COVID-19 and kids: answering the most important questions

As COVID-19 infections increase in children — right as the new school year begins — a UCHealth pediatrician answers some of the most common questions about kids and COVID-19.
Nov. 1, 2021
young girl and boy outside a school wearing masks. many questions around COVID-19 and kids
As new cases spike again around the U.S., parents have more questions about COVID-19 and kids. Photo: Getty Images.

As the pandemic persists for yet another school year – and the number of people infected with the highly contagious delta variant rises – parents have many questions about COVID-19 and kids and heading back to school.

In the past month, COVID-19 cases have risen in the U.S., and children make up 14-18% of weekly reported cases, according to the American Association of Pediatrics.

Pediatrician Dr. Brittany Weber
Pediatrician Dr. Brittany Weber

Each person who contracted the original strain of COVID-19, on average, sickened about two to three other people. People infected with the delta variant are passing the virus on to about four or five other people.

“It’s huge. It’s the perfect storm,” said Dr. Michelle Barron, senior medical director of infection prevention and control for UCHealth and a professor of medicine and infectious diseases at the University of Colorado School of Medicine on the Anschutz Medical Campus. “Even if you don’t have a huge portion of the population who are infected with the delta strain, it can spread like wildfire.”

As more children become ill, parents are reminded that their primary care providers are some of the best resources for information about COVID-19 and children. Dr. Brittany Weber, a pediatrician with UCHealth Pediatric Care – Peakview, answers some of the most common questions about COVID-19 and kids and the highly contagious delta variant.

How can I protect my child against COVID-19?

What should I do if my child is showing symptoms or has tested positive for the coronavirus?

Don’t panic. Many children who get COVID-19 suffer only minor symptoms. Severe COVID-19 illness is rare among children.

Contact your health care provider to see if your child should be seen at the clinic or virtually. Your physician will recommend the next steps.

“You need to have an appointment with a provider to get tested at our clinic, but that’s not just for the test. We want to make sure nothing serious is going on.”

Seeing a rash on your child’s finger or toes?

For some children, a rash, called “COVID toes” may be the only sign that they have COVID-19, according to the American Academy of Dermatology Association. You may see red or purple toes, swelling or sometimes pus. Sometimes this occurs in the fingers. This is generally nothing to be concerned about unless it is accompanied by other symptoms. Talk to your physician if you have questions or concerns.

COVID-19 symptoms can include:

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue or severe tiredness
  • Muscle pain or body aches
  • Headache
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • New loss of taste or smell

If you decide not to have your child see a provider, make sure to follow up with the provider if the child has a fever for more than three consecutive days, is having trouble breathing or drinking, or doesn’t urinate at least three times over a 24-hour period.

“Call your pediatrician’s office if you have any concerns or questions,” Weber said. “We have been working on this for a year and a half now so we can provide you with guidance.”

If your child tests positive for COVID-19, follow the CDC guidelines regarding quarantine and isolation, as well as other steps if your child might have exposed others before their diagnosis.

Are kids more vulnerable to the delta variant of COVID-19?

“Just prior to vaccines being released (in December 2020), we saw a decent spike in the number of children who were COVID-19 positive,” Weber said. “That number dropped once children went on summer break, but now we are seeing an increase again.”

In the summertime, Weber said, kids have been outside more. They also don’t have the required COVID-19 testing after exposure that many school districts enforce. Both are factors that may have contributed to fewer reported infections in kids over the summer months. And, symptoms may have been mild and parents treated their children at home without seeing a physician or getting a COVID-19 test, she suggested.

“Children get runny noses and cold-like symptoms, and parents know how to manage those symptoms — it’s not something they normally come in for,” Weber said.

kids in a classroom wearing masks to protect themselves and others from COVID-19.
In-person school is important for kids’ social growth, but making sure guidelines are in place to keep them safe from COVID-19 is also important. Photo: Getty Images.

How are COVID-19 symptoms showing up in children?

