Pediatrics Related Questions

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]

Pediatrics Related Questions

Are children with congenital heart diseases at increased risk of COVID-19?

  • A study published in the Journal of the American Heart Association investigated the effects of COVID-17 in the pediatric and adolescent population with congenital heart disease(CHD).[1] The results found that patients with CHD are more susceptible to being infected with COVID-19 and may in fact have worse outcomes and complications due to the disease. This is as a result of their already disturbed physiologic states as well as other co-morbidities associated with congenital heart diseases.[1] For these individuals, primary prevention and infection control processes are especially crucial.

Are children with underlying conditions at increased risk of hospitalization?

Is there an association between KAWASAKI disease and COVID-19?

  • Kawasaki disease, also known as lymph node syndrome, mucocutaneous node disease, infantile polyarteritis, and Kawasaki syndrome, is a poorly understood self-limited vasculitis that affects many organs, including the skin, mucous membranes, lymph nodes, blood vessel walls, and the heart.[5] The emergence of COVID-19 has seen new presentations of known medical conditions for the first time.[6] Numerous reports have shown a spike in new/concurrent cases of Kawasaki disease in COVID-19 positive patients. Information regarding the novel COVID-19 is still being gathered and although an exact association hasn't been established between Kawasaki disease and COVID-19, more research and investigations are still being conducted.[7]

Is Multi-system Inflammatory Syndrome in Children (MIS-C) fatal? What precautions can be taken to avoid it?

  • As described in the Health Advisory, Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19),”[8] the case definition for MIS-C is[9]:
    • An individual aged <21 years presenting with fever(>38.0°C for ≥24 hours, or report of subjective fever lasting ≥24 hours), laboratory evidence of inflammation (Including, but not limited to, one or more of the following: an elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, procalcitonin, d-dimer, ferritin, lactic acid dehydrogenase (LDH), or interleukin 6 (IL-6), elevated neutrophils, reduced lymphocytes, and low albumin), and evidence of clinically severe illness requiring hospitalization, with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological); AND
    • No alternative plausible diagnoses; AND
    • Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or exposure to a suspected or confirmed COVID-19 case within the 4 weeks prior to the onset of symptoms.
  • There have been very few cases of death reported in hospitalized patients.[9]
  • The best-known way to prevent MIS-C is primary prevention against COVID-19.[10] Individuals should follow already established social-distancing and sanitation guidelines.

Should routinely-recommended Hepatitis A and B vaccines continue to be administered to children?

  • At each patient visit, it is important to access the vaccination status of children and adolescents. As long as there are no specific contraindications to vaccination at that time, all due and over-due immunizations should be administered at that visit.[11]
    • According to the CDC;[12] Routine vaccinations are an essential preventive care service for children and adolescents and should not be delayed because of the COVID-19 pandemic.[11]

Should vaccinations for HBV exposed infants be continued during the COVID 19 pandemic?

  • In order to prevent the transmission of HBV in exposed infants, prompt administration of hepatitis B immune globulin at birth, and the completion of the hepatitis B vaccine series and post-vaccination serologic testing is warranted.This should not be delayed even during the COVID-19 pandemic.[11]


  1. 1.0 1.1 Alsaied T, Aboulhosn JA, Cotts TB, Daniels CJ, Etheridge SP, Feltes TF, Gurvitz MZ, Lewin MB, Oster ME, Saidi A (June 2020). "Coronavirus Disease 2019 (COVID-19) Pandemic Implications in Pediatric and Adult Congenital Heart Disease". J Am Heart Assoc. 9 (12): e017224. doi:10.1161/JAHA.120.017224. PMID 32441586 Check |pmid= value (help).
  2. 2.0 2.1 "Coronavirus Disease 2019 in Children - United States, February 12-April 2, 2020". MMWR Morb. Mortal. Wkly. Rep. 69 (14): 422–426. April 2020. doi:10.15585/mmwr.mm6914e4. PMC 7147903 Check |pmc= value (help). PMID 32271728 Check |pmid= value (help).
  3. "Coronavirus Disease 2019 (COVID-19) Treatment Guidelines".
  4. "UpToDate".
  5. "Kawasaki disease overview - wikidoc".
  6. "Association Between COVID-19 and Kawasaki Disease: Vigilance Required From Otolaryngologists - Henya Sandhaus, Dana Crosby, Arun Sharma, Stacie R. Gregory,".
  7. "Trending Clinical Topic: Kawasaki Disease and COVID-19".
  8. "HAN Archive - 00432 | Health Alert Network (HAN)".
  9. 9.0 9.1 "Information for Healthcare Providers about Multisystem Inflammatory Syndrome in Children (MIS-C) | CDC".
  10. "Multisystem inflammatory syndrome in children (MIS-C) and COVID-19 - Mayo Clinic".
  11. 11.0 11.1 11.2 "Ask the Experts about COVID-19 and Routine Vaccination - CDC experts answer Q&As".
  12. "Vaccination Guidance During a Pandemic".