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Clinical characteristics of children with COVID-19: a rapid review and meta-analysis
Zijun Wang1, Qi Zhou2, Chenglin Wang3,4,5
1Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China.
Insights
Most children with COVID-19 (coronavirus disease 2019) experience mild symptoms, with many being asymptomatic. Fever and cough are the most frequent indicators in pediatric cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Current COVID-19 guidelines often lack age-specific recommendations.
- Understanding the clinical profile of COVID-19 in children is crucial for effective management.
Purpose of the Study:
- To synthesize the clinical characteristics of COVID-19 in pediatric patients.
- To provide clinicians with a clearer understanding of disease presentation in children.
Main Methods:
- Systematic literature search of studies published up to March 31, 2020.
- Data extraction, risk of bias, and quality assessment of included studies.
- Single-arm meta-analysis of symptoms using a random-effects model.
Main Results:
- Analysis of 1,667 pediatric patients across 49 studies.
- 83% of pediatric cases occurred within family clusters; 19% were asymptomatic.
- Common symptoms included fever (48%) and cough (39%); digestive symptoms occurred in at least 7%.
Conclusions:
- COVID-19 in children predominantly presents with mild or no symptoms.
- Fever and cough are the most prevalent symptoms in pediatric COVID-19.
- Lymphocyte counts typically remain within normal ranges in children, unlike adults.
Background:
Most guidelines on COVID-19 published so far include recommendations for patients regardless of age. Clinicians need a more accurate understanding of the clinical characteristics of children with COVID-19.
Methods:
We searched studies reporting clinical characteristics in children with COVID-19 published until March 31, 2020. We screened the literature, extracted the data and evaluated the risk of bias and quality of evidence of the included studies. We combined some of the outcomes (symptoms) in a single-arm meta-analysis using a random-effects model.
Results:
Our search retrieved 49 studies, including 25 case reports, 23 case series and one cohort study, with a total of 1,667 patients. Our meta-analysis showed that most children with COVID-19 have mild symptoms. Eighty-three percent of the children were within family clusters of cases, and 19% had no symptoms. At least 7% with digestive symptoms. The main symptoms of children were fever [48%, 95% confidence interval (CI): 39%, 56%] and cough (39%, 95% CI: 30%, 48%). The lymphocyte count was below normal level in only 15% (95% CI: 8%, 22%) of children which is different from adult patients. 66% (95% CI: 55%, 77%) of children had abnormal findings in CT imaging.
Conclusions:
Most children with COVID-19 have only mild symptoms, and many children are asymptomatic. Fever and cough are the most common symptoms in children. Vomiting and diarrhea were not common in children. The lymphocyte count is usually within the normal range in children.
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