Children and COVID-19
Your questions answered by our experts
As the COVID-19 pandemic drags on and evolves, many parents have been left with renewed questions about protecting their children from the virus and the steps to take if their child, or a family member, has the symptoms of COVID-19 or tests positive.
UNICEF Health Experts answer parents' most common questions.
“Can children get COVID-19?”
Yes. It’s possible for anyone, of any age, to contract COVID-19 — including children.
Luckily most cases of COVID-19 in children are mild and very few require hospitalization. However, it’s important to ensure children get the care they need if they are diagnosed with COVID-19 and to monitor their symptoms closely.
An additional big impact of COVID-19 in South Asia has been the closure of and disruption to health services for mothers and children across the region.
This has meant that huge numbers of children are at risk of missing the routine vaccinations and health checks they need to keep them safe.
In fact, the risks to children's health from missing their routine vaccinations and health checks are much higher than they are from COVID-19.
So, if your child has missed out on their regular vaccinations because of the pandemic, try to book them in as soon as you can.
It’s important that your children’s regular vaccinations are kept up to date and that they continue to attend regular follow-ups where services are offered. Information on how to do so safely during the pandemic can be found here.
“Why are more children in South Asia testing positive for COVID-19 during the delta wave?”
As the number of people across South Asia testing positive for COVID-19 has increased, the number of children contracting the virus has also proportionally increased.
However, we have not yet seen any evidence that shows a higher percentage of children are now getting the virus than in the first waves.
Fortunately, children still have a very low risk of becoming severely unwell from the virus. Many of them recover from the virus without showing any symptoms at all.
However, while children have the virus they can still infect each other and adults — even if they don’t have any symptoms. One feature of the most recent wave is that entire households are now becoming infected with the virus, more so than in the first waves.
This is why it’s really important that every member of the family continues to follow the behaviours that keep the whole family safe — even if nobody feels sick, and if you have been vaccinated.
“How does COVID-19 affect children?”
COVID-19 affects different people in different ways. We’re still learning about how it affects children.
We do know that people of any age can be infected and transmit the virus. We also know that older people and those with pre-existing medical conditions are more likely to develop severe illness from the virus.
In fact, 60-70% of children who get COVID-19 don’t show any symptoms of the virus at all.
Of the children that do have symptoms of the virus, only 1-2% may develop severe disease.
Some children that have developed severe disease have needed treatment in an intensive care unit and some children have died. Fortunately, this seems to be relatively rare. But it does happen and we know that children with underlying health conditions are at higher risk of developing severe disease from COVID-19.
There have been reports across South Asia and the world of a link between COVID-19 and Multisystem inflammatory syndrome in children (MIS-C). MIS-C is a rare condition where different parts of the body can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. This can lead to multiorgan failure, shock and in very rare cases, death.
More information on MIS-C can be found here.
We are still learning about MIS-C, how it affects children and the link with COVID-19. Many children who have developed MIS-C have not shown any symptoms of COVID-19, but when they develop symptoms of MIS-C and a COVID-19 antigen test is done, they have tested positive for the virus.
Reports of MIS-C are rare and most children who were diagnosed with this condition have gotten better with medical care.
However, it is important to be aware of all the symptoms of COVID-19 in children, and know which ones are serious. If your child shows any serious symptoms of COVID-19, seek medical assistance immediately.
COVID-19 Symptoms in Children
The most common symptoms of COVID-19 infection in children are:
- Cold
- Mild or continuous cough
- Fever
- Body pain
Other COVID-19 symptoms that can be present in children include:
- Pain in the abdomen
- Vomiting
- Headache
- Tiredness
- Breathlessness
- Poor feeding
- Loss of taste or smell (in children over eight years old)
- Rash
- Red or pink eyes
- Swollen and/or red lips, tongue, hands or feet
- Diarrhoea and loose motions
Symptoms of serious illness/COVID-19 in children include:
- Difficulty breathing
- Fast or shallow breathing
- Blue lips or face
- Chest pain or pressure
- Abnormal or sudden state of confusion
- Inability to wake up or interact when awake
- Inability to keep liquids down
- Fever
Symptoms of serious illness/COVID-19 in infants (up to 5 years old) include:
- An inability to feed
- Vomiting everything
- Convulsions or grunting
- Lethargy
- Unconsciousness
- Fever
- Fast breathing or difficulty in breathing
“What should I do if my child has symptoms of COVID-19?”
