Covid in children: symptoms, test, positive, what to do?

CHILD CORONAVIRUS. An increase in Covid cases is confirmed in September, especially among children. They are always less at risk of serious forms compared to adults. Symptoms, positive test, isolation... Instructions in force.

[Updated September 16, 2022 at 11:33 a.m.] The Covid epidemic starts again in September, especially among children. According to figures published by Public Health France on September 15, the increase in the incidence rate is mainly driven by those under 20, with a 111% increase in 0-9 year olds and of 46% among 10-19 year olds . A child who has symptoms suggestive of Covid may be tested in pharmacy or laboratory for free (them tests are free of charge for minors ). If he is positive he must isolate himself. What are the symptoms from coronavirus in children? What is the incubation time for the virus at home with the arrival of Omicron? What recommendations when they are cas contact ? What test to do?

How many Covid cases in children in France?

In France , surveillance data show that children are less affected by maladie Covid-19 . They represented less than 1% of patients hospitalized at the start of the epidemic and up to almost 10% during the Omicron wave . According to figures published by Public Health France on September 15, the increase in the incidence rate observed in France in mid-September is mainly driven by those under 20, with a 111% increase in 0-9 year olds and of 46% among 10-19 year olds . The positivity rate is highest among 0-9 year olds.

  Covid incidence by class d'âge
Covid incidence by age group

What are the symptoms of Covid in children?

Children infected with SARS-CoV-2 are mostly asymptomatic or develop a mild form of the disease. When the infection manifests itself, it is most often ' by a common flu syndrome ' explains Dr. Fabienne Kochert, pediatrician.

→ Clinical signs suggesting Covid-19 disease

  • fever >38°, unusual irritability,
  • feverish cough,
  • loose stools, vomiting, abdominal pain
  • serious signs: cough or difficulty breathing associated with one of the following signs: cyanosis, acute respiratory distress (groaning), signs of pneumonia: impossible to drink or breastfeed, loss of consciousness or convulsions, tachycardia, mottling.

→ The severe forms and lethality in children are exceptional .

What is the incubation period in children?

Scientists do not distinguish between adult and child on the incubation of the disease. As a reminder, the incubation period (period between contamination and the appearance of the first symptoms, if they appear) of Covid-19 is 3-5 days in general. With the variant Omicron , this delay would be more like 3 days .

Covid test in children: when, how?

Screening for coronavirus in children is subject to the same conditions as in adults. It can be carried out during symptoms suggestive of Covid-19 or if the child is a 'contact case' of a person recently diagnosed positive. The child can be tested by nose test (PCR, antigen, self-test) or by saliva (PCR test performed in the laboratory and in healthcare facilities) .

How many days must a Covid-positive child isolate themselves?

A Covid-positive child under the age of 12 must self-isolate for 7 days from first symptoms or date of test collection if no symptoms ( 10 days if over 12 years old and that he is not vaccinated). His parents are case contacts and therefore should get tested as soon as possible.

  new rules of'isolement Covid
Covid isolation rules since March 2022

What to do if in doubt?

Does your child have symptoms such as fever, cough, fatigue, headache? It could be a viral infection but if he has been in contact with people carrying the coronavirus, it cannot be ruled out that his symptoms are related to it. It must be tested without delay, in a pharmacy by antigen test (without an appointment) or in the laboratory (PCR test in the nose or saliva for the little ones, more reliable, by appointment). In the event of signs of respiratory infection (fever, cough, acute breathing difficulties), or clinical signs of acute pneumonia (serious or not) on a fragile ground presenting at least one comorbidity, the French health authorities ask to:

  • Contact a doctor by telephone (pediatrician if possible) stating the symptoms perceived.
  • Avoid contact with those around you and wear a mask.

What is the percentage of children hospitalized because of Covid?

Data shows that children infected with SARS-CoV-2 have less severe symptoms than adults and in the vast majority of cases do not need hospital care . 'A once the infection is declared, the risk of developing a severe form in children is almost 25 times lower than that of adults ' I informed the HAS in November 2021. In chiffres, pendant les first months of 2021 , them children accounted for less than 1% of Covid hospitalizations -19. This proportion then increased between 3 and 5% throughout the period of predominance of the Delta variant and has greatly increased when the Omicron variant became predominant from the last week of 2021, especially for children with comorbidities , underlined Santé Publique France in a situation update of August 2022. seventh wave, mostly related to Omicron's BA.4 and BA.5 sublineages , resulted in a increase in hospitalizations in children. The children under the age of one remain in the majority in these pediatric hospitalizations.

  Children newly hospitalized for COVID-19 in France from 01/01/2021 to 08/21/2022 (data as of 08/23/2022)
Children newly hospitalized for COVID-19 in France from 01/01/2021 to 08/21/2022 (data as of 08/23/2022)

What are the complications of Covid in children?

The main complication are the ' pediatric multi-system inflammatory syndromes' (PIMS). R more serious airs they need to be detected early to initiate hospital treatment. As of August 21, 2022 and since the start of the epidemic, 1,070 cases of PIMS have been reported. They touch especially children between the ages of 3 and 11. The rate of hospitalization in critical care units was 71% before the fifth wave and 60% since the beginning of this wave.

Are adolescents more affected by Covid?

