Girl having her temperature taken

Our physicians answer questions about COVID-19 symptoms in children, including how to protect family members and what to do if your kids are in daycare.

Taking Care of Children

What is COVID-toe or COVID-fingers, and how can this affect my child?

People can react to infections in different ways. It is not uncommon for someone to have a viral infection and have a rash on his or her body. Like most viral rashes, COVID toe/fingers are another way the body can respond to a viral infection. It is possible this is a skin reaction or a small clog, or micro clot, in the blood vessels. It can be painful for some.

Should you note a rash or COVID fingers/toes in addition to common symptoms of COVID-19, it is important to call your healthcare provider. Not all people with COVID-19 get COVID-toe, and not all people with swollen toes or fingers have COVID-19. 

What are the chances my child will catch multisystem inflammatory syndrome at daycare or at the playground?

We are still learning about multisystem inflammatory syndrome and how it affects children. It is a rare condition, so the chances are low in general. However, we do not know why some children have gotten sick with multisystem inflammatory syndrome and others have not. Based on what we know, the best way to protect your child is by taking everyday actions to prevent the virus in your child and the entire household. 

Can you put hand sanitizer on a child younger than 2?

For children under 1 year, alcohol-free hand sanitizer is usually considered safe for babies. If you want to clean your little one’s hands, we recommend a small amount of soap and water. For older kids, most alcohol-based sanitizers are fine to use as long as they are handled with care. Use just a pea-size amount and rub your child’s hands until it is completely dry. Do not allow licking or swallowing of the gel and store the bottle safely out of reach. 

Why isn't COVID-19 affecting many kids?

The answer is not known. One possibility is that children do not have as many of the receptors for COVID-19 in their lungs. Kids are getting affected, but they are not getting as ill. It may be that if they do not have as many receptors in the lungs, then the virus just doesn't lead to the same problems with shortness of breath, pneumonia and lung inflammation.

What are the long-term effects on lung function for kids who get COVID-19?

Unfortunately, we do not know if there are any long-term effects on lung function for children after infection with COVID-19 because this is a new strain of virus. The good news is that children do seem to have milder symptoms than adults. Often coronavirus symptoms are the same as the common cold, which usually does not leave lasting damage to the lungs.

What should parents do if they get COVID-19 and they are the primary caregiver?

If at all possible, a caregiver with COVID-19 should try to isolate themselves from other household members including children. Try to have another family member or household member take care of the child and isolate yourself in one room of the house. 

If this is not possible, make sure that the caregiver who is infected wears a mask or cloth face covering at all times. People who should not wear masks include children under the age of 2, individuals with breathing problems and people who are unable to remove the mask themselves. 

The caregiver should continue to wash their hands frequently, do not share foods or drinks with the child, and coughs or sneezes into their elbow and washes their hands immediately afterward, try to social distance as much as possible. Ask for help from friends or family to have groceries and other essential items delivered to your house. 

How do you know if it is a cold or COVID-19?

It is hard to tell if a child has a cold or COVID-19 because the symptoms are very similar. Most children do seem to get mild or moderate symptoms, such as cough and fever, with COVID-19 that would appear the same as a cold. To be safe, all children with cold symptoms should stay home and practice good social distancing and hand-washing until symptoms are completely gone.

Can children get the virus twice in the same season?

It is not known if children can get the virus twice in the same season at this time. Most viruses only infect a child once in a season so it is our hope that COVID-19 will be the same way, but at this time it is too soon to tell. Even if they get symptoms of COVID-19 and recover they should continue to practice social distancing at this time.

How long will COVID-19 last if my child gets it?

Symptoms can last anywhere from 1 to 21 or more days. If your child gets COVID-19 they should stay quarantined at home for 14 days or until they are completely without symptoms, whichever is longer.  

What are the COVID-19 symptoms to watch out for in my child?

Parents and caregivers should look for cough, tiredness, and fever. They may have other coronavirus symptoms as well, such as vomiting, diarrhea, runny nose or sore throat. Parents and caregivers should also watch out for signs of difficulty breathing, such as fast or hard breathing or using extra breathing muscles around their ribs, neck and nose.

If parents or caregivers see that their child is having difficulty breathing, they should be evaluated urgently by a physician.

If kids get a fever, how high will it get? Fever temperatures can vary in viral illnesses. A fever is a temperature higher than 100.4 F in a child. There is not a specific temperature that is associated with COVID-19. Monitor your child for fever daily and before giving any fever-reducing medicine. If fever is lasting longer than 5 days or the number is getting higher over time, call your pediatrician.

What are the signs that babies or toddlers need a respirator?

Parents and caregivers should look for signs of difficulty breathing, such as fast or hard breathing or using extra breathing muscles. Look for extra breathing muscle use around the ribs, neck and nose. Look for blueish discoloration around the lips or fingers. If parents or caregivers see that their child is having difficulty breathing they should be evaluated urgently by a physician.

Is it safe to go to the doctor's office for regularly scheduled wellness exams?

You can still go to the doctor's office for some regularly scheduled wellness exams. It is important to keep wellness examinations where a child will be getting routine vaccinations to protect them against other viruses and bacteria in the community.

If your child is not up to date on their vaccines please do come into the clinic. Other routine wellness check-ups or follow-ups can be rescheduled for a later time. Call your pediatrician if you are not sure if your child still needs to be seen. It is important to continue social distancing as much as possible.

