Fatigue, headache and fever are the most common symptoms of coronavirus in children, with few developing a cough or losing their sense of taste or smell, researchers have found, adding to calls for age-specific symptom checklists.
The NHS lists three symptoms as signs of Covid-19 in adults and children: a high temperature, a new, continuous cough, and a loss or change in the sense of smell or taste.
However, the team behind the Covid symptom study app say new data shows that the disease presents differently in children compared with adults.
“We need to start to telling people what are the key symptoms at different ages rather than this blanket obsession with fever, cough and lack of smell,” said Prof Tim Spector, of King’s College London, who led the work.
The team’s latest findings are based on reports of symptoms among 198 children who tested positive for the disease out of almost 16,000 tested. Crucially, the team note, parents could have tested their children at the same time as they themselves took a test, meaning the children could have been tested even if they had no symptoms.
While a third of the children who tested positive showed no symptoms – adding weight to other work showing many infections are asymptomatic – the team say those who did showed a different set of symptoms than adults.
More than half of the Covid-positive children with symptoms – 55% – had fatigue, while 54% had a headache and almost half had a fever. Sore throats were present in around 38% of the children with symptoms, while almost 35% skipped meals, 15% had an unusual skin rash and 13% had diarrhoea.
By contrast, the team has found that the most common symptoms in adults are fatigue, headache, a persistent cough, sore throat and loss of smell.
Spector noted that of children who tested positive and had symptoms, around a half didn’t have any of the three main signs listed by the NHS.
“If you followed the government’s advice you’d be missing half of the [symptomatic] infections,” he said, adding that teachers and parents needed to be aware that the virus can present differently in children and adults.
“What we want to do here is not push [children] to have tests, but just keep them away from school [if they show symptoms],” he said.
While Spector noted some of the symptoms in children overlapped with those for colds, which could become increasingly problematic as the winter months approach, other symptoms, such as skin rashes, were unusual. The team have previously argued rashes should be added to the official list of symptoms, noting that they also appear in adults with Covid.
“It is certainly as important as the other features, and in children it is much more important,” he said. “One in six children will have [a rash] and many times it will be the only sign, and you don’t get a funny rash with most coughs, colds [or] flus.”
Spector said the difference in symptoms with age were probably down to differences in the way the immune system responded to the virus, and he said the team were now calling for parents to track their children’s symptoms on the app to help the team spot school outbreaks quickly.
Dr Tom Waterfield of Queen’s University Belfast, who was not involved in the research, said the findings chimed with his own work showing that symptoms such as fatigue, headaches and an upset stomach were common among children with Covid-19, while symptoms such as coughs were rarer than in adults.
Dr Sanjay Patel, a paediatric infectious diseases consultant at Southampton children’s hospital cautioned that while the NHS checklist would not mean all children with Covid were detected, it still allowed school outbreaks to be spotted, while many of the symptoms highlighted by the new study could be the result of a host of different illnesses, and keeping children home based on such signs could be problematic.
“The harms of that approach are very tangible,” he said. “Many children would be missing a lot of school, and the majority of children being tested would still be negative.”
Prof Martin Marshall, the chair of the Royal College of GPs, welcomed the study. “Understanding that children may exhibit symptoms that are different to adults is useful in order for GPs and our teams, as well as our specialist paediatric colleagues, to identify the virus in children and respond appropriately,” he said.