'Adolescents 12 to 18 years old seem to have the same susceptibility to the virus and same contagiousness to those around them as adults. However, they have less severe forms of the disease compared to adults, with a proportion of forms asymptomatic around 50% ', explained the Covid-19 Scientific Council in a Notice of October 26 . A study published in October had shown that in the United States, the risk of infection was twice as high among 12-17 year olds than among 5-12 year olds.

How many children are vaccinated from Covid in France?

End of August 2022, 80.9% of 12-17 year olds received a complete primary vaccination against Covid and 17.6% a booster (many were vaccinated to get their health pass). She stays low in 5-9 and 10-11 year olds (respectively 2.7% and 8.2% with a complete primary vaccination). Teenagers aged 12 to 17 can be vaccinated against COVID-19 since June 15, 2021 and receive a booster dose since January 24, 2022. Since December 22, 2021, parents who wish can have their child(ren) vaccinated. child(ren) 5-11 years against COVID-19.

Can Covid be transmitted through breastfeeding?

Transmission of coronavirus through breast milk is not not proven. Research is ongoing. A very small breast milk study of two mothers infected with Sars-CoV-2, conducted by the Elsevier laboratory, and published in the journal The Lancet on May 21, 2020, nevertheless demonstrates the presence of 'SARS-CoV-2 RNA in mother 2's milk on days 10 (postpartum) (...) and for 4 consecutive days. The samples collected subsequently were negative.' Research must continue. The main risk of transmission during breastfeeding lies in the close and prolonged contact between the mother and her child. Mothers wishing to breastfeed and having symptoms suggestive of Covid-19 (cough, fever, difficulty breathing) should contact a doctor. Considering the benefits of breastfeeding and very small role of human milk in the transmission of respiratory viruses , an infected mother can continue breastfeeding. However, precautions should be taken to avoid any contamination from mother to child through direct contact: it is necessary to wear a medical face mask when breastfeeding , to wash hands before and after breastfeeding and to clean and disinfect contaminated surfaces.

How to protect children from Covid?

Since the child can catch the disease without developing it, it is important ' of teach them from an early age to wash their hands well frequently “, recalls Dr. Pierre Parneix, public health doctor expert on Covid-19. wearing a mask also reduces contamination . Moreover, vigilance on the coronavirus can make ' miss out on other health issues. We recall that it is necessary to vaccinate infants as soon as possible so as not to expose them to other pathologies 'recalls Dr. Fabienne Kochert, pediatrician and president of the Afpa. Finally, vaccination against Covid is possible in France from the age of 5.

What are the risks for frail children?

According to the French Association of Ambulatory Pediatrics (AFPA) and the Pediatric Infectious Pathology Group (GPIP), the ' benign nature of Covid-19 infection in children also seems to be true in children with chronic disease' . Children with certain chronic conditions should receive reinforced protections when returning to school , especially when they have comorbidity factors. Currently known factors that make children frail when exposed to the virus are:

  • cystic fibrosis, stage 4 and 5 asthma, restrictive lung malformation, chronic respiratory failure or severe bronchopathy.
  • severe congenital heart disease.
  • Children undergoing chemotherapy treatment or immunosuppressive treatment and suffering from nephropathy are also cases at higher risk: chronic renal failure on dialysis.
  • Neuromuscular pathology. Polydisability.
  • The AFPA emphasizes that an unfavorable family and social environment, or the presence at home of a fragile person are also comorbidity factors which can be assessed by the doctor during his diagnosis.

'But there is no particular concern to have concerning these children. They should receive the same attention as during an influenza epidemic. The most important is to respect the 'barrier measures' : always wash your hands well, avoid crowded places and sick people who cough “, recalls Fabienne Kochert.

Can children do a long Covid?

Although their frequency is lower than in adults, symptoms of Covid-19 several weeks after infection have been described in adolescents and more rarely in children (with a 2-5% frequency in studies with a control group), confirmed the High Authority of Health on March 2022. Fatigue, headaches, sleep disturbances, difficulty concentrating, diffuse joint pain, abdominal pain, exercise intolerance, dizziness, chest pain, or even weight loss and prolonged cough, these signals are numerous and often associated. 'If the vast majority of children see their symptoms evolve favorably, often in less than three months, others need a longer recovery time, and may be subject to relapses ' explains authority. HAS recommends not carry out an additional assessment secondly, to eliminate a rare complication linked to Covid-19 (myocarditis, pericarditis, PIMS, etc.) or to screen for another disease unrelated to the virus. This check-up may be offered if symptoms have not gone away or improved within 4 weeks , if their impact on daily life is significant or if there is an abnormality detected during the history and physical examination.

How many children have died from Covid in France?

Since the beginning of the epidemic, a total of 89 deaths of children under 18 with SARS-CoV-2 infection were registered according to Public Health France, of which 38 were under 5 years old, 22 were between 5 and 11 years old and 29 were between 12 and 17 years old. For 70 deaths, the investigation could be completed and showed a possible link with Covid-19 in 31 cases (44%). Of these children, 26 ( 84%) had very severe comorbidities . A increase in the number of deaths was recorded between January and March 2022 , in relation to the major increase in contamination and hospitalizations, observed from November 2021 among those under 18 years old. Since at the end of March 2022, a drop in declarations is observed. Analysis of all-cause mortality data does not show no excess mortality among children under 15 in 2020, 2021 and early 2022 (until week 18).

Thank you to Dr. Fabienne Kochert, pediatrician and president of the Association for Professional Training in Pediatrics (AFPA), and Dr. Sylvie Hubinois, pediatrician and former president of AFPA.

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