If your child has any common symptoms of COVID-19 you should seek medical attention to get them tested for the virus. Children with mild symptoms of the virus can be treated at home with advice from a health worker.
If your child or infant has any serious symptoms of COVID-19, seek urgent medical attention immediately.
“In what situations should I test my child for COVID-19?”
Seek medical advice if your child is unwell or has any symptoms of the virus.
Depending on COVID-19 testing capacity, different countries across South Asia may have additional requirements on when you should test your child for COVID-19. Check with your Local Health Authority or nearest health provider for more information. Many countries have COVID-19 hotlines that you can call to get advice.
“My child has a fever. How can I tell if it is COVID-19 or something else?”
You cannot tell.
For an ordinary person and even for a doctor, it is difficult to know the difference between a common cold/fever and COVID-19, without a test.
This means that every case of fever or cough in your child could be COVID-19 — especially if a family member has COVID-19 or has recently recovered from the virus.
“How do I look after a family member with COVID-19 at home while keeping the rest of the family safe?”
Detailed guidance on safely caring for a family member with COVID-19 can be found here.
You should also speak to health workers to get tailored isolation recommendations for your living situation and family circumstances.
If someone in your house tests positive for COVID-19, other members of the household (including children) could have the virus too, even if they don’t have symptoms. Speak to the health worker about getting the whole household tested for the virus, as soon as you can.
“My child has COVID-19 but I don’t. How should I care for my child?”
The World Health Organization recommends that children with COVID-19 stay with their parents or caregivers wherever possible while recovering from the virus.
The majority of children with COVID-19 will only develop a mild illness that can be treated at home. Caring for your child should always be done in consultation with a health worker.
Planning your child’s isolation
Seek advice from your health care worker on how best to manage your child’s care while keeping the family safe.
The health worker will take into account:
- Your child’s age and independence.
- The number of rooms and toilets in your house.
- The number of people living in your house, their vulnerability, including their age, if they have any other health conditions and their risk of developing severe COVID-19.
Children who are isolating with COVID-19 can have more than one designated caregiver. While adults who are isolating with the virus are only recommended to have one.
Safety measures
While caring for your child at home, there is a risk that you, or other members of the household, could become infected.
Because of this increased risk, we recommend that everyone in the house follows even more thorough precautions than usual when washing their hands — and washes their hands for at least 40 seconds (in line with guidance for healthcare facilities), rather than 20 seconds (as we normally recommend).
Elderly people and those with underlying health conditions are at very high risk of serious disease from COVID-19. So, a child with COVID-19, should not be in physical contact, or stay in the same house as elderly people (including their grandparents), or those with underlying health conditions.
Discuss with the health worker:
- Testing the whole family for COVID-19 (you could already have the virus, even if you don’t have symptoms).
- Childcare plans for if all the caregivers in the household become ill.
- How you will manage food and grocery deliveries while your family is isolating.
While your child is isolating:
- Ideally, no-one in the household should leave the house or interact with others. Seek advice from your health worker for further guidance.
- If you have younger children, you should stay with them in their room, to provide the care and support they need.
- If you have older children they may be able to isolate more independently in a separate room.
- No more family members than necessary should stay in the same room as your child while they are isolating.
- If you are sharing a room with your child, keep your bed at least one meter from their bed.
- Open the windows to ventilate the room where your child is isolating.
- Give your child separate utensils to eat with from the rest of the family.
- Make sure they have toys, books and games to keep them occupied — and that these aren’t shared with the rest of the household during isolation.
Everyone in the house should:
- Wash their hands frequently with soap and water for at least 40 seconds.
- Keep at least 1-meter distance from the child with COVID-19, as much as possible.
Mask up correctly
While your child is in isolation, the whole family should wear surgical masks (instead of fabric masks). Surgical masks must be changed and disposed of safely after every use and when they get soiled or wet.
