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How will COVID 19 affect children as they return to school?

By: Daniel Wood, PA-C

Working in pediatrics in August 2021, I receive almost daily questions from parents about how COVID 19 will affect children as they return to school.   Common questions are: “How do  COVID-19 symptoms present in children?” “How dangerous is the virus for children?” And “What are strategies schools can implement to help keep my child safe?” These understandably are the questions that keep some parents up at night. So, let’s get the answers.

How do symptoms present in children?

Children of all ages can get COVID-19.  High school students (14yo – 17yo) accounted for the highest incidence at almost 40% of COVID cases between March 2020 and December 2020.  [1] The symptoms of COVID-19 in children are similar to adults.  In general, symptoms are milder than adults, but severe symptoms can occur.  Fever and cough are the most reported symptom occurring in about 60% of the cases. Children may also present with gastrointestinal symptoms (diarrhea and vomiting and abdominal pain), rash, Kawasaki-like symptoms, or be asymptomatic altogether. 

Children under a year may present with feeding difficulty and fever without an obvious source. Generally, respiratory symptoms may or may not be present. Also, cases of SARS CoV-2 bronchiolitis have been reported in this age group. [3]  Children, like adults, can have elevated lab findings with the most common elevations in CRP, D- dimer, and serum ferritin. [4]  Lymphocytopenia and elevated inflammatory markers may indicate Multisystem inflammatory Syndrome (MIS-C), which is an inflammatory reaction in the body that occurs about four weeks after a COVID-19 infection and can potentially lead to life-threatening problems with the heart and other organs in the body.

How dangerous is the virus for children?

The American Academy of Pediatricians collects state data on COVID and children.  As of August 26, 2021, children accounted for about 15% of all cases.  Among states that reported hospitalizations, children accounted for 2-3.5% of total hospitalizations.  Concerning mortality, children account for 0-.24%.  While these numbers are low, they tragically are not zero.

Risk of in school transmission

The school closures of last year have affected children on many fronts.  Studies show children have been impacted academically and socially by remote schooling, and many children face food insecurity because of the lack of in-person school.  Returning to school safely for the 2021-2022 school year is a priority for all parents, though opinions may vary on mask mandates and social distancing.   At this time, the CDC recommends that staff, students, and visitors wear a mask indoors regardless of vaccination status.  Other preventative strategies include physical distancing, frequent handwashing, contact tracing, and staying home when sick.  How these strategies are implemented, vary from district to district and state to state.[5]

COVID-19 can cause concern for parents as schools are opening across the country.   The symptoms vary from asymptomatic to more severe.  Schools will vary on the implementation of preventative strategies.  Hopefully, this will clear up some questions for practicing APP when parents ask about COVID and their children.


  1. COVID-19 Trends Among Persons Aged 0-24 Years – United States, March 1-December 12, 2020. Leidman E, Duca LM, Omura JD, Proia K, Stephens JW, Sauber-Schatz EK. MMWR Morb Mortal Wkly Rep. 2021;70(3):88. Epub 2021 Jan 22. 
  2. SARS-CoV-2 (COVID-19): What Do We Know About Children? A Systematic Review. Mehta NS, Mytton OT, Mullins EWS, Fowler TA, Falconer CL, Murphy OB, Langenberg C, Jayatunga WJP, Eddy DH, Nguyen-Van-Tam JS
  3. Clin Infect Dis. 2020;71(9):2469Can SARS-CoV-2 cause life-threatening bronchiolitis in infants?. AndréMC, Pätzug K, Bielicki J, Gualco G, Busi I, Hammer J. Pediatr Pulmonol. 2020;55(11):2842. Epub 2020 Sep 4.
  4. Accessed August 31, 2021: https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report/
  5. Accessed August 31, 2021: https://www.nytimes.com/2021/06/18/briefing/kids-covid-and-delta.html

See Daniel Wood, PA-C speak at a 2021 Skin, Bones, Hearts & Private Parts conference SkinBonesCME.com.