

Why is Coronavirus So Mild for Children?

Since coronavirus is a novel disease, experts still don’t know many things about it—including why children have lower transmission rates and milder symptoms. “We don’t definitively know the reason,” says K.C. Rondello, M.D., M.P.H., CEM. clinical associate professor at the College of Nursing and Public Health at Adelphi University. “Everyone from virologists to epidemiologists to infectious disease doctors are completely stymied as to why we’re seeing this phenomenon.”

Here are a few theories, however, within the medical community:

Kids Have a Better Immune Response

One theory is that children have better immune responses than adults, which helps them fight off coronavirus. “Children’s immune systems are not fully functional until later in their development. As a result, they have a considerably stronger and more robust immune response to pathogens than adults,” explains Dr. Rondello.

What’s more, “The death rate for COVID-19 is higher among individuals with certain pre-existing conditions, such as cardiovascular disease, diabetes, and cancer. This may help explain why many children seem to be at lower risk, since they are less likely to have these types of preexisting conditions,” says Aimee Ferraro M.D., faculty member for Walden University’s Master of Public Health (MPH).

Many experts tentatively support the hypothesis, but there’s also a hitch: Coronavirus seems to spare newborns even though their immune systems aren’t fully formed yet. In China, for example, only nine infants had confirmed coronavirus cases between December 8 and February 6, according to a February 14 report published in JAMA. The infants were between 1 month and 11 months old, but none required intensive care. No severe complications were reported either.

Experts Might Not Be Identifying All Coronavirus Cases

Robert Frenck M.D., medical director of the Division of Infectious Diseases at Cincinnati Children’s Hospital, says that a reporting bias might be to blame. When coronavirus first emerged, doctors in America and China were only testing people with severe symptoms. But they’ve since found that milder, cold-like symptoms may also occur.

“It’s possible that the coronavirus causes a spectrum of illnesses, and that medical organizations are only identifying the more serious ones,” summarizes Dr. Frenck. Children might not be getting diagnosed if they’re only experiencing mild symptoms—which means coronavirus may be affecting more children (and people in general) than reported.

Kids Could Have "Immunological Cross-Protection"

According to Dr. Rondello, a number of different viruses could give you the common cold—including milder forms of coronavirus. “Children get colds a lot, so they’re already being exposed to more benign, less intense coronaviruses. They could have potentially built immunity to them,” he says. Dr. Rondello calls this “immunological cross-protection.”

Kids Could Have Less Exposure

Other experts say kids might simply have less exposure to coronavirus, since infected adults are more careful to prevent the spread of sickness, according to Business Insider. Plus, the article adds, more adults probably visited the presumed source of coronavirus: the seafood and live animal market in Wuhan, China.

Smoking is a Potential Risk Factor

An earlier theory suggested that smoking might be a risk factor for COVID-19, since smokers tend to have greater SARS-COV receptors. “And since children do not smoke, they would be less susceptible to lower respiratory tract infections like COVID-19,” says Dr. Ferraro. This hypothesis has fallen out of favor, though, since experts found that coronavirus transmission was comparable in counties with both high levels and low levels of smoking.

How to Prevent Coronavirus in Children

Like the cold and flu, coronavirus is a respiratory illness that spreads through contaminated droplets. These droplets enter the body through the eyes, nose, and mouth, says Miryam Wahrman, PhD, biology professor and director of the microbiology research lab at William Paterson University in Wayne, New Jersey, and author of The Hand Book: Surviving in a Germ-Filled World.

The absolute best coronavirus prevention method, says Dr. Wahrman, is washing your hands with soap and water for at least 20 seconds. Alcohol-based hand sanitizer can also work in a pinch. Washing your hands is especially important before eating or touching your face. Parents should also disinfect common surfaces like doorknobs and countertops often.

Send your children to school like normal, but watch for updates from the school board or health organizations. The CDC has said that a coronavirus outbreak in America is “imminent,” and that parents should prepare for potential school closures. Indeed, schools have been shut down in Seattle, New York, and other areas impacted by the disease.

“You can also give children disposable wipes so they can clean commonly used surfaces like keyboards at school,” adds Dr. Ferraro. “Parents should keep their children home from daycare or school if they are sick, and call their healthcare provider early to discuss the best approach for treatment.”

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.

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