Pediatric COVID-19

Evidence repositories are collections of best available resources and evidence (clinical guidelines, peer reviewed literature, systematic reviews, etc.), collated by our knowledge synthesis team and content advisors. This evidence repository is not intended to be an exhaustive list of resources for a topic, but rather a curated list of current, evidence-based resources, based on expert consensus of relevance and usability for a general emergency department setting. We search databases (Cochrane Library, PubMed, TRIP Database) and web search engines (Google, Google Scholar) to locate evidence. Additionally, hospital websites are browsed for guidance documents, such as clinical practice guidelines (CPG) for healthcare professionals.

Every effort is made to identify resources that are open access (i.e. publicly available, free of charge, not requiring a subscription).

More information about the creation of our evidence repositories can be found at https://pubmed.ncbi.nlm.nih.gov/28537762/

Thank you to the following content experts and Knowledge Synthesis team who led the development of this evidence repository.

Shannon McPhee, MD Pediatric Emergency Medicine, IWK, Halifax

Liza Bialy Knowledge Synthesis Project Coordinator, Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta

TREKK developed resources for healthcare providers and parents & families can be found here.

1. Canadian Paediatric Society. Covid-19 information and resources for paediatricians. 2022.
2. La Liberte. eMagazine – No mercy for the coronas. 2022.
3. Children’s Healthcare Canada. COVID 19 and kids. 2022.
4. Canadian Association of Emergency Physicians. Canadian association of emergency physicians – COVID-19 information, resources and advocacy centre. 2021.
5. World Health Organization. Coronavirus disease (COVID-19) advice for the public: Parenting in the time of COVID-19. 2020.

1. US Centers for Disease Control Prevention. Info page: Coronavirus disease 2019 (COVID-2019) information for pediatric healthcare providers. 2022.
2. Liu E, Smyth RL, Li Q, et al. Guidelines for the prevention and management of children and adolescents with COVID-19. Eur J Pediatr. 2022;181(12):4019-37.
3. Henderson LA, Canna SW, Friedman KG, et al. American college of rheumatology clinical guidance for multisystem inflammatory syndrome in children associated with SARS-COV-2 and hyperinflammation in pediatric COVID-19: Version 3. Arthritis Rheumatol. 2022;74(4):e1-e20.
4. International Society for Pediatric and Adolescent Diabetes (ISPAD). Guideline: COVID in children with diabetes. 2022.
5. Thompson LA, Rasmussen SA. Info page: What does the coronavirus disease 2019 (COVID-19) mean for families? JAMA Pediatr. 2020;174(6):628.
6. Shen K, Yang Y, Wang T, et al. Consensus statement: Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: Experts’ consensus statement. World J Pediatr. 2020;16(3):223-31.

1. Gadiwala S, Mistry A, Patel S, et al. MIS-C related to SARS-COV-2 infection: A narrative review of presentation, differential diagnosis, and management. Infez Med. 2022;30(3):344-52.
2. Viner RM, Ward JL, Hudson LD, et al. Systematic review of reviews of symptoms and signs of COVID-19 in children and adolescents. Arch Dis Child. 2020.

