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.


The most important way to protect kids is ensuring they get the COVID vaccine when eligible. At this time, kids ages 5 and above can get the vaccine. Learn More: COVID Vaccine for Children


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?

Multisystem inflammatory syndrome is a complication of COVID-19 infection, and we are not able to predict which children will experience this effect of COVID-19. As such, taking all precautions possible to avoid infection is the key way to prevent this, such as masking when indoors and most importantly, getting your eligible children vaccinated as soon as possible. W

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.

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

Many children who get COVID-19 fortunately do recover completely, but there are some children who have prolonged difficulty with their breathing to the point that it may inhibit their ability to participate in activities they previously enjoyed. Due to this risk, we strongly encourage all eligible children to get vaccinated as soon as possible to prevent the risk of long-COVID effects in your child. 

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.

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 isolate based on CDC criteria and get tested for COVID-19 as soon as possible.  

Can children get the virus twice in the same season?

Yes, we have seen children with re-infections, though this still occurs rarely at this time. Vaccination remains the most effective means to decrease your child’s risk of infection, so even those who have had COVID-19 are recommended to receive the vaccine once they recover from their infection. 

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 10 days after positive testing or onset of symptoms, and must demonstrate improving symptoms without fever for 24 hours. 

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 are having trouble breathing?

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.

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 fewer children in relation to adults have died from this and that most kids will not become very ill if exposed. Sadly, there are still more than 700 children who have died of complications from COVID-19 infection, and even one preventable death is too many. This is another important reason why we recommend that all eligible children be vaccinated as soon as possible. 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?

The most important thing you can do is stay up to date on all recommended childhood immunizations and to receive the COVID-19 vaccine as soon as possible if your child is eligible. 

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.

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, cleaning and disinfecting frequently touched items, face coverings, at the very least for staff based on local recommendations, 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?

Many studies reinforce that children are generally accepting of masks and do not find them scary, nor do they negatively affect their learning and development. 

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

Updated 11/17/2021


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