Mild symptoms of COVID-19 often present like other viral infections.

“With pediatric patients, COVID-19 symptoms are not straightforward,” Weber said. “Sometimes they have a fever, sometimes barely a runny nose, and others will have all the symptoms.”

A majority of her patients present with a fever and runny nose, and the child may or may not have a cough.

Weber said parents and physicians can’t diagnose COVID-19 on symptoms alone. She recommends that any child with viral symptoms get tested for COVID-19 to help prevent the spread of the virus.

Are children’s COVID-19 symptoms more severe now with the delta variant?

Children don’t seem to be getting sicker with the delta variant. They are just more likely to catch it, Weber said.

As of Aug. 12, 2021, children made up 18% of reported weekly COVID-19 cases across the U.S. More than 4.41 million children have tested positive for COVID-19 since the onset of the pandemic, with 121,000 pediatric cases confirmed Aug. 5-12, according to American Association of Pediatrics.

Are specific groups of children, such as those with pre-existing health conditions, more prone to getting COVID-19?

What is troubling, Weber said, is physicians are seeing an increase in COVID-19 cases in the infant population and within children who have no other health problems — otherwise healthy children.

“Children under 5 are not eligible for the COVID-19 vaccine so the best thing parents can do to protect their children from the virus is get vaccinated themselves,” Weber said.

The Pfizer COVID vaccine for children ages 5 to 11 has been approved. And vaccine trials are underway for children 6 months to 5 years.

What other ways can I keep my child healthy during the pandemic?

Make sure your child is current on their vaccinations. This includes flu and other well-care vaccinations. Flu season is around the corner and health officials are unsure how children will do with what some are calling a ‘twindemic’ of both flu and COVID-19 outbreaks, Weber said.

“The flu hits our child population hard — kids don’t do as well as adults,” she said. “But it will be interesting because we did such a good job last year with masks, hand-washing and social distancing that we didn’t see many flu cases until late spring. But we fully expect to see flu and RSV (respiratory syncytial virus) season peak a bit — and we don’t know what’s going to happen if kids get flu or RSV and COVID-19 at the same time. They are both respiratory illnesses that compromise the lungs.”

At her Peakview clinic, she said children can be tested for COVID-19, influenza and RSV with the same swab.

Nonetheless, Weber highly encourages parents to have their children get the flu vaccine this year — before children are exposed to the flu.

“Get it ahead of the season,” she said. “Our clinic expects to have the flu vaccine by September/October.”

kid with COVID-19 laying her head on her mother's lap
Health experts are concerned about this year’s flu season and how kids will fair with COVID-19 and flu or RSV outbreaks at the same time — a circumstance that some are calling a possible ‘twindemic.’ Source: Getty Images.

Should I get my child tested for COVID-19 if they have viral symptoms?

With so much access to testing — rapid PCR tests through pediatric clinics, hospital-setting tests and at-home test kits — there is no reason not to test a child if signs of COVID-19 arise, Weber said.

Testing not only helps isolate and eliminate the spread of COVID-19 but is important for the child’s health history.

“We don’t know what might happen down the road,” she said. “We must get it in their medical history so, in the rare case of a new side effect or rare complication from having COVID-19, we can then use our medical record system to quickly find those kids and complete any screening that might need to be done as we learn more about this virus and secondary effects is causes.”

How are children being exposed to the coronavirus?

It’s not always clear where a child contracts COVID-19, Weber said.

“In the beginning, exposure mostly happened within the home, or sometimes there would be an event that it could be traced back to,” she added. “But as families venture out more, that’s no longer the case.”

Should I be concerned about my child attending in-person school?

Weber stressed the importance of in-person school for a child’s mental and social growth.

“That said, it is important to make smart choices,” she said. “Try to do outdoor activities, wash hands frequently, wear masks inside and stay away from extremely busy places, especially if you have a high-risk individual in your family.”

