COVID-19 INFECTION IN CHILDREN
The COVID-19 infection, which has changed our way of life over the past year, continues to remain at the top of our agenda. Due to the increased transmission rate of the virus after mutations and the fact that vaccination efforts are still ongoing, it is essential to strictly follow preventive measures. Although COVID-19 infection in children is generally mild, it can sometimes lead to severe infections.
Transmission: Children usually contract the virus through household contact. There is insufficient data showing transmission of the virus from mothers who had COVID-19 during pregnancy to their babies; only two such cases have been reported so far. During breastfeeding, transmission via breast milk has not been demonstrated, and mothers can breastfeed their babies by taking precautions such as wearing a mask and maintaining hand hygiene.
Symptoms: Symptoms generally begin around 5 days after exposure. The clinical course in children is usually mild. In about 80% of cases, upper respiratory symptoms such as fever and cough are seen, and sometimes diarrhea and vomiting may occur. In 15% of cases, pneumonia and respiratory distress may develop, and another 15% may require hospitalization due to severe illness. Higher hospitalization rates are observed in children under one year of age and in those with chronic conditions (heart, lung, kidney diseases, obesity, immune deficiencies, or muscular diseases).
Some children may spread the virus more easily because they experience the infection without symptoms.
MIS-C SYNDROME
In May 2020, cases resembling Kawasaki disease—with high fever and involvement of the skin and heart—were observed in Europe and later in Turkey. These cases were thought to be associated with COVID-19. The World Health Organization named this condition in children under 19 years of age as MIS-C.
Multisystem Inflammatory Syndrome in Children (MIS-C)
It develops 2–4 weeks after a child has been diagnosed with COVID-19 or has had contact with an infected individual. The factors determining which children develop this syndrome are not yet known.
The virus triggers the disease rather than directly causing it. An excessive immune response leads to inflammation of blood vessels and damage to the body's own tissues.
Fever above 38°C lasting more than 24 hours is the most prominent symptom and usually persists for more than 4 days. In addition to general symptoms such as muscle pain, fatigue, and abdominal pain, findings may involve multiple organ systems.
Skin findings are characteristic: peeling and swelling of the hands and feet, redness and cracking of the lips, and redness in the eyes may be observed.
Respiratory system: chest pain and shortness of breath may occur.
Cardiovascular system: hypotension, arrhythmia, and circulatory disorders may occur and can lead to permanent heart damage.
Gastrointestinal system: abdominal pain may be severe enough to mimic appendicitis. Nausea, vomiting, and diarrhea may be present.
Nervous system: confusion, headache, and seizures may occur.
Kidney failure may also develop.
Diagnosis: PCR and antibody tests are used for diagnosing COVID-19 and can be applied at all ages.
In PCR testing, a swab is taken from the throat and nose to detect the presence of the virus. Antigen tests performed with swabs have lower sensitivity. Antibody tests measure antibodies developed against COVID-19 in the blood, which typically take 2–3 weeks to form.
In MIS-C syndrome, PCR tests are negative in about 65% of cases, while antibody tests are usually positive. Inflammatory markers in the blood are elevated, and lymphocyte counts are low.
Treatment: In mild cases, paracetamol is sufficient. In children with lung involvement, treatment is planned based on imaging such as CT scans.
Since MIS-C can affect multiple organs, treatment should be initiated rapidly. Treatment includes oxygen and fluid support, medications that suppress the inflammatory response (such as corticosteroids), and anticoagulants.
Prevention:
Families should provide age-appropriate information to children and teach proper handwashing and mask use.
Masks are not recommended for children under two years of age due to the risk of suffocation. Young children should not be taken to crowded indoor places such as shopping malls. Playing outdoors is beneficial both for vitamin D intake and physical activity.
Handwashing is one of the most important preventive measures. Children should be taught to wash their hands with soap and water for at least 20 seconds before and after meals and after being in public places. They should also be taught not to touch their face with dirty hands and to cover their mouth with a tissue or their elbow when coughing or sneezing.
The most important factors for strengthening the immune system are a balanced diet, adequate sleep, and outdoor exercise. Nutrition should include fruits, vegetables, legumes, and probiotic-rich foods such as yogurt, ayran, and kefir. Consuming fish 1–2 times per week and maintaining adequate fluid intake are also important.
There is currently no vaccine available for children against COVID-19, but vaccination studies are ongoing.
Specialist Dr. Hale Yener
Pediatrics Specialist