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COVID-19 Diagnosed or Suspected

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Definition

  • Child has symptoms of COVID-19 AND:
  • diagnosis was confirmed by a positive test OR
  • suspected diagnosis was made by your doctor 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
  • Patients with a positive COVID-19 test but without any symptoms are also covered in this guide
  • COVID-19 Symptoms:
  • The most common symptoms are cough, sore throat, headache and fever. Some patients progress to shortness of breath and trouble breathing.
  • Other common symptoms are runny nose, chills, shivering (shaking), muscle pains or body aches, fatigue (tiredness) and loss of smell or taste
  • The CDC also includes the following less-common symptoms: nausea, vomiting and diarrhea
  • Care Guide Update: September 14, 2022. Version 20.

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:
    • Always follow the most current CDC recommendations if they are different than those in this care guide.
  2. COVID-19 Symptoms:
    • This COVID-19 coronavirus most often causes a respiratory illness. The most common symptoms are cough, sore throat, headache and fever. Some patients progress to shortness of breath (trouble breathing).
    • Other common symptoms are chills, shivering (shaking), runny nose, muscle pain, fatigue (tiredness) and loss of smell or taste.
    • The CDC also includes the following less-common symptoms: nausea, vomiting and diarrhea.
    • Some people may have very mild symptoms. Some can have no symptoms, but still spread the disease.
  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, sneezes, shouts or sings. 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.
  4. Multisystem Inflammatory Syndrome (MIS-C):
    • MIS-C is a very rare and severe complication associated with COVID-19. It is especially rare in vaccinated children.
    • Symptoms: The most common symptoms are fever with a red rash, red eyes, red lips and red palms and soles. Abdominal pain, vomiting and diarrhea also occur. Half of the patients develop trouble breathing. MIS-C always has multiple symptoms.
    • 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 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 and steroids.
    • Outcome: most children make a full recovery.
    • Prevention: MIS-C can be prevented by getting your child vaccinated against COVID-19.
  5. Other COVID-19 Facts:
    • Incubation period: average 3 to 5 days (range 2 to 10 days) after coming in contact with the secretions of a person who has COVID-19. Incubation periods can vary depending on the variant.
    • No Symptoms, but Infected: more than 30% 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. If you have had a previous COVID infection or had the vaccine, the infections are usually mild to moderate.
    • Severe Infections: 20% of people not vaccinated 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. Severe infections are very rare in people who are up to date with vaccines and boosters.
    • 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, obesity or weak immune systems, have the highest death rates. The overall death rate in adults is 2 per 1,000 in the US.
    • Vaccine: safe and effective vaccines are available. At this time, vaccines have been tested and are now FDA approved for ages 6 months and older.
    • Breakthrough cases are COVID-19 infections that happen despite vaccine protection. They are more common with new variants. Many of these infections do not cause any symptoms. The vaccine prevents almost all hospital admissions and deaths.
    • Booster Vaccines: the CDC recommends a booster shot for those 5 and older. Stay up to date by getting all recommended boosters when eligible.
    • Treatment: anti-viral treatments for COVID-19 are available. They are mainly used for high risk patients and those who are hospitalized.
    • Prevention: the COVID-19 vaccine and booster are the best way to prevent serious infections.
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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, obesity and other serious chronic disease.
  • Age less than 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 less than 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

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 testing, questions about
  • COVID-19 prevention, questions about
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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 having COVID-19 by a positive test (home kit or lab) OR
    • You or your doctor suspect COVID-19 because it is widespread in your community and your child has developed symptoms that match.
      • The most common symptoms are cough, sore throat, headache and fever. Some patients progress to shortness of breath (trouble breathing).
      • Less common symptoms are chills, shivering (shaking), runny nose, muscle pain, fatigue (tiredness) and loss of smell or taste.
      • Get a COVID-19 test if you have COVID-19 symptoms or had possible exposure. See Testing section below.
      • 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.
    • Antiviral treatments have been developed for patients who are high risk for complications. They work best when given early. Check with your doctor for the most current information.
    • Antibiotics are not helpful for viral infections.
    • You don't need to call or see your doctor unless your child is at high risk for complications, 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.
    • 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. For children younger than 6 months, only give formula or breastmilk. Staying well-hydrated also 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: 1-2 teaspoons (5-10 mL) up to 4 times per day when coughing.
      • 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.
    • In most patients, these senses return within days to weeks.
    • In some patients, the return can take several months.
  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 also helps the body sweat and give off heat.
  10. Call Your Doctor If:
    • Shortness of breath occurs
    • Trouble breathing occurs
    • Your child becomes worse

COVID-19 Home Isolation Questions

  1. Home Isolation is Needed for Those with a Positive COVID-19 Test - With or Without Symptoms:
    • Isolation means separating sick people with a contagious disease from people who are not sick (CDC). That means stay at home.
    • The patient with a positive test needs to stay at home for at least 5 full days, but does not need to be confined to a single room. Wear a mask for 10 days. Preventing spread of respiratory infections within a home is nearly impossible. The sick person should wear a mask when around others. 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 who need hands-on care. Children under 2 years: stay home for a full 10 days. Reason: they don't wear masks.
    • Living with a COVID-19 positive patient implies close contact has occurred and continues to occur.
    • Family members with no symptoms do not need to be on home quarantine unless they develop a positive test. They do need to wear a mask outside the home for 10 days.
    • All people with close contact should be tested 5 days after close contact with an infected person. Test sooner if you develop symptoms.
    • 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 Your Child Is Sick:
    • Stay home for at least 5 full days. Do not allow visitors.
    • You are most contagious (able to spread the virus to others) during those first 5 days.
    • Wear a mask for 10 days. Wear a face mask when around others or if you have to go to a medical facility.
    • Children under 2 years: home isolation will be needed for a full 10 days. Reason: they don’t wear masks.
    • Do Not go to school.
    • 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.
    • 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 24 hours after stopping fever-reducing medicines AND
    • Cough and other symptoms are gone or almost gone AND
    • Symptoms started more than 5 days ago.
    • Patients with no symptoms (and no symptoms developed): stay at home until 5 days have passed since the date the sample was collected for their positive COVID-19 test.
    • Summary: must isolate at home for at least 5 days. Then wear a mask around others for another 5 days.
    • If you're unsure it is safe for you to leave isolation, check the CDC website or call your doctor.