As school starts, Weber has been fielding a lot of questions from parents and students. She provides health care advice based on her medical experience and research. Many parents, she said, want to discuss the COVID-19 vaccine that’s available for children 12 and older (and now recently, 5 and older).

“We discuss their child getting that vaccination — how safe it has been and how it decreases their risk for infection,” Weber said. “We understand it’s different for a parent to decide to get vaccinated versus giving it to their child. Being that non-judgmental person parents can speak to is important in our practice.”

Should my child participate in sports or other physical activity after having COVID-19?

Pediatricians see cardiac inflammation (myocarditis) as a result of COVID-19 within a small percentage of adolescents. Children’s Hospital Colorado has guidelines of what should be done in order for a child to return to sports depending on the severity and length of their illness (the determining risks for myocarditis), Weber said.

“Your physician will want to make sure their heart is healthy before returning to sports,” she said. “Some patients just need re-evaluated by a pediatrician, some need an EKG prior to returning to sports, and in rare circumstances, some may need to see a cardiologist prior to returning.

“As with everything with COVID-10, these guidelines are fluid and could change as we see more adolescent infections. Even if they were diagnosed just through a lab, they should be re-evaluated by their physician prior to returning to sports.”

What is your mask-wearing advice for parents and children?

“Children follow what they see, so parents also need to wear masks,” Weber said. “If you all go indoors, put the masks on. And if you go outdoors, the masks go off — whether you are vaccinated or unvaccinated, that’s the most important thing to remember.”

Use gentle reminders to help kids remember they need to keep their mask over their nose, mouth and chin. There is no shame, she said, in using little bribes to encourage safe mask-wearing. For example, letting your child know that they need to wear their mask now but once they get outside, they can take it off.

Finding a mask that fits well will help your child keep it on. For children who wear glasses, find a mask that has a wire across the top. Pinch it tight across the nose to help eliminate the glasses fogging up. “If they’re fogging all day, again, they’re going to pull their mask down.”

Weber also stressed that masks do not hinder breathing for kids with asthma and shouldn’t be a concern.

How can I address my child’s mental health, not just their physical health? 

Kids are feeling the stress of the pandemic, Weber said.

“We are seeing much higher depression scores coming out of our well-child visits, especially in older kids,” she said.

Parents need to be looking for changes in behavior within their children. Are they pulling away from friends, family or activities they enjoy? Are they eating less or taking more naps?

“Talk to them about it — talk to them about how they feel about this pandemic,” she said. “They know what is going on so make sure there is open dialog.

“Kids are worried about getting COVID-19 and worried about having to return to virtual school. They’ve gone through these emotions and have lost their peer interactions. They’ve been through a lot and recognizing that if they were to need help, those resources are available for them.”

Not all kids may be open to talking with their parents about these feelings. Pediatricians can be a great alternative resource, Weber said.

For early school-aged children, the pandemic has hindered emotional growth and social development, she said.

“Parents and teachers can observe how the child plays with friends, how they share toys and carry on conversations with other kids. Watch for emotional outbursts as young school-aged kids show anxiety and depression differently.

“The goal of education at that age is social interaction, but it is hard to learn to read people’s emotions when we have masks on.” Weber said. “We are going to see (school-aged) kids behind on these social interactions so we need to be watching those kids closely to make sure they are socially OK.”

(This article was first published on Aug. 25, 2021 and was last updated on Jan. 6, 2022.)

About the author

Kati Blocker has always been driven to learn and explore the world around her. And every day, as a writer for UCHealth, Kati meets inspiring people, learns about life-saving technology, and gets to know the amazing people who are saving lives each day. Even better, she gets to share their stories with the world.

As a journalism major at the University of Wyoming, Kati wrote for her college newspaper. She also studied abroad in Swansea, Wales, while simultaneously writing for a Colorado metaphysical newspaper.

After college, Kati was a reporter for the Montrose Daily Press and the Telluride Watch, covering education and health care in rural Colorado, as well as city news and business.

When she's not writing, Kati is creating her own stories with her husband Joel and their two young children.