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JAMA Pediatrics Patient Page
December 28, 2020

One Year Later, How Does COVID-19 Affect Children?

Author Affiliations
  • 1Department of Pediatrics, University of Florida College of Medicine, Gainesville
  • 2Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville
  • 3Department of Epidemiology, University of Florida College of Public Health and Health Professions and College of Medicine, Gainesville
  • 4Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville
JAMA Pediatr. 2021;175(2):216. doi:10.1001/jamapediatrics.2020.5817

We have all lived with coronavirus disease 2019 (COVID-19) for about a year now.

Overall, we have learned that children get sick less often than adults, but a few children have gotten severely sick. This update summarizes the current understanding of how children are affected and gives ways to keep families safe as children continue to grow and thrive.

Children Are at Risk

We know that this virus mostly spreads via respiratory droplets when people with infection cough, sneeze, talk, or even breathe, although it can spread in other ways. Some people with COVID-19 have fever, cough, shortness of breath, muscle aches, headache, and diarrhea, symptoms that are similar to those from other viral infections such the flu, but some have no symptoms at all. Children can get COVID-19 from family members and other close contacts such as friends and teachers at school and from sports activities. As children get older, their risk of getting sick enough to be hospitalized is higher, although newborns and young infants are also at increased risk. Risk of death in children is far lower than in adults, but some children have died of COVID-19. Children who are Hispanic, Black, or American Indian or Alaska native are at higher risk for severe disease and death.

Children With Special Health Care Needs Are at Higher Risk

Studies have shown that children with certain underlying conditions are at higher risk for severe COVID-19. These conditions include obesity, asthma, neurologic disorders, heart disease, and being immunocompromised, among others.

What Is Multisystem Inflammatory Syndrome in Children?

Rarely, children who have been infected with the virus that causes COVID-19 develop a condition called multisystem inflammatory syndrome in children. Children may develop this syndrome about 2 to 4 weeks after infection, and some of these children had no symptoms of COVID-19. These children require hospitalization and many need complex supportive therapies to help respond to what seems to be the body’s strong response to being infected with the virus. Some children with this condition have died.

What Can Parents Do?

The most important way to prevent COVID-19 is to avoid getting infected. All family members should follow important recommendations. First, practice the 3 W’s: (1) watch your distance, keeping at least 6-ft distance between you and others; (2) wear a cloth mask when out of your house; and (3) wash your hands often with soap and water for more than 20 seconds, avoiding touching your eyes, nose, and mouth with unwashed hands. Second, avoid the 3 C’s: (1) closed spaces with poor ventilation; (2) crowded places with many people nearby; and (3) close-contact settings, such as close-range conversations.

Flu shots are recommended for all children every year for children older than 6 months and are even more important this year because it is possible to get both COVID-19 and the flu. When a safe and effective COVID-19 vaccine becomes available, talk to your physician about you and your family getting vaccinated.

Parents need to balance their children’s needs to stay safe with their needs to learn and socialize with peers. Parents should consult their school system and health department for the best information on local spread of COVID-19, area rules and recommendations, and school procedures. We want to keep children safe and learning while minimizing risks to themselves, their friends, family members, including grandparents, and other vulnerable members of society.

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Article Information

Published Online: December 28, 2020. doi:10.1001/jamapediatrics.2020.5817

Conflict of Interest Disclosures: None reported.

1 Comment for this article
How are Children Affected by COVID-12?
Michael McAleer, PhD(Econometrics),Queen's | Asia University, Taiwan
Personal hygiene, social distancing, and masking are essential to mitigate the effects of COVID-19, regardless of the availability of several approved vaccines.

As children are not included in clinical trials, the question remains whether the approved vaccines are safe, effective, and durable, especially for children who are immunocompromised from preexisting conditions.

In the month since the informative guide was reported, the escaped mutants from the UK, South Africa, Brazil, and possibly the USA, have established themselves globally, with the UK now dealing with the mutated domestic strain and also from South Africa.

Even if safe flu shots
are given to children, how will this provide any protection against the original wild-type coronavirus, or any of its mutations?

It is essential to provide clear and timely answers to the following additional questions as to whether children are more or less likely to:

(1) become infected by COVID-19?

(2) transmit and infect others?

(3) be protected through vaccination?