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Coronavirus (COVID-19) Diagnosed or Suspected

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Definition

  • Child has symptoms of COVID-19 (cough, fever or trouble breathing) AND:
  • diagnosis was confirmed by a positive lab test OR
  • suspected diagnosis was made by a health care provider based on symptoms OR
  • parent or patient suspects COVID-19 based on symptoms consistent with COVID-19 AND the infection is widespread in their community. In areas with major community spread, lab tests are mainly reserved for patients who have serious symptoms or are admitted to the hospital.
  • An update on Multisystem Inflammatory Syndrome (MIS-C), a rare and severe complication, is included in the Causes section.
  • COVID-19 Symptoms:
  • The most common symptoms are cough, fever and trouble breathing
  • Other common symptoms are chills, shivering (shaking), sore throat, muscle pains or body aches, headache, loss of smell or taste
  • The CDC also includes the following less-common symptoms: runny nose, fatigue (tiredness), nausea, vomiting and diarrhea
  • Care Guide version: 7/9/2020
  • Author: Bart Schmitt MD, FAAP

COVID-19 Disease: Frequently Asked Questions

  1. Trusted Sources for Accurate Information: CDC and AAP
    • To meet the high demand for COVID-19 information, when possible, find your answers online. Here are the most reliable websites:
    • Nurse advice lines and medical call centers are needed for sick patient calls.
  2. COVID-19 Symptoms:
    • This COVID-19 coronavirus causes a respiratory illness. The most common symptoms are cough, fever and shortness of breath (trouble breathing).
    • Other common symptoms are chills, shivering (shaking), sore throat, muscle pain, headache and loss of smell or taste.
    • The CDC also includes the following less-common symptoms: runny nose, fatigue (tiredness), nausea, vomiting and diarrhea.
  3. COVID-19 - How it is Spread:
    • COVID-19 is spread from person to person.
    • The virus spreads when respiratory droplets are produced when a person coughs or sneezes. The infected droplets can then be inhaled by a nearby person or land on the surface of their eyes.
    • Most infected people also have respiratory secretions on their hands. These secretions get transferred to healthy people on doorknobs, faucet handles, etc. The virus then gets transferred to healthy people when they touch their face or rub their eyes.
    • These are how most respiratory viruses spread.
    • Reports from China suggest that the initial coronavirus (COVID-19) cases were spread from animals (probably bats) to humans.
  4. Multisystem Inflammatory Syndrome (MIS-C):
    • MIS-C is a very rare and severe complication associated with COVID-19.
    • Symptoms: the most common symptoms are fever, a red rash, abdominal pain and vomiting. Half of the patients develop trouble breathing. Some children become confused or overly sleepy. All patients with this syndrome should be seen by a doctor. Most need to be admitted to the hospital. Some cases are similar to Kawasaki’s Disease (KD).
    • Incidence: a very, very rare complication of COVID-19. In general, COVID-19 continues to be a mild disease in most children.
    • Onset of symptoms: usually about 4 weeks after COVID-19 infection and apparent recovery.
    • Age: 6 months to 21 years. Peak age 8 years.
    • Treatment: MIS-C is treatable with medications, including IV immune serum globulin (ISG). At this time, it cannot be prevented nor predicted.
    • Reassurance: if a child gets this rare complication, a parent will know that their child needs to see a doctor.
  5. COVID-19 - Travel:
    • Avoid all non-essential travel.
    • If you must travel, go to the CDC website for updates on travel advisories: Travelers.
  6. Other COVID-19 Facts:
    • Incubation period: average 5 days (range 2 to 14 days) after coming in contact with the secretions of a person who has COVID-19.
    • No Symptoms, but Infected: over 20% of infected patients have no symptoms.
    • Mild Infections: 80% of those with symptoms have a mild illness, much like normal flu or a bad cold. The symptoms usually last 2 weeks.
    • Severe Infections: 20% of those with symptoms develop trouble breathing from viral pneumonia. Many of these need to be admitted to the hospital. People with complications generally recover in 3 to 6 weeks.
    • Deaths: children generally have a mild illness and recover quickly. Pediatric deaths are very rare. Older adults, especially those with chronic lung disease, heart disease, diabetes or weak immune systems, have the highest death rates. The overall death rate is around 1%.
    • Vaccine: there is currently no vaccine to prevent COVID-19. Research is on the fast track in many labs. New vaccines usually take at least a year to develop.
    • Treatment: new treatments for severe COVID-19 are becoming available. They are only used on hospitalized patients. Most are given by vein (IV).
  7. COVID-19 - CDC Definition of Exposure (Close Contact): You are at risk of getting COVID-19 if the following has occurred:
    • Close contact with a person who tested positive for COVID-19 AND contact occurred while they were ill.
    • Living in or traveling from a city, country or other geographic area where there is documented community spread of COVID-19. This carries a lower risk compared to close contact if one observes social distancing.
    • Community spread is occurring in most of the US, especially in cities.
    • The CDC has the most up-to-date list of where outbreaks are occurring: Coronavirus.
  8. COVID-19 Outbreak:
    • An outbreak of this infection began in Wuhan, China in early December 2019.
    • The first COVID-19 patient in the United States was reported on January 21, 2020. During March 2020, cases were reported in all states.
    • The first COVID-19 patient in Canada was reported January 31, 2020.
    • The World Health Organization (WHO) declared COVID-19 a global pandemic.
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When To Call

