COVID-19 can affect babies if they get an infection with the novel coronavirus.
While COVID-19 tends to be less severe in children, this protection does not extend to babies, who may be as vulnerable to severe illness as older adults.
A Chinese analysis that included more than 2,000 children with COVID-19 found that 10.6% of infants under 1 year of age had severe or critical symptoms. All of these infants survived, but a small number of infants in the United States have died following diagnosis with COVID-19.
Knowing the symptoms of COVID-19 in babies and young infants can help with early diagnosis and treatment.
As with other age groups, most babies and toddlers with COVID-19 will have mild symptoms similar to those of a severe cold or the flu. Some have no symptoms at all.
Some of the most common symptoms in babies and toddlers include:
- symptoms of an upper respiratory tract infection, such as a cough, sore throat, runny nose, and sneezing
- muscle pain that may cause frequent crying, trouble sleeping, or moodiness in young babies
- changes in mood or behavior — such as sleeping more or less often, feeding difficulties, or more frequent tantrums — because of pain or a fever
- digestive problems, such as nausea, vomiting, stomachache, or diarrhea
- loss of sense of smell that, in infants who are too young to express this symptom, may manifest as changes in eating habits
- dry cough and symptoms of mild pneumonia, such as more rapid breathing or shortness of breath
Babies who develop more serious symptoms usually do so within a week of mild symptoms appearing. Severe symptoms may include:
- intense shortness of breath that may cause a child to gasp for air
- signs of low oxygen, such as blue lips or tongue, white fingernails, or a rapid heart rate
- low oxygen saturation of 92% or less
- severe organ failure
The severity of these symptoms may quickly progress, so close monitoring is essential.
Monitoring a baby
As babies and young toddlers cannot verbally express their symptoms, parents and caregivers should find other ways of evaluating their health, such as taking their temperature and monitoring their breathing.
Some signs of respiratory distress in babies include:
- very rapid breathing, which is more than 60 breaths per minute in a newborn
- making snoring-like sounds when breathing
- sucking in the muscles surrounding the rib cage when breathing
- flaring the nostrils in newborns
Some very young babies have feeding difficulties. A 2020 case series of three newborns younger than 2 months old found that each had a fever and trouble eating, but no cough.
In a study by the Centers for Disease Control and Prevention (CDC) involving more than 2,500 children with COVID-19 in the U.S., 62% of 95 babies under the age of 1 year had to go to the hospital. Five of these babies required an intensive care unit (ICU) stay.
Although three of the 2,572 children that the study included died, the CDC are not yet certain that COVID-19 was the cause of death. This suggests that, even for children with severe illness, the risk of fatality is low.
Babies with COVID-19 can develop severe complications, such as:
- sepsis, a type of systemic infection that can damage the organs
- organ failure, especially of the kidneys
- heart failure
- hypoxia, which happens when the body cannot get enough oxygen, potentially damaging the brain and other organs
Doctors do not yet know if there are long-term risks associated with having COVID-19.
Some children have developed a type of severe inflammation following COVID-19. This syndrome is called multisystem inflammatory syndrome in children (MIS-C). Doctors may also refer to it as pediatric multi-inflammatory syndrome (PMIS).
A related condition called Kawasaki disease also causes inflammation and potentially life threatening complications.
Some warning signs of severe inflammation include:
- intense stomach pain, nausea, vomiting, or diarrhea
- high fever
- bloodshot eyes
- chest pain or pressure
There is no cure for COVID-19, and all treatments are currently experimental. For babies and children with mild-to-moderate symptoms, the disease usually resolves within a few weeks.
However, it is important to make contact with a doctor if a child develops any symptoms of COVID-19. A doctor can refer the child for testing and provide advice on which symptoms to monitor.
Following a diagnosis with COVID-19, parents or caregivers should call a doctor if the baby’s symptoms suddenly get worse after improving or they develop any of the following symptoms:
- signs of respiratory distress or trouble breathing
- signs of organ problems, such as an irregular heartbeat or decreased urination
- a rash
- changes in consciousness, such as constant sleeping or signs of confusion
- inability to breastfeed or eat
- sunken eyes or lethargic behavior
In most cases, a baby with these symptoms will need care in the hospital. If the baby is very ill or the doctor does not immediately answer the phone, go to the hospital. Wear a mask or another protective face covering and keep the baby away from other patients.
If a baby appears to recover from COVID and later develops a rash or other unusual symptoms, call a doctor. These symptoms could warn of MIS-C.
There is no cure for COVID-19. Instead, doctors focus on treating the symptoms. In some cases, this might mean hospitalizing the baby to monitor them. The baby might also need intravenous fluids, oxygen treatment, or, rarely, a ventilator.
Breastfeeding babies may need pumped breast milk through a feeding tube if they are unable to eat on their own.
People can reduce the risk of a baby getting COVID-19 by:
- avoiding going out in public with the baby as much as possible
- limiting or banning visitors
- washing the hands every time anyone in the house comes into contact with another person
- washing the hands before eating and after using the bathroom, coughing, or touching packages, mail, or any other surfaces that a person outside the household may have touched
- disinfecting surfaces such as doorknobs and changing tables regularly
- wearing a mask or other face covering when out in public
- practicing physical distancing when contact with people outside the household is necessary
- quarantining anyone in the household who gets sick in one room and frequently disinfecting any surfaces that they touch
COVID-19 is potentially dangerous for babies, though most recover without serious complications.
Parents and caregivers with concerns about the virus should stay home and take other precautions to protect their baby. If a baby does get sick, it is important not to panic but to monitor their symptoms and schedule a phone or video appointment with a pediatrician.
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