You or your child have symptoms of COVID-19 (fever, cough, shortness of breath or others) AND:
Diagnosis was confirmed by positive lab test OR
Suspected diagnosis was made by a doctor OR
You suspect COVID-19 based on symptoms consistent with COVID-19 AND possible close contact with a COVID-19 patient
Updated: February 2, 2022 (version 15)
COVID-19 Symptoms: The most common symptoms are cough and fever. Some patients progress to shortness of breath. Other common symptoms are chills, shivering (shaking), runny nose, sore throat, muscle pains or body aches, headache, and loss of smell and taste. The CDC also includes the following less common symptoms: fatigue (tiredness), nausea, vomiting and diarrhea. Some people may have very mild symptoms. Some can have no symptoms, but still spread the disease
Incubation Period: average 5 days (range 2 to 10 days) after coming in contact with the secretions of a person who has COVID-19.
No Symptoms but Infected: Over 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.
Severe Infections: 20% of those with symptoms that are not vaccinated 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 vaccinated.
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 adult death rate is around 2 per 1000.
Vaccine: Safe and highly effective vaccines are available. At this time, vaccines have been tested and are FDA approved for 5 years and older. Trials on children younger than 5 years have started.
Breakthrough cases are COVID-19 infections that bypass vaccine protection. They are more common with new variants. Many do not cause any symptoms. The vaccine prevents almost all hospital admissions and deaths.
Booster Vaccines: The CDC recommended a booster shot for those 12 and older. Booster vaccines are needed if 5 or more months have passed since the Pfizer or Moderna vaccine primary series. Boosters are needed if 2 or more months have passed since the Johnson and Johnson vaccine primary series. These booster shots reduce the rate of COVID-19 breakthrough infections. Experts predict we may need a yearly COVID-19 booster, just like the yearly flu vaccine.
Treatment: New treatments for severe COVID-19 are becoming available. They are mainly used for hospitalized patients and high-risk patients.
Trusted Sources for Accurate COVID-19 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:
CDC website: https://www.cdc.gov/coronavirus
American Academy of Pediatrics parent website: www.healthychildren.org
Always follow the most current CDC recommendations if they are different than those in this document.
COVID-19 - How it is Spread
COVID-19 is spread from person to person.
The virus spreads from respiratory droplets 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 face or 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 methods are how most respiratory viruses spread.
Multisystem Inflammatory Syndrome (MIS-C)
MIS-C is a very rare but severe complication of COVID-19. In general, COVID-19 continues to be a mild disease in children.
Symptoms: The most common symptoms are fever with red eyes, red lips, red palms and soles. Abdominal pain with vomiting and diarrhea also occur. Half of the patients develop trouble breathing. MIS-C always has more than two symptoms.
Onset of symptoms: Usually about 4 weeks after a COVID-19 infection and apparent recovery.
Peak age: 8 years. Age range: 6 months to 21 years.
Treatment: Children with MIS-C need to be admitted to the hospital. 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 fully vaccinated against COVID-19.
COVID-19 Infection with Mild Symptoms - Overview:
You or your child have been diagnosed as having COVID-19 by a positive lab test OR
You or your doctor suspect COVID-19 because it is widespread in your community and you have developed symptoms that match (cough and/or fever).
Get a COVID-19 test if you have COVID-19 symptoms or had possible exposure. See Testing #9 below.
Most infections stay mild, especially in children.
Here’s some care advice to help the sick person feel better.
Treatment of Symptoms:
The treatment is the same whether you have COVID-19, influenza or some other respiratory virus.
The only difference for COVID-19 is you need to stay on home isolation until you recover. Reason: You want to protect other people from getting it.
Treat the symptoms that are bothering you the most.
There is no anti-viral medication for treating COVID-19 at home.
Antibiotics are not helpful for viral infections.
You don’t need to call or see your doctor unless you develop trouble breathing or become worse in any other way.
For fever above 102 F (39 C), you may use acetaminophen or ibuprofen if the patient is uncomfortable. (See Dosage table).
