COVID-19 in Infants and Young Children


Q1. Is there any difference between COVID-19 in infants/children and adults such as symptoms?
There are some differences between infants/children and adults when infected with COVID-19. While it is far less severe to children with relatively mild symptoms, COVID-19 can be more serious in those below 1 year old. It can cause encephalitis, severe respiratory diseases, breathing difficulties and multisystem inflammatory syndrome in children.
Q2. Why do children continue to have high fever when infected? Are there any other serious complications?
COVID-19 can cause fever in children. If there is high fever or persistent fever, other complications may arise and affect the brain with encephalitis, or other organs with multisystem inflammatory syndrome.
Encephalitis can cause symptoms such as high fever, poor appetite and vomiting. As far as treatment is concerned, it is more than taking antipyretics or antiemetics. The key is to treat the underlying condition. Seek medical attention and proper treatment as soon as possible. If symptoms such as skin rashes, swollen mouth, red eyes, coughing, fever, vomiting, etc. occur, , multisystem inflammatory syndrome should be suspected and specific treatment is warranted. 

Q3. What kind of respiratory infections are life-threatening? What are the symptoms?
COVID-19 mostly affects the respiratory system of children. While most cases are self-limiting, when should I seek medical attention if necessary? Consult a doctor when the child is noted to have fever and fast respiratory rate as the child may be suffering from pneumonia. Croup may occur in children when COVID-19 affects the epiglottis. And it is characterised by stridor while breathing. When you hear stridor, please consult a doctor as soon as possible. Croup can cause breathing difficulties, suffocation or even death if severe.  
Q4. Should I give strong antipyretics to my children to speed up recovery?
Many parents are worried about fever in children as it is the most common COVID symptoms. Antipyretics are important. If the temperature is over 38.5°C, you may take Paracetamol in accordance with the drug label. Some parents may wonder if there are any stronger antipyretics. As an important sign, fever can tell us if the patient is getting well or worse. If fever persists, i.e. above 39.5°C, you should take your child to a doctor for diagnosis of other complications such as encephalitis, pneumonia or multisystem inflammatory syndrome.
If it is encephalitis, pneumonia or multisystem inflammatory syndrome that causes fever, they must also be treated. In case of fever, medical attention is required to confirm any possible complications.

Ibuprofen is recommended if complications are ruled out and the fever is above 39.5°C. It is more effective at lowering temperature, providing symptom relief to children with fever. Ibuprofen is a strong antipyretic. It should be used in accordance with doctor’s instructions.
Q5. As far as diet is concerned, what can I do to speed up children’s recovery from COVID-19?
For children infected with COVID-19, hydration and nutrition are the keys to speedy recovery. Try to ensure adequate daily water intake with a 10 to 20% increase of daily water intake, so that your child can urinate 6 times a day. The body is less likely to cool down in case of dehydration.
Nutrients such as carbohydrates and proteins are also very important for recovery. Rather than eat plain porridge, children should have highly nutritious foods during illness help fight off the virus. Try to give frequent, small feeds if your child has poor appetite. You may consider liquid nutrition such as PediaSure, Nutren Junior to ensure adequate energy and proteins in children with poor appetite.
We all know vitamins are crucial to strengthening our immune system. They help the white blood cells to fight off the virus. To increase vitamin C intake, children with COVID-19 should have two portions of fruits every day. If two portions are too much for them, parents may consider a daily supplement of no more than 200mg. Having too much supplements is not recommended. Vitamin D is also important in the fight against COVID-19 as it helps boost the immunity. Foods that are rich in vitamin D include deep-sea fish such as salmon, mackerel and sardine. If children cannot eat that much fish, parents may provide a daily Vitamin D3 supplement of no more than 800 IU. With good nutrition, quick recovery would occur.

Check out YouTube videos from HKSH Medical Group for more health information.