Call 911 Now

  • Severe trouble breathing (struggling for each breath, can barely speak)
  • Lips or face are bluish now
  • You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

  • Trouble breathing, but not severe (includes tight breathing and hard breathing)
  • Ribs are pulling in with each breath (called retractions)
  • Breathing is much faster than normal
  • Lips or face have turned bluish during coughing
  • Wheezing (tight, purring sound with breathing out)
  • Stridor (harsh sound with breathing in)
  • Chest pain or pressure and can't take a deep breath
  • Sore throat with serious symptoms (such as can't swallow fluids or new-onset drooling)
  • Muscle pains with serious symptoms (such as can't walk or can barely walk)
  • Headache with serious symptoms (such as worst headache ever, confused, weak, stiff neck)
  • Dehydration suspected. No urine in over 8 hours, dark urine, very dry mouth and no tears.
  • Weak immune system, such as HIV, cancer, organ transplant, taking oral steroids.
  • High-Risk child. This includes lung disease, heart disease, diabetes and other serious chronic disease.
  • Age under 12 weeks old with fever
  • Fever over 104° F (40° C)
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Nonstop coughing spells
  • Age under 3 months old with any cough
  • Earache or ear discharge
  • Sinus pain (not just congestion)
  • Fever lasts more than 3 days
  • Fever returns after gone for more than 24 hours
  • You think your child needs to be seen, but the problem is not urgent

Home-Quarantine; Self-Monitor

  • COVID-19 infection with MILD symptoms (cough, fever, sore throat, muscles pains, headache, loss of taste or smell, or others) and no trouble breathing
  • COVID-19 home isolation, questions about
  • COVID-19 prevention, questions about
  • COVID-19 testing, questions about
  • COVID-19 infection with SERIOUS symptoms: Going to an ER or Other Medical Facility
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Care Advice

