Clinical characteristics of children with COVID-19: a rapid review and meta-analysis

Abstract

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 metaanalysis 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.

Sudden anosmia and ageusia in a child: A COVID-19 case report

“…Clinical manifestations of COVID-19 in children include fever, cough, shortness of breath, rhinorrhea, myalgia or fatigue, diarrhea, vomiting, and headache. Fever and cough have been consistently noted as the most common presenting symptoms in multiple studies across several countries [ 12 , 13 ]. In a meta-analysis of studies on the clinical characteristics of children with COVID-19, symptoms of fever and cough were present most commonly at 48% and 39%, respectively, while gastrointestinal symptoms such as vomiting and diarrhea were much less common at 7% and 6%, respectively.…”

“…In a meta-analysis of studies on the clinical characteristics of children with COVID-19, symptoms of fever and cough were present most commonly at 48% and 39%, respectively, while gastrointestinal symptoms such as vomiting and diarrhea were much less common at 7% and 6%, respectively. The majority of pediatric patients generally have mild symptoms [ 12 ]. Anosmia and ageusia are seldomly reported as presenting symptoms of COVID-19 in the pediatric population.…”

Correlations of Clinical and Laboratory Characteristics of COVID-19: A Systematic Review and Meta-Analysis

“…These papers did not describe clinical features, but only summarized laboratory findings. Wang et al [17] summarized the clinical characteristics and laboratory findings in children but it is difficult to apply these to all adults and correlation between the findings is not investigated. Lastly, Lovato et al [18], Fu et al [19] and Li et al [20] analyzed clinical characteristics and laboratory findings associated with critical outcomes such as intensive care unit (ICU) care or case-fatality rate (CFR).…”

Epidemiological and Clinical Characteristics of COVID-19 in Children: A Systematic Review and Meta-Analysis

“…For this reason, most of the guidelines published so far are more appropriate for adults than for children. Several systematic reviews with simple meta-analysis have been reported, but these have mainly focused on the clinical characteristics of pediatric COVID-19 (5)(6)(7), and data on the transmissibility, rate of viral coinfections, and treatments of pediatric COVID-19 are still lacking. Asymptomatic transmission is the Achilles' heel of COVID-19 pandemic control, as reported by Gandhi et al (8), but the number of asymptomatic infections in children is unknown.…”