ObjectiveTo describe the risk factors, clinical profile and outcomes of COVID-19 in the paediatric population.DesignMulticentre, retrospective observational study.SettingFour tertiary hospitals in Saudi Arabia.PatientsWe recruited 390 paediatric patients aged 0–18 years who presented from March to December 2020 and tested positive for COVID-19 on PCR.Main outcome measuresWe retrospectively analysed medical records for sociodemographics, health indicators, clinical presentations, laboratory findings, clinical complications, and outcomes.ResultsThe mean participant age was 5.66±4.90 years, and the mean hospital stay was 2.17±3.48 days. Forty patients, mostly school-aged children (16, 40.00%; p=0.005) and children with comorbidities (25, 62.50%; p<0.001), received more than just supportive care. Complications were seen in 15 (3.9%) patients, bacterial infection being the most common (6, 40.00%). Patients presented with dyspnoea (OR 6.89; 95% CI 2.89 to 20.72), abnormal chest radiographs (OR 6.11; 95% CI 1.26 to 29.38), lethargy (OR 9.04; 95% CI 2.91 to 28.06) and elevated ferritin (OR 14.21; 95% CI 4.18 to 48.37) and D-dimer (OR 48.40; 95% CI 14.32 to 163.62), with higher odds of developing complications. The odds of paediatric intensive care unit (ICU) admission were higher for patients with dyspnoea (adjusted OR 4.66; 95% CI 1.24 to 17.50) and elevated white blood cell count (adjusted OR 3.54; 95% CI 1.02 to 12.30).ConclusionsCOVID-19 complications were limited among our patients. However, dyspnoea, abnormal chest radiographs, lethargy and elevated ferritin and D-dimer were associated with an increased risk of complications. Dyspnoea, leucocytosis, comorbidities and abnormal chest radiographs at presentation increased the risk of ICU admission.

As cases for the COVID-19 pandemic increase, the presence of atypical presentations' becoming more prevalent which may reflect the pathogenesis and nature of the disease; this is quintessential for clinicians to understand the disease to combat the pandemic effectively. Here we present an atypical COVID-19-associated parotitis in a 7 year old boy along with some differences between the different causes of parotitis as well as a possible explanation for the infection.