COVID-19 in children
Virology
SARS-CoV-2 is an enveloped, positive-sense single-stranded RNA virus, from
beta-coronavirus genera of coronaviridae family. The nomenclature arises from
surface spike (S) proteins giving the appearance of “crown” (latin corona) on
electron microscopy. SARS-CoV-2 enters respiratory epithelial cells by
attaching to angiotensin converting enzyme-2 (ACE-2) via S-protein; ACE-2 is
also a receptor for SARS-CoV-1. Cellular entry is facilitated by proteolytic
cleavage of ACE-2 by trans membrane serine protease-2. Affinity of SARSCoV-2 for ACE-2 is approximately 10–20 times higher than SARS-CoV-1,
which could explain higher infectivity of SARS-CoV-2. ACE-2 is found on
apical membranes of nasal, oral, nasopharyngeal and oropharyngeal mucosal
epithelium, alveolar epithelium, endothelial cells of blood vessels and heart,
renal tubules, and enterocytes in small intestine.
Clinico-Immunological Phases
Clinico-immunological progression suggests that COVID-19 can be divided into
3 phases:
(1) Flu like illness with high viral load;
(2) Critical phase (decreasing viral titres with accelerated inflammatory response
causing lung and end-organ injury); and
(3) Recovery phase. SARS-CoV-2 titres in nasopharyngeal and endotracheal
aspirate specimens are high during first week of symptoms followed by gradual
decline starting at end of first week.
Caring for newborns when the mother has COVID-19
While much is still unknown about the risks of COVID-19 to newborns born to
mothers with COVID-19, we do know that:

COVID-19 is uncommon in newborns born to mothers who had COVID19 during pregnancy.

Some newborns have tested positive for COVID-19 shortly after birth. It
is unknown if these newborns got the virus before, during, or after birth.

Most newborns who tested positive for COVID-19 had mild or no
symptoms and recovered. However, there are a few reports of newborns
with severe COVID-19 illness.
Caring for newborn in the hospital if you are diagnosed with or test positive for
COVID-19.
Current evidence suggests that the risk of a newborn getting COVID-19 from
their mother is low, especially when the mother takes steps (such as wearing a
mask and her washing hands) to prevent spread before and during care of the
newborn.
Breastfeeding and COVID-19
Current evidence suggests that breast milk is not likely to spread the virus to
babies. along with family and healthcare providers, should decide whether and
how to start or continue breastfeeding. Breast milk provides protection against
many illnesses and is the best source of nutrition for most babies.
Among infants born preterm or at low birthweight.
 kangaroo mother care has been shown to reduce infant deaths by as much as
40%, hypothermia by more than 70%, and severe infections by 65%.WHO
advises that mothers should continue to share a room with their babies from
birth and be able to breastfeed and practice skin-to-skin contact – even when
COVID-19 infections are suspected or confirmed - and should be supported to
ensure appropriate infection prevention practices.
 If mother is breastfeeding, can receive a COVID-19 vaccine.
Can newborns get COVID-19?
It appears that women infected with the coronavirus can, in very rare cases, pass
the disease to her baby. Infants can also become infected shortly after being born.
According to the U.S. Centers for Disease Control and Prevention (CDC), most
newborns who test positive for the coronavirus have mild symptoms or none at
all, and recover, but serious cases have occurred. Pregnant women should take
extra precautions to avoid the coronavirus.
Factors protecting children Differences in innate and adaptive immunity
What is multisystem inflammatory syndrome in children (MIS-C)?
Multisystem inflammatory syndrome in children (MIS-C) is a serious condition in
which some parts of the body — such as the heart, lungs, blood vessels, kidneys,
digestive system, brain, skin or eyes — become severely inflamed. Evidence
indicates that many of these children were infected with the COVID-19 virus in
the past, as shown by positive antibody test results, suggesting that MIS-C is
caused by an excessive immune response related to COVID-19.
Possible signs and symptoms of MIS-C include:

Fever that lasts 24 hours or longer

Vomiting & Diarrhea

Pain in the stomach

Skin rash

Fast heartbeat

Rapid breathing

Red eyes

Redness or swelling of the lips and tongue

Feeling unusually tired

Redness or swelling of the hands or feet

Headache, dizziness or lightheadedness

Enlarged lymph nodes
Emergency warning signs of MIS-C include:

Inability to wake up or stay awake

Difficulty breathing

New confusion

Pale, gray or blue-colored skin, lips or nail beds — depending on skin tone

Severe stomach pain
COVID-19 vaccine
If children don’t frequently experience severe illness with COVID-19, why do
they need a COVID-19 vaccine?
 A COVID-19 vaccine can prevent child from getting and spreading
the COVID-19 virus. If child gets COVID-19, a COVID-19 vaccine could
prevent him or her from becoming severely ill.
 Getting a COVID-19 vaccine will also allow child to start doing things that he
or she might not have been able to do because of the pandemic, including not
wearing a mask or social distancing in any setting except where required by a
rule or law.
 To prevent fainting and injuries related to fainting, child should be seated or
lying down during vaccination and for 15 minutes after the vaccine is given.
 After child’s COVID-19 vaccination, will be asked to stay for 15–30 minutes
so child can be observed in case they have a severe allergic reaction and need
immediate treatment.
 What Myocarditis/Pericarditis Symptoms Should I Be on the Lookout for after
mRNA COVID-19 Vaccination?
Be on the lookout for any of the following symptoms:
Chest pain, Shortness of breath,
Feelings of having a fast-beating, fluttering, or pounding heart