News sources say that children experience "mild" symptoms. What, exactly, does that mean?

We know that the vast majority of kids experience mild or moderate symptoms and are not classified as severe. For many, this will be nasal congestion and a mild or moderate cough and may include fevers and/or diarrhea. Some kids on this spectrum may even have no symptoms at all, while others may have a significant cough and fever but would not require admission to a hospital.

Overall, this is reassuring, as it means that very, very few children have died from this and that most kids will not become very ill if exposed. However, there is a subset of kids who will develop symptoms of pneumonia and many will still need to be hospitalized for difficulty breathing, or who will get severe diarrhea and need help to stay hydrated.

While it is reassuring that kids do not get as sick, it is not a sign that this should be taken less seriously or that we do not need to work together to slow the spread. We also know that kids are likely to carry this virus without as many symptoms as adults, increasing the chances of infecting others who are higher risk without knowing it.

Is there anything my kids should take to boost their immune system?

There are no strong recommendations for any supplements to take to boost your child's immune system. The most effective strategies are to teach good hand washing skills, including 20 seconds of washing and making sure to wash all fingers and your thumb, as well as the front and backs of your hands.

Make sure to keep offering a healthy and varied diet to your kids and encourage fruits and veggies, as well as trying to encourage regular exercise to keep their bodies healthy.

If my child does develop symptoms, who do I call?

We recommend reaching out to your child's primary care doctor if they start to feel sick with symptoms. Since we know most kids will not become so ill that they require hospitalization, most of the time kids can be treated at home and will recover on their own, and your child's pediatrician can help you to understand if they need to be seen by a doctor.

You should call first before going to your doctor's office so that they can advise you where you should be seen. If your child is struggling to breathe (using their breathing muscles, breathing hard or fast), or cannot tolerate drinking by mouth and are not peeing as regularly, you may need to be seen in the Emergency Department.

Family Members

How do we know if the kids are carriers when they don't show any symptoms?

Unfortunately, we cannot tell if a child is a carrier when they don't show coronavirus symptoms. At this time there are not enough tests to check everyone. In the meantime, social distancing is very important. Try to keep 6 feet from people that are not in your household, stay at home when possible, and wash your hands frequently with soap and water for at least 20 seconds. 

What signs do we look for in order to feel safe making decisions about seeing grandparents again?

Currently, there’s no way to ensure total safety. Here are a few steps you can take to keep the risk as low as possible.

  • Be well. Make sure you are not sick when you plan to visit or have grandparents come to visit.
  • Wear a mask. A mask can help keep you from spreading the virus.
  • Wash your hands and disinfect frequently touched surfaces.
  • Greet without touching. Avoid hugs and kisses. Keep your distance. 

How do we safely visit grandparents?

Until there’s a vaccine, the most vulnerable people should continue to stay home if they can. Visiting grandparents should be a shared decision. Assess possible risk of exposure. If there has been a risk of exposure to the virus, it is best to visit virtually and not in person. 

Have children wash their hands for 20 seconds with soap and water at least every 3 hours during the day, before eating, and after coughing. Try to have children cough or sneeze into their elbow. 

Older caretakers can wear cloth face covering, as recommended by the CDC to try to prevent spread of the virus when social distancing is not possible. People who should not wear masks include children under the age of 2, individuals with breathing problems and people who are unable to remove the mask themselves. 

Daycare

What signs do we look for in order to feel safe making decisions about sending kids back to daycare?

The decision to send kids back to daycare is a personal decision based on the family’s needs. It is important to know the strategies your kid’s daycare plans to take to prevent the spread of COVID-19. Every child care program should have a plan in place to protect staff, children and their families from the spread of the virus.

Plans should include preventative actions such as washing hands, temperature checks on the way in, cleaning and disinfecting frequently touched items, face coverings, at the very least for staff, and how they plan to manage sick children and staff. 

When my toddler goes back to daycare, how do I get her used to teachers in masks?

Masks can be very scary at first to a young child. Children thrive when they feel loved, supported and safe. Seeing their teachers’ faces covered can make them feel nervous or scared. It is important to carefully introduce masks in a positive way that the child understands.

For children under 3, it is best to answer their questions simply in a language they understand. If they ask about why their teachers are wearing masks, explain that sometimes people wear them to prevent the spread of germs. For children over 3, try to focus on germs. Some germs are good and some are bad. Since we cannot tell which are good or bad, face coverings help make sure we keep germs away. 

Answers provided by:

  • Mutiat Onigbanjo, MD, assistant professor of pediatrics at University of Maryland School of Medicine and pediatrician at Pediatrics at Midtown  
  • James Campbell, MD, professor of pediatrics at University of Maryland School of Medicine and pediatric infectious disease expert
  • Deborah Badawi, MD, assistant professor of pediatrics at University of Maryland School of Medicine and pediatric developmental and behavioral expert
  • Rebecca Carter, MD, assistant professor of pediatrics at University of Maryland School of Medicine and pediatrician at UM Pediatrics at Midtown
  • Margaret Pyle, MD, clinical assistant professor assistant professor of pediatrics at University of Maryland School of Medicine and pediatrician at UM Pediatrics at Midtown

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