For fevers 100-102 F (37.8 to 39 C), fever medicines are not needed. Reason: Fever turns 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: prevent dehydration. For children younger than 6 months, only give formula or breastmilk. Staying well hydrated helps the body sweat and give off heat.
Homemade Cough Medicine:
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: 1-3 teaspoons (5-15 ml) four times per day.
If nothing else helps: Give a small amount of corn syrup. Dosage: 1/4 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 1/2 to 1 teaspoon (2 to 5 ml) as needed as a homemade cough medicine. It can thin the secretions and loosen the cough. (If 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.
OTC cough medicines are not recommended. (Reason: no proven benefit for children.) Honey has been shown to work better.
Don’t use OTC cough medicines under 6 years of age. Reason: Cough is a protective reflex.
Sore Throat Pain Relief:
COVID-19 often causes a sore throat. Here are some tips on treating it:
Age over 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 over 6 years: Can also suck on hard candy or lollipops. Butterscotch seems to help.
Age over 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.
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 per day.
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 every 4 hours OR ibuprofen every 6 hours as needed. (See Dosage table.) Not needed for mild aches.
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 helps the body sweat and give off heat.
Home Isolation Is Needed for Those Who are Sick:
Isolation means separating sick people with a contagious disease from people who are not sick. (CDC) That means stay at home for at least 5 full days after symptoms started.
Living with a suspected COVID-19 patient implies close contact has occurred.
Both patient and family members should stay home on isolation and quarantine.
Exception: A fully vaccinated person with no symptoms does not need to quarantine. You should be tested 5 days after close contact with an infected person. You should also wear a mask in public indoor settings for 10 days or until you get a negative test result.
Children under 2 years: Isolate at home for a full 10 days.
Essential workers who have COVID-19 exposure but no symptoms should talk to your employer.
The sick person does not need to be confined to a single room. Reason: Preventing spread of respiratory infections within a home is nearly impossible.
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.
Older children and adults with symptoms should try to wear a mask in common household areas.
Isolation Questions for Your Doctor: Home isolation can be complicated. A parent may need to return to work. Someone in the household may be elderly or have a serious medical problem. If you have additional questions, call your doctor during office hours. Your doctor is the best resource for up-to-date information on COVID-19.
Stopping Home Isolation - Must Meet all 3 CDC Requirements:
Fever gone for at least 24 hours after stopping fever-reducing medicines AND
Cough and other symptoms are gone or almost gone (resolving) AND
Symptoms started more than 5 days ago.
Patients with no symptoms (and no symptoms developed): stay at home until 5 full 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 full 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 during office hours.
COVID-19 Testing - When and Where:
If COVID-19 is suspected, get a COVID-19 test. Testing is also needed if you have had an exposure, but have no symptoms.
Your doctor may provide COVID tests in their office. Many 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 (such as Walgreens).
Here are some facts that may answer some of your questions:
Diagnostic Tests: These are performed on nasal or mouth secretions. The test 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 but with a COVID-19 close contact. Get a test on day 5 after exposure. To be safe, people who have received the COVID-19 vaccine should also be tested. (CDC)
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 10 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. If the test is again negative AND you live with a high risk person, talk with your doctor about getting a more accurate PCR test. Reason: negative home tests are not always reliable.
Antibody Tests: These are performed on blood. 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.
If you have testing questions, call your doctor during office hours.
How to Protect Others - When You or Your Child are Sick:
Stay home. Don’t go to school or work if you are sick. Don’t go to stores, restaurants, places of worship or other public places. Avoid public transportation or ride sharing. Leave the house only if you need to seek medical care.
No visitors. Do Not allow any visitors, even friends.
Cover the cough. 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 trash can.
Wash hands often with soap and water. After coughing or sneezing are important times.
Don’t share glasses, plates or eating utensils.
Wear a face mask when around others or you have go to a medical facility.
Call Your Doctor If
Trouble breathing occurs
You think you or your child needs to be seen
Symptoms become worse
Author: Barton 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. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.