COVID-19 Testing

  1. COVID-19 Testing Questions
    • If COVID-19 is suspected, get a test to know for sure. You can’t tell by symptoms. Reason: most respiratory viruses cause similar symptoms.
    • Testing is offered at many sites without a doctor's order. Many doctor’s offices, retail clinics, and urgent care centers offer testing. Community drive-through sites or pharmacies may also be testing site options. At home self-tests can also be bought in most drugstores and grocery stores.
    • Your doctor is often the best resource for up-to-date information on testing. If you have testing questions, call them during office hours.
    • Here are some facts that may answer some of your questions:
      • Diagnostic tests: these are performed on nasal or mouth secretions. The tests can tell us if you have a COVID-19 infection now. Timing is important on when to do this test:
        • With Symptoms. Get a test within 3 days of onset of symptoms.
        • Without Symptoms and a COVID-19 close contact. You can get a test on day 3 to 5 after the last day of exposure.
      • Repeat diagnostic tests: after a positive test, repeat tests are not recommended. Positive tests are reliable. Even after it is safe to stop isolation (usually 5 days), tests may stay positive. A positive test does not mean the patient can spread the infection once the required isolation period is completed. After a negative home test, if you have symptoms, re-test at home in 2 days.
      • Antibody Tests: these are performed on blood. They are rarely needed and currently not very helpful. They can sometimes tell us if you have antibodies from a previous infection. They are not done until at least 2 to 3 weeks have passed from the start of the infection. Talk with your doctor if you have questions about this test.

COVID-19 Prevention

  1. COVID-19 Vaccine - Get Your COVID-19 Shot and a Booster Shot:
    • Vaccines have saved more lives than any other public health action. They are the most powerful weapon we have against deadly infectious diseases. Follow the science.
    • Safe and effective vaccines are now available for people age 6 months and older.
    • Get your COVID-19 vaccine and booster. It could save your life and protect your family.
    • Vaccine Sites: find a nearby vaccine site at vaccines.gov or call your doctor’s office.
  2. COVID-19 - How to Protect Yourself and Family from Catching It - The Basics:
    • Get the COVID-19 vaccine and booster when recommended. It is your best protection against serious infection.
    • Avoid close contact with people outside your family unit. Avoid closed spaces (indoors) when possible and all crowds (even outdoors).
    • Wear a face mask when in public indoor settings. Also, observe social (safe) distancing if the spread is high where you live.
    • 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.
    • 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. Medical offices are also safe places.
  3. Social (Safe) 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 known to be sick, especially if they are coughing. 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.
    • Wear a mask when entering any public building or crowded outdoor area.
  4. Face Masks and COVID-19 Prevention:
    • Mask requirements have been reduced in most parts of our country. The CDC website can tell you the COVID-19 community level in any county in the US. Your county will be listed as Low, Medium or High. High means everyone should wear a mask indoors in public. Medium means people at high risk for serious illness should wear a mask. Low means masks are not needed. Go to the CDC website and click on COVID-19 County Check.
    • Overview: face masks help reduce the spread of COVID-19. Reason: people with COVID-19 can have no symptoms, but still spread the virus. Masks also will reduce the spread of flu.
    • Mask wearing is even more important if you are in an area of high COVID-19 spread or have health problems.
    • Sick patients: must always wear a face mask, if you are around other people or need to leave the home. Example: for medical visits. Exception: patients with trouble breathing in a mask (CDC). Consider a loose face covering, such as a bandana.
    • Also, wear a mask if you have to be around someone who is sick with COVID-19 or has tested positive for it.
    • Well people should wear masks if spread is high where you live:
      • You are in indoor public spaces (such as a church or a grocery store).
      • You are in a crowded outdoor setting (e.g., concert, music festival, rally).
      • You are traveling on a plane, bus, train, or other form of public transit.
      • You are in a transportation hub such as an airport or train station.
      • Well People Exceptions: face mask or covering is optional if outdoors.
    • Age Limits: face coverings are not recommended for children less than 2 years (CDC).
  5. Keep Your Mind and 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. Go outdoors if you can. Caution: avoid physical exhaustion.
    • Think positive thoughts.
    • Stay well-hydrated.
    • Eat healthy meals.
    • Avoid the over-use of anti-fever medicines like acetaminophen and ibuprofen. Fever fights infections and ramps up your immune system.
  6. Breastfeeding and COVID-19:
    • Breastfeeding experts recommend you continue to breastfeed even if you are sick with COVID-19. Research has shown that the virus is not passed through breastmilk.
    • Wash your hands before feeding your baby.
    • The CDC recommends wearing a well-fitting face mask. 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.
    • Breastfeeding mothers should also get the COVID-19 vaccine and a booster (CDC). Your protective antibodies from the vaccine will be passed to your baby in your breastmilk.
    • Call your doctor if breastfeeding isn't going well OR your baby becomes sick.

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 2000-2023 Schmitt Pediatric Guidelines LLC.
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