1. Zheng Y-B, Zeng N, Yuan K, et al. Prevalence and risk factor for long COVID in children and adolescents: A meta- analysis and systematic review. Journal of infection and public health. 2023;16(5):660-72.
2. Naeimi R, Sepidarkish M, Mollalo A, et al. SARS-COV-2 seroprevalence in children worldwide: A systematic review and meta-analysis. EClinicalMedicine. 2023;56:101786.
3. Yu B, Chen HH, Hu XF, et al. Comparison of laboratory parameters, clinical symptoms and clinical outcomes of COVID-19 and influenza in pediatric patients: A systematic review and meta-analysis. World J Clin Cases. 2022;10(29):10516-28.
4. Vosoughi F, Makuku R, Tantuoyir MM, et al. A systematic review and meta-analysis of the epidemiological characteristics of COVID-19 in children. BMC Pediatr. 2022;22(1):613.
5. Sumner MW, Kanngiesser A, Lotfali-Khani K, et al. Severe outcomes associated with SARS-COV-2 infection in children: A systematic review and meta-analysis. Front Pediatr. 2022;10:916655.
6. Lee B, Lewis G, Agyei-Manu E, et al. Risk of serious COVID-19 outcomes among adults and children with moderate-to-severe asthma: A systematic review and meta-analysis. Eur Respir Rev. 2022;31(166).
7. Jiang L, Tang K, Irfan O, et al. Epidemiology, clinical features, and outcomes of multisystem inflammatory syndrome in children (MIS-C) and adolescents-a live systematic review and meta-analysis. Curr Pediatr Rep. 2022;10(2):19-30.
8. Jari R, Alfuraih AM, McLaughlan JR. The diagnostic performance of lung ultrasound for detecting COVID-19 in emergency departments: A systematic review and meta-analysis. J Clin Ultrasound. 2022;50(5):618-27.
9. Christophers B, Gallo Marin B, Oliva R, et al. Trends in clinical presentation of children with COVID-19: A systematic review of individual participant data. Pediatr Res. 2022;91(3):494-501.
10. Alhumaid S, Alabdulqader M, Al Dossary N, et al. Global coinfections with bacteria, fungi, and respiratory viruses in children with SARS-COV-2: A systematic review and meta-analysis. Trop Med Infect Dis. 2022;7(11).
11. Alhumaid S, Al Alawi Z, Alnaim AA, et al. Intussusception and COVID-19 in children: A systematic review and meta-analysis. Children (Basel). 2022;9(11).
12. Zou H, Lu J, Liu J, et al. Characteristics of pediatric multi-system inflammatory syndrome (PMIS) associated with COVID-19: A meta-analysis and insights into pathogenesis. Int J Infect Dis. 2021;102:319-26.
13. Simon Junior H, Sakano TMS, Rodrigues RM, et al. Multisystem inflammatory syndrome associated with COVID- 19 from the pediatric emergency physician’s point of view. J Pediatr (Rio J). 2021;97(2):140-59.
14. Radia T, Williams N, Agrawal P, et al. Multi-system inflammatory syndrome in children & adolescents (MIS-C): A systematic review of clinical features and presentation. Paediatr Respir Rev. 2021;38:51-7.
15. Badal S, Thapa Bajgain K, Badal S, et al. Prevalence, clinical characteristics, and outcomes of pediatric COVID-19: A systematic review and meta-analysis. J Clin Virol. 2021;135:104715.
16. Yasuhara J, Kuno T, Takagi H, et al. Clinical characteristics of COVID-19 in children: A systematic review. Pediatr Pulmonol. 2020;55(10):2565-75.
17. Rodriguez-Gonzalez M, Castellano-Martinez A, Cascales-Poyatos HM, et al. Cardiovascular impact of COVID-19 with a focus on children: A systematic review. World J Clin Cases. 2020;8(21):5250-83.
18. Li B, Zhang S, Zhang R, et al. Epidemiological and clinical characteristics of COVID-19 in children: A systematic review and meta-analysis. Front Pediatr. 2020;8:591132.
19. Hoang A, Chorath K, Moreira A, et al. COVID-19 in 7780 pediatric patients: A systematic review. EClinicalMedicine. 2020;24:100433.
20. de Souza TH, Nadal JA, Nogueira RJN, et al. Clinical manifestations of children with COVID-19: A systematic review. Pediatr Pulmonol. 2020;55(8):1892-9.
21. Abrams JY, Godfred-Cato SE, Oster ME, et al. Multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2: A systematic review. J Pediatr. 2020;226:45-54.e1.