The child with COVID-19 should wear a surgical mask (as long as they can tolerate it):
- Whenever anyone comes into their room.
- At all times when outside their room.
The people caring for the child with COVID-19 should wear a surgical mask:
- Whenever they provide any care to the child.
- Before they enter the room where the child is isolating.
- While they are in any spaces in the house shared with the child (e.g. the toilet, hallway).
The rest of the household (including children) should wear a surgical mask:
- Whenever they come within 1 meter of the sick child.
- While they are in any spaces in the house shared with the child (e.g. the toilet, hallway).
If your child under 5 is required to wear a mask, make sure they are always within a direct line of sight to you, or supervised by an adult.
If you are sharing a room with the child with COVID-19, everyone in the room should wear a surgical mask as much as possible.
Keeping shared spaces safe and clean
- Limit your child’s movements around the house and reduce the number of rooms or spaces they share with other family members.
- Ventilate the room by opening windows.
- Shared spaces and surfaces should be cleaned every day with bleach.
- All surfaces must be rinsed with soap and water or detergent, before rinsing and applying bleach.
- Wear utility gloves when cleaning to protect your skin.
- Your child should use a separate toilet and bathroom from the rest of the family, if possible.
- If you don’t have a separate toilet/bathroom, the toilet/bathroom should be cleaned after every use, by every person.
Full guidance on caring for someone with COVID-19 and cleaning your home can be found here.
Caring for your child
When caring for your child, it’s important that you wear personal protective equipment (PPE) for your own protection, including:
- A surgical mask
- Disposable gloves
- A plastic apron
To help aid your child’s recovery from COVID-19:
- Feed them a soft, light diet of nutritious home-cooked food. Milk, eggs, fruit and vegetables are all good options.
- Keep them well hydrated by providing plenty of liquids.
If your child is suffering from fever, muscle pain or headaches, these can be treated with paracetamol (always follow the dosage advice for children from the pharmacy).
A fever can also be soothed with a cold wet cloth on the forehead.
Helping your child stay connected
While your child is isolating they will not be able to hug or touch other members of this family, without putting them at risk. This can be a very difficult and anxiety-inducing experience for children, especially younger ones.
During their isolation:
- Try to find creative ways to bring happiness and stimulation to their days.
- Maintain routines where possible.
- Talk to them about how they’re feeling.
- Use digital technology to help them feel connected to their friends and family.
- Encourage yoga, meditation and exercise.
Monitoring your child’s symptoms
While your child is isolating, stay in regular contact with your doctor and monitor their symptoms for any signs of deterioration.
If your child or infant develops any of the serious symptoms of COVID-19 (listed above) seek urgent medical attention.
Using pulse oximeters
You can also monitor the severity of your child's symptoms by using a pulse oximeter to check their oxygen levels. Talk to your health worker for more information and guidance on using one.
“I have COVID-19. My children don’t. Can I continue to look after them at home?”
If you have COVID-19, staying in the same house as your children put them at risk of becoming infected with the virus too.
If you have to isolate, and your children don’t have COVID-19, ideally they should be cared for by another member of the family or a friend without COVID-19, preferably in a separate building.
If you have no other child-care options and your children have to stay with you while you’re isolating, it’s important that you strictly follow isolation health guidance (including use of masks, distancing and handwashing) to reduce the risk of infecting your children with the virus.
Full guidance on keeping your family safe when isolating with COVID-19 can be found here.
“If all of my family are hospitalized with COVID-19, who will look after our children?”
When you first become aware of a COVID-19 case in your household, it’s important that you plan ahead for worst-case scenarios.
If more than one member of the family has COVID-19, the family members with the virus can isolate themselves in the same room.
Every family should identify relatives or friends who can take care of their children, if everyone in the household becomes too ill to care for them. This should ideally be done in consultation with a health worker.
If you find yourself in an urgent situation where you cannot find anyone to care for your children, local NGOs and community-based organizations specializing in social services may be able to help.
