During this Q&A session, pediatric cardiologists Gul Dadlani, MD, and Deepika Thacker, MD, answer questions from parents about kids and COVID-19. While COVID-19 transmission rates in children have been lower than adults, it can still be significant for your child. Symptoms are typically milder in children, and children can also be asymptomatic.
Q: How will the COVID-19 variants affect children?
A: Multiple variants of the virus are circulating globally. The UK variant (B.1.1.7) is reported to be more contagious and serious. Cases caused by the South African variant (B.1.351) and Brazilian variant (P.1) were reported in January 2021. There have been no signs of more serious disease in children caused by these variants yet, but only time will tell. Visit cdc.gov to stay up to date on the latest information about variants of the virus that causes COVID-19.
Q: Why are the rates rising in kids?
A: As rates of COVID-19 cases in the community increase, then rates in children will rise as well. We have seen an increase in the percentage of positive cases in people 18 and younger. In the spring of 2020, about 1.5% of total cases were of children and now 10-13% of total cases are of children. That could be due to increased interaction with others, which increases the transmission of the virus. We all are trying to get back to some level of “normal,” but we’ll have to still be vigilant, wearing masks, washing hands, and socially distancing.
Q: If my child is diagnosed with COVID-19, do they need to see a pediatric cardiologist?
A: Not necessarily. If your child has mild symptoms or is asymptomatic, your pediatrician will be able to treat your child. If there are cardiac symptoms such as chest pain, shortness of breath, dizziness, feeling like their heart is racing or skipping a beat, or intolerance of aerobic activity, then your child should see a pediatric cardiologist. There is a small percentage of children who end up having inflammation of the heart, called myocarditis, and an even smaller percentage of children have Multisystem Inflammatory Syndrome in Children (MIS-C).
As states begin to reopen youth sports, please make sure you see a pediatrician before your child returns to play. It’s important to have a pediatrician sign off on your child’s return to sports. Additionally, returning to sports should be gradual. Increase the activity level over 7 days.
Q: Are children with hypoplastic left heart syndrome (HLHS) at higher risk?
A: Children with complex congenital heart disease (CHD) can be at higher risk because the inflammation caused by COVID-19 can cause more issues, although we have not seen increased hospital admission rates or mortality rates because of that. Children with compromised immune systems are at the highest risk. Some children have congenital heart disease and also compromised immune systems, such as those with DiGeorge syndrome. The greatest risk factors are a compromised immune system, diabetes, or obesity.
There have been some reports of children with HLHS who have received the Fontan Procedure who have been sicker than others with complex CHD, but they still have done well with appropriate management.
Q: What’s the best way to keep kids under 2 years old safe, since they can’t wear masks?
A: Keep their environment safe. This includes parents maintaining social distancing, proper and frequent hand hygiene, maintaining social distancing, and avoiding public areas and events.
Q: Are babies with Down syndrome and CHD at higher risk than a baby with only CHD?
A: Yes, babies with Down syndrome are at a higher risk because they have lower muscle tone and respiratory capacity. It’s important to remember that every child is unique. Some COVID-19 patients with Down syndrome have been very sick while others were no sicker than those without Down syndrome.
Q: Is MIS-C a heart issue?
A: It affects many systems, but is most dangerous because of the way it affects the heart. Over half the children with MIS-C are noted to have some extent of heart involvement. It can cause a decrease in heart function by causing inflammation of the heart muscle. Because of the inflammation and loss of fluid in the body, it can cause shock.
Symptoms of MIS-C are: abdominal pain, nausea, diarrhea, inflammation from head to toe, very high fevers, rash, conjunctivitis, headaches and more. Over 50% of MIS-C patients need to be in an ICU. Treatment for MIS-C is proven and Nemours has treated more than 40 patients with MIS-C. All have recovered. Many research studies are underway to learn more.
Q: Do my kids still need to wear a mask when they’re with their grandparents who are vaccinated?
A: Absolutely. We don’t yet know the incidence of transmission after vaccination. Reports are that the incidence is low, but transmission is still possible. Be cautious. None of the clinical trials have shown 100% vaccine efficacy, so you still need to practice all the measures to reduce spread of the virus.
Q: What are signs to look for in kids that have had no previous heart issues? I’m not sure I would know if they need to see a pediatric cardiologist.
A: Symptoms of cardiac illness, such as chest pain on the left side, persistent shortness of breath, and inability to exercise, palpitations, are signs to see a pediatric cardiologist. Discuss your child’s symptoms with your pediatrician, who will guide you on when to see a pediatric cardiologist.
Symptoms can affect young athletes’ performance 2-6 weeks after the virus is diagnosed.
Many changes brought on by COVID-19 can cause anxiety, stress, and depression for your children. Having open discussions with your kids about the risks for children will help.
Q: I am a school nurse and we will begin requiring a doctor’s note for students to return to school. Should we require a doctor’s note for students who tested positive for COVID-19 in December and January?
A: Each school district will individualize their reopening and return-to-play plans. Schools should have policies in place that require a pediatrician’s approval to return to play. If students have ongoing cardiac symptoms, they should see a pediatric cardiologist before returning to the field or court. If they had COVID-19 several months ago, the likelihood that symptoms would appear now is very low.
Q: After a kid is diagnosed with MIS-C, they go home on aspirin or another anticoagulant medication. Have you seen many with blood clots?
A: No, this protocol was based on data for adults. Ongoing research has shown the incidence of blood clots is lower in children. We’re updating our protocols to decrease the duration of time pediatric patients should take aspirin after being treated for MIS-C. Although children are at a lower risk, the threat of blood clots after COVID-19 infection is real, and something we monitor closely.
Q: Can you tell us about vaccine trials for kids?
A: Moderna and Pfizer have completed enrollment in their clinical trials for children. The Moderna vaccine is approved for people 18 years old and older. Pfizer is approved for people 16 years old and older. The clinical trials have kids as young as 12 years old. We hope to have data on the safety of vaccinating children this spring, and then hopefully vaccinate children before the 2021-22 school year begins in August. We are unsure if the vaccine will protect against MIS-C directly, but we are hopeful it will because it protects against COVID-19, which precedes MIS-C.
Q: Are children with asthma more susceptible to COVID-19?
A: Anyone with pre-existing cardiac or lung disease can be at higher risk with COVID-19. If your child has severe asthma and has been intubated multiple times, you should be cautious as schools, sports, and other activities begin to open back up. Studies have shown that transmission rates in communities with open schools are no higher than communities with closed schools. Be vigilant and do what you think is best for your family.