COVID-19 in Children

Masked child sitting in hospital bed holding a stuffed toy.There is a great deal still to learn about how COVID-19 infection affects children. Children can become infected with the virus that causes COVID-19 and can get sick with COVID-19. Although most have mild or no symptoms, children with underlying medical conditions and infants younger than 1 year old may be at increased risk for severe illness from COVID-19.

Physicians around the world are also investigating multisystem inflammatory syndrome in children (MIS-C) that seems to be related to previous exposure to COVID-19. MIS-C is a spectrum of inflammatory processes with features that overlap with toxic shock syndrome and are similar to the heart condition known as Kawasaki disease. MIS-C can present with symptoms seemingly unrelated to COVID-19, such as severe abdominal pain. MIS-C usually affects school-age children, specifically those who were previously healthy and who may have initially had only mild COVID-19 symptoms or no symptoms at all.

Among NICHD’s efforts are co-leading, with the National Institute on Drug Abuse, the Trans-NIH COVID-19 Workgroup on Pregnant & Lactating Women and Children, which coordinates NIH’s Strategic Response Activities for these populations.

Some NICHD research activities, including collaborations across NIH, on COVID-19 in children and MIS-C include the following :

  • NIH’s Collaboration to Assess Risk and Identify loNG-term outcomes for Children with COVID (CARING for Children with COVID) program aims to better understand why symptoms vary among children with COVID-19 disease, and how to identify children at risk for severe illness from SARS-CoV-2 infection, including MIS-C. NIH effort seeks to understand MIS-C, range of SARS-CoV-2 effects on children explains more about the CARING for Children with COVID program.
  • In addition, HHS has organized an interagency team, which includes leadership teams from NICHD and the National Heart, Lung, and Blood Institute, among other institutes, centers, and offices, to collaboratively address the Departmental response to MIS-C. This interagency team is collaborating with domestic and international partners to better understand MIS-C, including its epidemiology, establish a coordinated system for surveillance and research, and eventually provide guidance and recommendations to parents and healthcare providers. NICHD will be involved in the coordination of clinical trials, primarily through its funded networks.
    • For example, the International Maternal, Pediatric, Adolescent AIDS Clinical Trials (IMPAACT) Network, co-funded by NICHD, the National Institute of Allergy and Infectious Diseases, and the National Institute of Mental Health (NIMH), is a global collaboration that conducts clinical trials of HIV (and other infectious diseases) therapy, prevention, and potential remission/cure in maternal, pediatric, and adolescent patients. IMPAACT researchers are initiating a study to characterize immune responses in U.S. children with a history of COVID-19 infection and identify associations with the clinical course of COVID-19. The researchers will collect biosamples, medical history (including HIV exposure), and demographics at enrollment and at several follow-up visits over 2 to 12 months. This project can shed light on why most children have mild COVID-19 disease, investigate the impact of HIV co-infection, and potentially serve as controls/comparison population for studies of MIS-C.
  • An NICHD-led project—Predicting Viral-Associated Inflammatory Disease Severity in Children with Laboratory Diagnostics and Artificial Intelligence (PreVAIL kIds)—aims to encourage development of cutting-edge approaches for understanding the underlying factors that influence the spectrum of conditions that may occur in children infected with the SARS-CoV-2 virus. Part of the trans-NIH Rapid Acceleration of Diagnostics (RADxSM) initiative, PreVAIL kIds aims to understand the range of symptoms of COVID-19 and the factors leading to MIS-C. Studies funded through PreVAIL kIds will evaluate genes and other biomarkers in COVID-19 pediatric cases, as well as examine how the virus interacts with its host and how the immune system responds.
  • NICHD will manage the Safe Return to School Diagnostic Testing Initiative, a part of the RADx-Underserved Populations program, which will fund projects to build evidence on safely returning students, teachers, and support staff to in-person school in areas with vulnerable and underserved populations.
  • The institute is also working with NIMH on a range of studies related to the effects of the pandemic on school-age children. These projects, which include studies of the mental health effects of school disruptions and development of new diagnostic approaches to enable the return to in-person school, will provide an evidence base for the U.S. effort to get children back to in-person learning.
    • Safe Return to School For All external link summarizes current evidence and best practices to help administrators, educators, and families and students—including students with disabilities—return to school safely in the context of COVID-19. The information provided is based on collaborative research from the NICHD-funded Washington University Intellectual and Developmental Disabilities Research Center, the University of Missouri-Kansas City Institute of Human Development, and the Kennedy Krieger Institute (Maryland), in collaboration with the Special School District of St. Louis County, Missouri.

The NIH Director’s Blog post, What We Know About COVID-19’s Effects on Child and Maternal Health featured highlights from an interview with NICHD Director Diana W. Bianchi, M.D., and NIH Director Francis S. Collins, M.D., Ph.D., during which they discussed SARS-CoV-2 and COVID in children.

Dr. Bianchi also used her Director’s Corner to discuss NIH-wide efforts to understand Post-Acute Sequelae of COVID (PASC), long-term effects of infection that persist after a person should feel better. NICHD will be studying children who are among these so-called “COVID long haulers.”

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