COVID-19 Symptoms in Children: What to Look For and When to Act

How COVID typically appears in children

COVID-19 symptoms in children overlap significantly with other common respiratory viruses, making it impossible to distinguish by symptoms alone 1Ref 1Centers for Disease Control and Prevention (2024).Information for Pediatric Healthcare Providers: COVID-19.COVID-19 in children most often causes mild illness; symptoms include fever, cough, sore throat, rhinorrhea, headache, fatigue, GI symptoms; infants are disproportionately represented among severe acute cases. Most children develop mild illness or no symptoms at all. Common presentations include:

• Fever
• Runny nose, congestion
• Cough
• Sore throat
• Fatigue
• Headache
• Muscle aches
• Loss of taste or smell (more common with earlier variants)
• Vomiting or diarrhea — more common in younger children

Testing (rapid antigen test or PCR) is the only reliable way to identify which virus is causing the illness.

How COVID tends to differ by age

The way COVID presents can vary by a child's age 1Ref 1Centers for Disease Control and Prevention (2024).Information for Pediatric Healthcare Providers: COVID-19.COVID-19 in children most often causes mild illness; symptoms include fever, cough, sore throat, rhinorrhea, headache, fatigue, GI symptoms; infants are disproportionately represented among severe acute cases:

• Infants and babies under 1 year: May have fever, fussiness, poor feeding, or nasal congestion. Infants are disproportionately represented among severe acute cases. Any fever in a baby under 3 months is always urgent regardless of cause.
• Toddlers (1–3 years): Fever, runny nose, cough, fussiness, sometimes vomiting or diarrhea. Often mild.
• School-age children (4–12): Tends to look like a mild cold or flu. Some children have minimal or no symptoms.
• Teens: Can have a presentation more similar to adults — fever, fatigue, body aches, possible loss of taste or smell. Most still have mild illness.

MIS-C — a rare but serious post-COVID complication

Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare condition that can occur in the 2–6 weeks following a COVID infection — sometimes even in children who had mild or no symptoms during the acute illness 2Ref 2Centers for Disease Control and Prevention (2024).About MIS (Multisystem Inflammatory Syndrome).MIS-C is a rare but serious post-COVID inflammatory condition; typically appears 2–6 weeks after SARS-CoV-2 infection; most affected children are ages 5–11; most recover without long-term symptoms4Ref 4Centers for Disease Control and Prevention (2024).Clinical Overview of Multisystem Inflammatory Syndrome in Children.MIS-C presents with fever, multisystem organ involvement, and elevated inflammatory markers; more than 50% of patients may require ICU admission; vaccination is protective against MIS-C development. It involves widespread inflammation affecting multiple organ systems.

Signs of MIS-C can include: - Persistent fever (often several days) - Abdominal pain, vomiting, or diarrhea - Rash - Red eyes (without discharge) - Red, cracked lips or a strawberry-red tongue - Swollen hands or feet - Unusual tiredness or confusion

More than half of children with MIS-C may require ICU admission 4Ref 4Centers for Disease Control and Prevention (2024).Clinical Overview of Multisystem Inflammatory Syndrome in Children.MIS-C presents with fever, multisystem organ involvement, and elevated inflammatory markers; more than 50% of patients may require ICU admission; vaccination is protective against MIS-C development. Most children with MIS-C recover, but the condition requires prompt medical evaluation and often hospital management. If a child develops these symptoms in the 2–6 weeks after a COVID infection, same-day evaluation is appropriate.

Testing and isolation guidance

Rapid antigen tests (at-home tests) can be used for children and are widely available. A negative rapid test early in illness does not completely rule out COVID — if clinical suspicion is high, a repeat test 24–48 hours later or a PCR test ordered by a provider may be more reliable 1Ref 1Centers for Disease Control and Prevention (2024).Information for Pediatric Healthcare Providers: COVID-19.COVID-19 in children most often causes mild illness; symptoms include fever, cough, sore throat, rhinorrhea, headache, fatigue, GI symptoms; infants are disproportionately represented among severe acute cases.

Isolation guidance can change as public health recommendations evolve. The CDC provides current guidance on isolation periods — checking their website directly is the most reliable approach, as these recommendations have been updated multiple times.

Home care and managing COVID symptoms

Most children with COVID can recover at home with supportive care 1Ref 1Centers for Disease Control and Prevention (2024).Information for Pediatric Healthcare Providers: COVID-19.COVID-19 in children most often causes mild illness; symptoms include fever, cough, sore throat, rhinorrhea, headache, fatigue, GI symptoms; infants are disproportionately represented among severe acute cases:

• Fever reducers — acetaminophen (appropriate for most ages with weight-based dosing) and ibuprofen (for children 6 months and older) can help with fever and discomfort
• Fluids — keeping a sick child well-hydrated is important; watch for signs of dehydration
• Rest
• Honey for cough — for children over 1 year only; never give honey to infants under 12 months

COVID antiviral medications are available for some high-risk groups and may be appropriate for certain children. If your child is under 1 year, immunocompromised, or has certain chronic conditions, contacting the pediatrician early in the illness to discuss treatment options is worthwhile.

COVID vaccination for children

COVID-19 vaccines are recommended for all children 6 months and older in the United States 3Ref 3American Academy of Pediatrics (2025).When Should Kids Get the COVID Vaccine?.AAP recommends COVID-19 vaccine for all children 6 months and older; infants and children 6–23 months are at highest risk for severe COVID-19. The AAP notes that infants and young children 6–23 months are at the highest risk for severe COVID-19. Updated vaccine formulations are released periodically to track circulating variants. Your child's pediatrician can advise on the appropriate schedule for your child's age and vaccination history.