Diagnosed or Suspected COVID-19 with Mild Symptoms - Treatment

  1. COVID-19 Infection: What You Should Know about It
    • Your child has been diagnosed as probably having COVID-19 OR
    • You or your doctor suspect COVID-19 because it is widespread in your community and your child has developed symptoms that match (cough, fever or others).
    • Your child probably did not receive a lab test for COVID-19. It doesn't matter.
      • The most common symptoms are cough and fever.
      • Less common symptoms are chills, shivering (shaking), sore throat, muscle pain, headache, and loss of smell or taste.
      • Most infections are mild, especially in children.
  2. Treatment of Symptoms
    • The treatment is the same whether your child has COVID-19, influenza or some other respiratory virus.
    • The only difference for COVID-19 is the need to stay on home isolation until your child recovers. Reason: you want to protect other people from getting it. The elderly and people with serious health problems can die from COVID-19.
    • Treat the symptoms that are bothering your child the most. See other Care Guides (such as Sore Throat or Cough) for details of treatment, if needed.
    • There is no anti-viral medicine for treating COVID-19 at home. New antiviral treatments have been developed for patients who need to be hospitalized.
    • Antibiotics are not helpful for viral infections.
    • You don't need to call or see your doctor unless your child develops trouble breathing or becomes worse in any other way.
  3. Fever Treatment
    • For fever above 102° F (39° C) you may use acetaminophen or ibuprofen if the patient is uncomfortable. There are no proven reasons to avoid ibuprofen.
    • For fevers between 100° to 102° F (37.8° to 39 ° C), fever medicines are not needed. Reason: fevers turn on your body's immune system. Fever helps fight the infection.
    • Exception: if the patient also has pain, treat it.
    • Fluids: offer cool fluids in unlimited amounts. Reason: to prevent dehydration. Staying well-hydrated helps the body sweat and give off heat.
  4. Cough Treatment
    • Age 3 Months to 1 Year:
      • Give warm clear fluids (e.g., apple juice or lemonade) to thin the mucus and relax the airway. Dosage: 1-3 teaspoons (5-15 ml) four times per day.
      • If nothing else helps: give a small amount of corn syrup. Dosage: ¼ teaspoon (1 ml). Can give up to 4 times a day when coughing. Caution: avoid honey until 1 year old. Reason: risk for botulism.
    • Age 1 year and older: Use honey, ½ to 1 teaspoon (2 to 5 ml) as needed as a homemade cough medicine. It can thin the secretions and loosen the cough. If honey is not available, can use corn syrup. OTC cough syrups containing honey are also available. They are not more effective than plain honey and cost much more per dose.
    • Age 6 years and older: Use cough drops (throat drops) to decrease the tickle in the throat. If not available, can use hard candy. Avoid cough drops before 6 years. Reason: risk of choking.
    • Over the Counter (OTC) cough medicines are not recommended. Reason: no proven benefit for children. Honey has been shown to work better.
    • Never use OTC cough medicines under 6 years of age. Reason: cough is a protective reflex and should not be suppressed.
  5. Sore Throat Pain Relief: COVID-19 often causes a sore throat. Here are some tips on treating it:
    • Age greater than 1 year: Can sip warm fluids such as chicken broth or apple juice. Some children prefer cold foods such as popsicles or ice cream.
    • Age greater than 6 years: Can also suck on hard candy or lollipops. Butterscotch seems to help.
    • Age greater than 8 years: Can also gargle. Use warm water with a little table salt added. A liquid antacid can be added instead of salt. Use Mylanta or the store brand. No prescription is needed.
    • Pain medicine: Use if pain interferes with swallowing. Not needed for mild pain.
  6. Muscle Pains - Treatment:
    • COVID-19 can normally cause muscle pains and body aches.
    • Massage: gently massage any sore muscles.
    • Stretching: gently stretch any sore muscles.
    • Apply Heat: use a heat pack, heating pad or warm wet washcloth. Do this for 10 minutes, 3 times daily.
    • Warm bath: for widespread muscle pains, consider a warm bath for 20 minutes 2 times a day. Gently exercise the sore muscles under water.
    • Pain medicine: for widespread body aches, give acetaminophen (such as Tylenol) every 4 hours OR ibuprofen (such as Motrin or Advil) every 6 hours as needed. Not needed for mild aches.
  7. Headache - Treatment:
    • COVID-19 can cause a headache.
    • Pain medicine: give acetaminophen every 4 hours OR ibuprofen every 6 hours as needed. Not needed for mild headaches.
    • Cold pack: apply a cold wet washcloth or cold pack to the forehead for 20 minutes.
    • Massage: stretch and massage any tight neck muscles.
  8. Loss of Smell or Taste:
    • Losing the sense of smell or taste can be an early symptom of COVID-19.
    • Most of these patients have a mild course.
    • These senses usually return within 1 to 2 weeks.
  9. Fluids - Stay well Hydrated
    • Drink lots of fluids. Water is best.
    • Goal: keep the patient well hydrated.
    • It loosens up any phlegm in the lungs. Then it's easier to cough up.
    • It helps the body sweat and give off heat.
  10. Call Your Doctor If:
    • Shortness of breath occurs
    • Breathing difficulty occurs
    • Your child becomes worse