“Which children are at risk of getting seriously ill from COVID-19? ”
Children with pre-existing major diseases, such as a heart, kidney or liver disease are at a higher risk of getting seriously ill from COVID-19.
Children with low immunity, for example those with cancer, cystic fibrosis, an immunity disease and obese children, are also at a higher risk.
“Do all children who develop severe COVID-19 need to go to the ICU?”
We have witnessed very few severe cases of COVID-19 among children in the region that required hospitalization. Most children are asymptomatic, or develop mild flu-like symptoms, which can be treated at home.
Children who have been sick due to other illnesses, for example lung disease, cancer, heart disease, asthma and kidney disease have weak immunity and have a higher risk of developing a severe COVID-19 infection that may require ICU care.
“My child tested COVID-19 positive one week ago. She is due for her routine vaccinations in two weeks. What should I do?”
Your child can have their routine vaccinations when it has been two weeks since they showed any symptoms of COVID-19.
“Can I continue to breastfeed my child if I have COVID-19 symptoms?”
Yes. A mother can breastfeed if she has COVID-19, or the symptoms. The benefits of breastfeeding far outweigh the risks of infection.
At the same time, it’s really important that the mother follows all the recommended practices to prevent her from spreading the infection to her baby or anyone else in the household.
Mothers who have confirmed or suspected COVID-19 can breastfeed safely by:
- Washing their hands frequently with soap, for at least 20 seconds, especially before touching their babies.
- Wearing a surgical mask.
- Regularly cleaning and disinfecting any surfaces.
- Sneezing or coughing into a tissue. Afterwards, they should immediately dispose of the tissue and wash their hands with soap and clean water.
- Washing their breast with soap and warm water for at least 20 seconds, if they cough on their exposed chests, before feeding.
“I am too sick with COVID-19 to breastfeed. What can I do?”
If you are too sick to breastfeed your baby, there are a few options:
- You can express milk that you, or someone else, can then feed to your baby with a clean cup and spoon.
- Another breastfeeding woman can breastfeed your baby.
- You can seek advice and support from a health worker.
More information on breastfeeding on COVID-19 and breastfeeding from WHO and UNICEF.
“Does my child need to wear a mask?”
Whether your child should wear a mask depends on a number of factors, including their age, ability to safely use one and if they are in physical contact with someone who is ill.
Across South Asia, some governments have additional requirements on mask use in public and by age. Check your local authority’s guidelines.
The World Health Organization (WHO) and UNICEF recommend that:
- In general, children aged 5 years and under should not wear masks unless they are physically close to someone who is ill.
- Children aged 6-11 wear masks:
- If COVID-19 is widespread in your area.
- If your child is able to safely wear a mask.
- If your child is in physical contact with other people who are at high risk of developing a serious illness from COVID-19. For example, the elderly and people with health conditions.
- Children aged 12 and over wear masks in the same way that adults do.
If your child under 5 is required to wear a mask, make sure they are always within a direct line of sight to you, or supervised by an adult.
“Can my child get vaccinated against COVID-19?”
Children’s immune systems are different from those of adults and can vary significantly depending on their age.
The World Health Organization (WHO) has currently recommended the use of one vaccine – Pfizer/BioNTech – in children, starting from the age of 12 years old.
According to WHO, if your child doesn’t have a specific vulnerability or health condition, COVID-19 doesn’t pose a high risk to their health. Because of this, and to help tackle COVID-19 globally while vaccines are still in urgent supply, it’s important that vaccine doses be prioritized for the most at risk everywhere in the world, such as elderly people and frontline workers, before being rolled out to children widely — and, if they are rolled out to children, this should be after careful assessment of the risks and benefits to the child.
If your child is over the age of 12 and has a vulnerability or health condition that puts them at a higher risk if infected by COVID-19, speak to your health worker about getting them vaccinated.
In South Asia, some countries have started vaccinating children over the age of 12 who are at high risk of getting the virus or getting ill from it, and some have commenced reaching children more widely.
Most of these countries have already vaccinated a high proportion of the adults at the highest risk from COVID-19.
Check with your local health authority for more information.
