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March 20, 2020

Infants may have higher risk of coronavirus complications than older children, studies show

Doctors say that understanding the impact on children is important to slowing the coronavirus pandemic

Children's Health Coronavirus
Infants may have higher risk of COVID-19 complications than older children Source/Pixabay

Infants and preschoolers appear more vulnerable to severe coronavirus cases than other children, who typically develop mild COVID-19 symptoms.

The coronavirus pandemic has mostly spared children while placing seniors and people with compromised immune systems at high risk for severe complications.  

But that doesn't mean the risk to children is nonexistent. 

In China, a 10-month old and a 14-year old have died from COVID-19, according to the Los Angeles Times. And recent studies have shown that infants and preschoolers can be vulnerable to serious illness.

Children with COVID-19 tend to have mild symptoms, or none at all, according to a study of more than 2,100 infected children in China, where the pandemic originated. But they occasionally suffer severe illnesses, with infants having the greatest risk.

Half of the Chinese children who developed critical symptoms were under 1 year of age, according to the study, published Monday in the journal Pediatrics. Overall, 7 infants developed critical symptoms while another 33 babies suffered from severe symptoms.

This vulnerability could be due to the babies' young immune systems.

"The immune systems in children are not weaker than adults. Instead, they are untrained," Bria Coates, an attending physician at Ann & Robert H. Lurie Children's Hospital of Chicago, told Vox.

The immune system gets better at fighting off disease as it matures, Lurie said. Babies also haven't received any built-in immunity to the coronavirus from their mothers, because it is a new virus.

Most data shows COVID-19 's impact on children to be low. Of the first 72,000 people in China affected by the virus, only 2% were under the age of 19, according to a study published by the Journal of the American Medical Association in February. 

A World Health Organization report, also from February, found similar results, showing only 2.4% of those infected in China were 18 years or younger. Of the young people infected, 2.5% had severe symptoms and 0.2% became critical.

Still, Dr. Steven L. Zeichner, head of University of Virginia Health's pediatric infectious diseases division, and Dr. Andrea T. Cruz, a pediatric emergency medicine physician at Houston's Baylor College of Medicine, issued a warning in a recent commentary published in Pediatrics. 

"Many infectious diseases affect children differently than adults and understanding those differences can yield important insights," they wrote. "This will likely be true for COVID-19, just as it was for older infectious diseases."

Their commentary accompanied a new study indicating both babies and preschoolers are at greatest risk among children.

The doctors also delved into the role children have in transmitting the coronavirus, citing a study that found the virus can remain in a child's stool for a few weeks after diagnosis. Nasal and cough secretions are other typical routes of transmission. And even when asymptomatic, children can spread the virus. 

According to a study published by the New England Journal of Medicine, 15.8% of the children who tested positive for COVID-19 in Wuhan, China did not have symptoms of infection or radiologic evidence of pneumonia. Another 12 patients had radiologic features of pneumonia, but no symptoms of infection.

"Since many children infected with COVID-19 appear to have had mild symptoms, or even no symptoms at all," Zeichner said, "It is important to practice all the social distancing, hygiene and other precautions being recommended by public health authorities to minimize transmission from children to others, including family members who may be at greater risk from the infection, such as grandparents or family members with chronic medical conditions." 

He also added that a better understanding of why the virus affects children differently than adults may give insights into understanding the disease and developing ways to treat or prevent it. 

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