COVID-19 Home Isolation Questions

  1. Home Isolation is Needed for those Who are Sick:
    • Isolation means separating sick people with a contagious disease from people who are not sick (CDC). That means stay at home.
    • The patient needs to stay at home, but does not need to be confined to a single room. Preventing spread of respiratory infections within a home is nearly impossible. The sick person should try to avoid very close contact with other family members. That includes hugging, kissing, sitting next to or sleeping in the same bed. None of this is realistic for young children.
    • Other family members should also stay at home on quarantine. Living with a suspected COVID-19 patient implies close contact has occurred. Exceptions: essential workers who have COVID-19 exposure, but do not have any symptoms. Talk to your employer.
    • Do Not allow any visitors (such as friends).
    • Do Not go to school or work.
    • Do Not go to stores, restaurants, places of worship or other public places.
    • Avoid public transportation or ride sharing.
  2. How to Protect Others - When You or Your Child Are Sick:
    • Stay home from school or work if you are sick. Your doctor or local health department will tell you when it is safe to return.
    • Cough and sneeze into your shirt sleeve or inner elbow. Don't cough into your hand or the air.
    • If available, sneeze into a tissue and throw it into a trash can.
    • Wash hands often with soap and water. After coughing or sneezing are important times.
    • Don't share glasses, plates or eating utensils.
    • Wear a face mask when around others.
    • Always wear a face mask if you have to leave your home (such as going to a medical facility). Always call first to get approval and careful directions.
    • Carefully avoid any contact with the elderly and people with weak immune systems or other chronic health problems.
  3. Stopping Home Isolation - Must Meet all 3 Requirements (CDC):
    • Fever gone for at least 72 hours (3 full days) off fever-reducing medicines AND
    • Cough and other symptoms must be improved AND
    • Symptoms started more than 10 days ago.
    • If you're unsure it is safe for you to leave isolation, check the CDC website or call your PCP.

COVID-19 Prevention

  1. COVID-19 - How to Protect Yourself and Family from Catching It - The Basics:
    • Wash hands often with soap and water (very important). Always do this before you eat.
    • Use an alcohol-based hand sanitizer if water is not available. Remember: soap and water work better.
    • Don't touch your eyes, nose or mouth unless your hands are clean. Germs on the hands can get into your body this way.
    • Don't share glasses, plates or eating utensils.
    • No longer shake hands. Greet others with a smile and a nod.
    • If your child needs to be seen for an urgent medical problem, do not hesitate to go in. ERs and urgent care sites are safe places. They are well-equipped to protect you against the virus. For non-urgent symptoms, talk to your doctor's office first.
  2. Social Distancing and COVID-19 Prevention:
    • Avoid any contact with people known to have COVID-19 infection. Avoid talking to or sitting close to them.
    • Social Distancing: try to stay at least 6 feet (2 meters) away from anyone who is sick, especially if they are coughing. Also called physical distancing. Avoid crowds, because you can’t tell who might be sick.
    • If COVID-19 becomes widespread in your community, try to stay 6 feet (2 meters) away from everyone outside your family unit.
    • Stay at Home Orders: follow any stay at home (stay in place) orders in your community. Leave your home only for essential needs such as buying food or seeking medical care.
    • After Stay at Home Orders are Lifted: continue social distancing. Also wear a mask when entering any public building. These precautions will be needed for many months. Your state public health department will decide when they are no longer needed.
  3. Face Masks and COVID-19 Prevention:
    • Sick patients: must always wear a face mask, if they need to leave the home. Example: for medical visits. Exception: patients with trouble breathing (CDC). Consider a loose face covering, such as a bandana.
    • Well people: as community spread became high, the CDC has also recommended face masks or coverings for everyone going outside the home. Masks are critical if entering a public building, such as a grocery store. Reason: many people with COVID-19 have no symptoms but can spread the virus.
    • Well People Exceptions: face mask or covering is optional if outdoors and can avoid being within 6 feet (2 meters) of other people. Examples: on an outdoor walk or run.
    • Age Limits: face coverings are not recommended for children less than 2 years (CDC).
  4. Keep Your Body Strong:
    • Get your body ready to fight the COVID-19 virus.
    • Get enough sleep (very important).
    • Keep your heart strong. Walk or exercise every day. Take the stairs. Caution: avoid physical exhaustion.
    • Stay well-hydrated.
    • Eat healthy meals. Avoid overeating to deal with fears.
    • Avoid the over-use of anti-fever medicines. Fever fights infections and ramps up your immune system.
  5. Keep Your Mind Positive
    • Live in the present, not the future. The future is where your needless worries live.
    • Stay positive. Use a mantra to reduce your fears, such as "I am strong."
    • Get outdoors. Take daily walks. Go to a park if you live near one. Being in nature is good for your immune system.
    • Show love. As long as they are well, hug your children and partner frequently. Speak to them in a kind and loving voice. Love strengthens your immune system.
    • Stay in touch. Use regular phone calls and video chats to stay in touch with those you love.
    • "2-Household Bubble." To reduce social isolation, especially for young children, some families have joined up with one other family for visits. Rules: both families must agree that they will not have social contacts with any other families. No one in either family can work outside the home. Not approved by CDC, but a reasonable family decision.
  6. Breastfeeding and COVID-19:
    • Breastfeeding experts recommend you continue to breastfeed even if you are sick with COVID-19.
    • Wash your hands before feeding your baby.
    • The CDC recommends to wear a mask, if available. Be careful to avoid coughing on your baby.
    • Breastmilk gives beneficial antibodies your body is making against this illness to your baby. This should provide some protection against this illness for your baby, like it does for influenza and most other viral illnesses.
    • The virus is probably not passed through breastmilk, but this is not yet known for sure.
    • Call your doctor if breastfeeding isn't going well OR your baby becomes sick.