All vaccines other than Pfizer/BioNTech are yet to be approved by WHO for use in children under 18 years old. This is because children were not included in the initial trials for COVID-19 vaccines, so there is currently limited or no data on the safety or efficacy of these vaccines in children.
Vaccine trials in children are ongoing and we will update the recommendations as more information becomes available.
It is important, however, to make sure that your child is continuing to receive routine childhood vaccinations. Read about how to do so safely here.
“Do children need to be vaccinated for schools to reopen?”
No. Safely reopening schools is not dependent on every child being vaccinated against COVID-19.
The direct health benefits of vaccination are limited for children, especially younger ones, as they have a low risk of becoming severely ill from COVID-19.
The evidence continues to show that schools are not a main driver of community transmission, and children are more likely to get the virus outside of school settings. With risk mitigation measures in place, schools can be safe environments for children.
School closures in South Asia have had a devastating impact on children’s learning and wellbeing – and children need to return to face to face learning as soon as possible.
All schools should reopen safely, without barriers, such as compulsory vaccination, which could delay or prevent the most disadvantaged children from returning.
Schools can reopen safely with sensible safety precautions in place, like access to soap and clean water, protective equipment, regular handwashing physical distancing, and the sanitization of surfaces. It’s also important that schools consider the level of COVID-19 transmission in the local area in their operational decisions. Nationwide school closures must be avoided whenever possible.
This way we can prevent transmission and every child can get back to learning as soon as possible.
“I am worried. How can I prevent my child from getting COVID-19? ”
There are no medicines or pills proven to prevent COVID-19 infection in any person.
Recently, vaccines have become available that prevent people from getting seriously ill from COVID-19. However, COVID-19 vaccines are not currently being widely rolled out to children in South Asia.
The best way to protect your children is to continue to:
- Stay at home as much as possible.
- Wash your hands with soap and water for a minimum of 20 seconds, or hand sanitizer — as often as you can.
- Cough or sneeze into your elbow.
- Keep at least 1 meter distance between yourself and others.
- Avoid attending public functions, social gatherings and group play.
- Meet people in well ventilated, or outdoor spaces.
- Wear a mask when you leave the house. This is especially important when you can’t keep your distance from others, or are inside a public space.
- Get vaccinated, when it’s your turn.
- Discuss and demonstrate the importance of these behaviours with your children.
“How can I best protect my children’s mental health during this stressful time?”
The recent surge in COVID-19 cases across South Asia has hit families' mental health hard. Every child and young person responds to stress and anxiety in different ways — and this is completely normal. As caregivers we need to respond to all emotions as valid emotions, and respond to children with empathy.
These tips and resources will help you support your child’s mental health, however they’re coping.
General tips
- Find creative ways to help your children explore their feelings.
- Listen to what they’re saying and take it seriously.
- Sometimes engaging in a creative interactive activity, such as playing and drawing can facilitate this process. Help children find positive ways to express disturbing feelings such as anger, fear and sadness.
- Keep regular routines and schedules as much as possible. Children need routine and structure as much as they need free time and play.
- If children are witnessing violence at home, or if they are the target of the violence, it causes trauma and distress and may lead to disruptive behaviour.
- Explain to them that nobody should be stigmatized for having COVID-19.
- Avoid watching, reading, listening or discussing too much news about COVID-19 and persuade children to divert their attention to other topics as well.
- If someone is sick in the family, or if there has been a death, children may experience added anxiety and may need specialized help. Talk to professional counsellors for support and next steps.
Helplines for children in South Asia:
Sometimes children don't want to talk to their parents about how they’re feeling. This does not make you a bad parent.
Helplines for children are available across South Asia. Most helplines are open 24 hours a day and are free for children can call and talk to someone about how they’re feeling.
Guidance for parents:
- Four things you can do to support your teen’s mental health
- Tips to help you deal with COVID-19 parenting challenges
- Manual for parents: psychosocial support for children during COVID-19
- Supporting your children return to school during COVID-19
- Emerging Minds: Communicating with your child about COVID-19
- Starting a conversation with your child
Guidance for teenagers:
- How to take care of yourself during stressful times
- How teenagers can protect their mental health during COVID-19
