COVID-19 Clinical Presentations and Management in Pediatric Patients

Common Clinical Presentations

The American Academy of Pediatrics notes that fever and cough are the most common presentations of COVID-19 in pediatric patients, occurring in 47.5% and 41.5% of cases, respectively 1
Nasal symptoms, including congestion and runny nose, occur in 11.2% of pediatric COVID-19 cases 2
Fatigue is present in 38.5% of pediatric patients and is an independent predictor of severe disease (OR = 2.505) 3
Gastrointestinal symptoms, including diarrhea and nausea/vomiting, may occur with or without respiratory symptoms in pediatric COVID-19 patients 2
Headache occurs in 7.2% of pediatric COVID-19 cases 4, 3
Loss of taste and loss of smell are stronger predictors of COVID-19 than fever itself, occurring in 88.8% and 85.6% of cases, respectively 3
Sore throat is present in 5.1% of pediatric COVID-19 cases 3

Severe disease is defined as dyspnea, respiratory rate ≥30/min, oxygen saturation ≤93%, and occurs in 2.1% of pediatric COVID-19 cases 2
Critical disease, characterized by respiratory failure, shock, or multiorgan dysfunction, occurs in 1.2% of pediatric COVID-19 cases 2

Children should be admitted to the hospital if they display abnormal vital signs, respiratory distress, neurologic deficits, or altered mental status 5, 6
The American Academy of Pediatrics recommends hospital admission for children with evidence of renal or hepatic injury, marked inflammation, or abnormal cardiac markers 6

MIS-C is a rare but serious post-infectious complication occurring 2-6 weeks after SARS-CoV-2 infection, characterized by persistent fever, multiorgan involvement, and mucocutaneous findings 5, 7, 1
The American College of Rheumatology notes that MIS-C patients are typically older than those with Kawasaki disease, with a median age of 8-9 years 5, 1
MIS-C has higher rates of cardiac involvement and shock compared to Kawasaki disease 1

Elevated procalcitonin levels correlate with disease severity in pediatric COVID-19 patients 2
Bilateral and multi-lobe involvement is common in severe cases of pediatric COVID-19, with chest CT abnormalities present in 63.0% of cases 2

The American Academy of Pediatrics recommends a multidisciplinary team approach to managing children with MIS-C, including pediatric rheumatologists, cardiologists, infectious disease specialists, and hematologists 5, 6, 1, 4
A diagnostic evaluation pathway for children under investigation for MIS-C includes tier 1 screening with CBC, CMP, ESR, CRP, and SARS-CoV-2 PCR and/or serology, with additional studies as needed 5, 6