COVID-19 Testing

  1. COVID-19 Testing: Who Needs It
    • Your doctor is the best resource for up-to-date information on the availability of testing in your community and who needs it. Since testing is not urgent, if you have questions, call during office hours.
    • There are 2 types of tests:
      • Diagnostic tests: these are performed on nasal secretions and tell us if you have a COVID-19 infection now.
      • Antibody Tests: these are performed on blood and tell us if you have antibodies from a previous infection. They are not done until at least 3 weeks have passed from the start of your infection.
    • Tests for COVID-19 are mainly done on people who are sick (have symptoms of COVID-19). Tests are usually not done on people who have no symptoms.
    • Testing is usually performed on patients who have serious symptoms or are admitted to the hospital. It is usually not done on patients with mild symptoms who don't need to be seen.
    • Testing is also needed on adults who have essential jobs and need to know if they can return to the work force.

Going to an ER or Other Medical Facility: Doing It Safely

  1. Call Ahead First, if Going to an ER or Other Medical Facility
    • Most patients with COVID-19 never need to see a doctor. That will change if you develop trouble breathing or any other serious symptoms.
    • In that case, your doctor or nurse will tell you where to go and call ahead.
    • If you are going to a medical facility without a referral, you must call ahead first.
    • Tell them you are bringing a person exposed to COVID-19 who now has symptoms (fever or cough). They may transfer your call to a doctor or triage nurse to help decide if you need testing. Often you will not.
    • Reason to call first: so healthcare workers can make plans to prevent spread of COVID-19 to others. You don’t want to be a "spreader."
    • They can also tell you the safest way to enter the medical facility.
  2. Announce Possible COVID-19 Exposure When You Arrive:
    • Tell the first healthcare worker you meet that the patient may have been exposed to COVID-19.
    • Tell them the patient has been referred for COVID-19 testing because of symptoms. If you were referred to an ER, it will also be for a full medical exam.
  3. Cover Your Mouth and Nose - Wear a Mask:
    • Cover the patient’s mouth and nose with a disposable tissue (e.g., Kleenex or paper towel) or a washcloth.
    • Have the patient wear a disposable face mask if you have one.
    • Ask for a mask on arrival.

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Barton D. Schmitt, MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2020 Schmitt Pediatric Guidelines LLC. All rights reserved.
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