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Review
. 2021 May 28:9:668484.
doi: 10.3389/fped.2021.668484. eCollection 2021.

Coronavirus Disease 2019 in Children

Melissa Borrelli  1 , Adele Corcione  1 , Fabio Castellano  1 , Francesca Fiori Nastro  1 , Francesca Santamaria  1
Affiliations
Review

Coronavirus Disease 2019 in Children

Melissa Borrelli et al. Front Pediatr. .

Abstract

Since its appearance in Wuhan in mid-December 2019, acute respiratory syndrome coronavirus 2 (SARS-CoV-2) related 19 coronavirus disease (COVID-19) has spread dramatically worldwide. It soon became apparent that the incidence of pediatric COVID-19 was much lower than the adult form. Morbidity in children is characterized by a variable clinical presentation and course. Symptoms are similar to those of other acute respiratory viral infections, the upper airways being more affected than the lower airways. Thus far, over 90% of children who tested positive for the virus presented mild or moderate symptoms and signs. Most children were asymptomatic, and only a few cases were severe, unlike in the adult population. Deaths have been rare and occurred mainly in children with underlying morbidity. Factors as reduced angiotensin-converting enzyme receptor expression, increased activation of the interferon-related innate immune response, and trained immunity have been implicated in the relative resistance to COVID-19 in children, however the underlying pathogenesis and mechanism of action remain to be established. While at the pandemic outbreak, mild respiratory manifestations were the most frequently described symptoms in children, subsequent reports suggested that the clinical course of COVID-19 is more complex than initially thought. Thanks to the experience acquired in adults, the diagnosis of pediatric SARS-CoV-2 infection has improved with time. Data on the treatment of children are sparse, however, several antiviral trials are ongoing. The purpose of this narrative review is to summarize current understanding of pediatric SARS-CoV-2 infection and provide more accurate information for healthcare workers and improve the care of patients.

Keywords: COVID-19; SARS-CoV-2; adolescents; chest imaging; children; drugs; novel coronavirus; therapy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Distribution of COVID-19 cases, in the general and pediatric populations of the USA (A) (14), Italy (B) (16), and Australia (C) divided into age groups (17).
Figure 2
Figure 2
Possible protective mechanisms in the pediatric population against SARS-CoV-2 infection.
Figure 3
Figure 3
Key manifestations and organ and apparatus involvement in the pediatric population with SARS-CoV-2 infection.
Figure 4
Figure 4
Chest CT scan showing bilateral consolidations in a 17 year old boy affected by SARS-CoV-2.
See this image and copyright information in PMC

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