Most Severe Acute Respiratory Syndrome
Coronavirus 2 (SARS-CoV-2) infections in children are
mild or asymptomatic. Severe Coronavirus Disease 2019
(COVID-19) in children is infrequent. An estimated
0.3–1.3% of children with SARS-CoV-2 infection were
admitted to hospital, and of these 13–23% needed critical
care. SARS-CoV-2 related deaths were very rare in children, estimated at 2 per million. The vast majority of
admitted children had one of shortness of breath, fever,
and cough, but atypical symptoms are more common in
children. Cases of Multisystem Inflammatory Syndrome in
Children (MIS-C) have been linked to SARS-CoV-2 infection. Cardinal symptoms include prolonged fever, clinical
signs of inflammation, gastro-intestinal symptoms, and
cardiac dysfunction. Twenty two to 80% of patients with
MIS-C needed critical care; mortality of MIS-C is around
2%. Six to 24% of children with MIS-C had coronary artery
dilatation or cardiac aneurysms. Equipoise still exists
between first-line treatment with immunoglobulins and
steroids. Outcomes for children with MIS-C are generally
very good in those recognised early and started on
appropriate treatment. Vaccination schemes for children
are rapidly expanding, with the benefits of preventing
severe COVID-19 disease and MIS-C and reducing community transmission outweighing the risks of adverse
events of, amongst others, myocarditis temporally related
to COVID-19 vaccination in children and young adults.
The imposed social distancing measures reduced the
overall number of children with acute illness or injury
presenting to urgent and emergency care facilities
worldwide. No clear signal was seen that large numbers of
children had a delayed presentation to emergency care
departments with a serious illness. The social distancing
measures negatively impacted the mental health of
children.