Fever most common symptom among hospitalized children with COVID
About one-third of children hospitalized with COVID had co-morbidities Heading link
Among children hospitalized with COVID-19 in the U.S., fever was the most common symptom—present in nearly all cases—followed by gastrointestinal and respiratory symptoms, according to a paper published in the Journal of Pediatric Health Care on March 17.
The paper, a review of 23 studies that reported on COVID-19 symptom presentation among 484 children seeking medical care at U.S. hospitals, was authored by UIC College of Nursing researchers Celeste Schultz, PhD, RN-BC, CPNP-PC, Larisa Burke, MPH, and Denise Kent, PhD, APRN.
The authors found that one-third of the pediatric patients seeking medical care had comorbidities (having more than one medical condition), such as HIV, disabilities, neurological disorders, sickle cell disease, and obesity.
The intent of the paper was to analyze data across multiple studies to better understand COVID-19 symptom presentation among hospitalized children, which the authors noted is not as well understood as in adults.
“When we started work on this paper, there were a lot of unanswered questions on COVID in general, and even more questions on COVID symptom presentation in children,” Kent says. “We were all worried. What is the magnitude, what is the significance, of COVID-19 symptoms in our kids? And what is the mortality associated with those that are hospitalized?”
She adds: “We found in our study, thankfully, very low mortality, among children hospitalized with COVID-19.”
Across the studies, thirteen deaths were reported, fewer than 3% of hospitalized cases. (Among all diagnosed pediatric COVID-19 cases in the U.S. – 73 million – fewer than .0001% of children have died, according to the American Academy of Pediatrics).
Fever was reported in 95% of cases of children with COVID-19 seeking medical care, while gastrointestinal symptoms were reported in about 62% of cases and respiratory symptoms in about 52%.
Notably, although loss of smell and taste is often highlighted as a symptom among adults who have contracted COVID-19, almost none of the children across the studies experienced these symptoms.
This might be attributable to the low frequency with which children reported those symptoms, the lack of documentation, or “because children lack the vocabulary to express sensory experiences,” according to the paper.
“We speculate that the loss of smell and taste may be exhibited in behavior and not verbalized to clinicians,” the authors wrote, adding that such behavior could include “poor feeding” and weight loss.
The authors also compared COVID-19 symptoms and outcomes to three other common childhood viral illnesses: influenza, RSV (respiratory syncytial virus) and gastroenteritis.
They found that the frequency of positive COVID-19 lab tests was about 4% in children under four years old and about 6% in children ages 5-17, less than the rate of COVID-19 in adults and the rates of influenza and RSV in children.
Among the four illnesses the authors looked at (COVID-19, flu, RSV and gastroenteritis), children with gastroenteritis had the highest risk mortality as compared to the other viral illnesses, according to the paper.
Although COVID-19 symptoms present like those of other common childhood illnesses, knowing the clustering of symptoms and relationship to health outcomes can be helpful for practitioners caring for children, the authors wrote.
“With this knowledge, practitioners who care for children can be reassured that the incidence of COVID-19 and the risk for poor health outcomes, particularly death, is low,” says Schultz. “Moreover, the management of COVID-19, like other childhood viral illnesses, is making sure that children are well hydrated, have nutritious foods, their fever is managed appropriately, and they are comfortable.”