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CDC Identifies Children at High Risk for COVID-19

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Key Takeaways

  • New data from the CDC details the "medical complexities" that may put kids at an increased risk for severe COVID-19.
  • Children without underlying conditions will likely develop only mild symptoms if they are infected.
  • Some children with COVID-19 develop multisystem inflammatory syndrome in children (MIS-C), but experts say this is both rare and treatable.

The Centers for Disease Control and Prevention (CDC) has once again updated its list of people at increased risk of developing severe COVID-19. As of July 17, the organization elaborated on what might put children at an increased risk. 

“Children who are medically complex, who have serious genetic, neurologic, metabolic disorders, and with congenital (since birth) heart disease might be at increased risk for severe illness from COVID-19,” the CDC says.

At the beginning of the pandemic, children were thought to be at a lower risk for contracting the virus compared to adults. Kelly Fradin, MD, a board-certified pediatrician and author of Parenting in a Pandemic: How to help your family through COVID-19, tells Verywell that this misconception can be attributed to the substantial testing shortages at the time. Still, she says children typically exhibit more mild symptoms. 

“Research continues to suggest that children under 10 are less likely to catch and transmit the virus, likely due to differences in the presence of ACE2 receptors where the virus binds,” she says. 

What Is an ACE-2 Receptor?

An ACE-2 receptor is found mainly in endothelial cells (found on the surface of blood vessels). It allows SARS-CoV-2—the virus that causes COVID-19—to infect cells in the body.

What Is a Medical Complexity in Children?

Smita Malhotra, MD, a Los Angeles-based pediatrician and author, tells Verywell that children who are medically complex have compromised immune systems and require more intensive care than children with no underlying medical conditions. 

“Medically complex children can get very sick from the common cold," she says. "Therefore, they are also more susceptible to developing severe illness from COVID-19."

Neurological Conditions

Fradin adds that neurological conditions are part of these medical complexities. Certain neurological conditions, such as cerebral palsy, can cause people to struggle with clearing phlegm and leave them with a more limited supply of energy when they need to exert respiratory effort. 

“For these reasons, we find that children [with neurological conditions] are at a higher risk for severe outcomes from many respiratory infections, such as influenza and RSV,” she says. 

Genetic Conditions

Fradin says that the rarity of most genetic conditions in children makes predicting how COVID-19 will effect these kids difficult. An exception, however, is Down syndrome, which effects about 1 in every 700 babies born each year.

“Preliminary research has indicated these children may be at increased risk, which we could have guessed based on the fact that the syndrome is associated with impairments in immune functioning, obesity, and structural abnormalities that may increase risk,” she says. 

Metabolic Conditions

Fradin says an example of a metabolic condition mentioned by the CDC includes diabetes, and that juvenile diabetes may increase a child's risk of developing a more severe case of COVID-19.

Congenital Heart Disease

Malhotra says congenital heart disease does not increase a child's odds of contracting COVID-19, but it can make the effects of COVID-19 more severe.

"This is due to the inflammatory response that COVID-19 initiates in the body which can weaken an already fragile heart," she says. 

Symptoms of COVID-19 in Children

According to Fradin, fever, cough, and muscle aches are the most common symptoms to watch out for in children, though congestion, headaches, and sore throats could also be COVID-19 red flags.

“The variety of presenting symptoms in both children and adults is striking," Fradin says. "Symptoms vary by age; newborns and the elderly experience different symptoms. Only half infected people have a fever, even when we use a low cutoff for fever, like 99.5° F or 100.4° F,” she says. 

Multisystem Inflammatory Syndrome in Children (MIS-C)

Beginning in April, doctors began identifying a potential link between COVID-19 and a condition called multisystem inflammatory syndrome in children (MIS-C). This syndrome triggers inflammation throughout various parts of the body, including internal organs. This is thought to be a result of a dysregulated immune system from COVID-19. Symptoms include:

  • Fever lasting more than 3 days
  • Abdominal pain
  • Neck pain
  • Diarrhea or vomiting
  • Rash
  • Bloodshot eyes
  • Fatigue
  • Trouble breathing
  • Chest pain
  • Confusion
  • Inability to wake up or remain awake
  • Bluish lips or face

“Although the children are often critically ill, MIS-C seems quite rare and highly treatable,” Fradin says. “Most children are discharged within a week and anticipated to have a full recovery. There are likely subtle differences in the immune systems of children who come down with MIS-C."

What This Means For You

If you are caring for a child, be on the lookout for the main COVID-19 symptoms that they tend to develop, which include fever, cough, and muscle aches. Remember that for a child with an underlying condition, it's especially important to stay on top of well-child visits, medications, and vaccinations throughout the pandemic.

Treatment Options

Fradin says that most children infected with COVID-19 will exhibit mild symptoms and require only outpatient care. Those admitted to hospitals require tailored treatment plans based on their age and condition. 

“Regarding direct infection with coronavirus, most of the children hospitalized or requiring intensive care have either had a serious underlying condition or multiple viruses," Fradin says. "It's also worth noting that infants under 2 months and children over 12 seem more likely to require hospitalization."

If your child does have any of the medical complexities or underlying conditions mentioned, the CDC suggests the following action items:

  • Give medicines as prescribed for your child’s underlying conditions.
  • Make sure that you have at least a 30-day supply of your child’s medicines.
  • Discuss your child’s specific conditions and risk for severe illness from COVID-19 with your healthcare provider.
  • Stay up-to-date on well-child visits and vaccines.

In addition to reiterating the CDC guidelines, Malhotra says parents and caregivers should prioritize the emotional wellbeing of their children throughout the pandemic.

"[Parents] should remember to care for their child's mental health as much as their physical health by creating a safe space for their child to express their feelings and fears and validating them," she says. "Children are incredibly resilient, but they need the support of a consistent, reliable and nurturing caregiver."

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Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. COVID-19: People with certain medical conditions. Updated July 17, 2020.

  2. Davies NG, Klepac P, Liu Y, et al. Age-dependent effects in the transmission and control of COVID-19 epidemicsNat Med. 2020. doi:10.1038/s41591-020-0962-9

  3. R&D Systems. ACE-2: The receptor for SARS-CoV-2.

  4. National Down Syndrome Society. What Is Down Syndrome?

  5. Kim KW. MIS-C and COVID-19: Rare inflammatory syndrome in kids and teens. Johns Hopkins Medicine. Updated May 22, 2020.

  6. American Academy of Pediatrics. COVID-19 and multi-system inflammatory syndrome in children. HealthyChildren.org. Updated June 25, 2020.