1. Zambrano LD, Wu MJ, Martin L, et al. Risk factors for multisystem inflammatory syndrome in children: A case- control investigation. The Pediatric infectious disease journal. 2023.
2. Welzel T, Atkinson A, Schöbi N, et al. Methylprednisolone versus intravenous immunoglobulins in children with paediatric inflammatory multisystem syndrome temporally associated with SARS-COV-2 (PIMS-TS): An open- label, multicentre, randomised trial. Lancet Child Adolesc Health. 2023.
3. Wacks M, Wortley E, Gregorowski A, et al. Fifteen-minute consultation: Managing post-COVID-19 syndrome (long COVID) in children and young people. Archives of disease in childhood Education and practice edition. 2023.
4. Vasichkina E, Kofeynikova O, Fetisova S, et al. Severe course of COVID-19 and long-COVID-19 in children: Difficulties in diagnosis. Life (Basel, Switzerland). 2023;13(3).
5. Taylor A, Duncanson M, Mitchelson B, et al. Multisystem inflammatory syndrome in New Zealand children. The Pediatric infectious disease journal. 2023.
6. Tartof SY, Frankland TB, Puzniak L, et al. BNT162b2 against COVID-19-associated emergency department and urgent care visits among children 5-11 years of age: A test negative design. J Pediatric Infect Dis Soc. 2023.
7. Stephenson T, Pinto Pereira SM, Nugawela MD, et al. Long COVID-six months of prospective follow-up of changes in symptom profiles of non-hospitalised children and young people after SARS-COV-2 testing: A national matched cohort study (the clock) study. PloS one. 2023;18(3):e0277704.
8. Sakurada Y, Otsuka Y, Tokumasu K, et al. Trends in long COVID symptoms in Japanese teenage patients. Medicina (Kaunas, Lithuania). 2023;59(2).
9. Rankin DA, Spieker AJ, Perez A, et al. Circulation of rhinoviruses and/or enteroviruses in pediatric patients with acute respiratory illness before and during the COVID-19 pandemic in the US. JAMA Netw Open. 2023;6(2):e2254909.
10. Morello R, Martino L, Buonsenso D. Diagnosis and management of post-COVID (long COVID) in children: A moving target. Current opinion in pediatrics. 2023.
11. Morello R, Mariani F, Mastrantoni L, et al. Risk factors for post-COVID-19 condition (long COVID) in children: A prospective cohort study. EClinicalMedicine. 2023;59:101961.
12. Mizrahi B, Sudry T, Flaks-Manov N, et al. Long COVID outcomes at one year after mild SARS-COV-2 infection: Nationwide cohort study. BMJ (Clinical research ed). 2023;380:e072529.
13. Jamaica Balderas L, Navarro Fernández A, Dragustinovis Garza SA, et al. Long COVID in children and adolescents: COVID-19 follow-up results in third-level pediatric hospital. Front Pediatr. 2023;11:1016394.
14. Goretzki SC, Brasseler M, Dogan B, et al. High prevalence of alternative diagnoses in children and adolescents with suspected long COVID-a single center cohort study. Viruses. 2023;15(2).
15. Feleszko W, Okarska-Napierała M, Buddingh EP, et al. Pathogenesis, immunology, and immune-targeted management of the multisystem inflammatory syndrome in children (MIS-C) or pediatric inflammatory multisystem syndrome (PIMS): EAACI position paper. Pediatr Allergy Immunol. 2023;34(1):e13900.
16. Edinoff AN, Alpaugh ES, Newgaard O, et al. Tocilizumab for severe COVID-19 infection and multisystem inflammatory syndrome in adults and children. Life (Basel, Switzerland). 2023;13(4).
17. Davis HE, McCorkell L, Vogel JM, et al. Long COVID: Major findings, mechanisms and recommendations. Nature reviews Microbiology. 2023.
18. Corso CM, Marchisio P, Agostoni C, et al. Frequency of SARS-COV-2 positivity among children presenting with gastroenteritis in emergency department. Pediatr Infect Dis J. 2023;42(1):e38-e9.
19. Chelabi K, Osmanlliu E, Gravel J, et al. The effect of the COVID-19 pandemic on pediatric asthma-related emergency department visits and hospital admissions in Montréal, Quebec: A retrospective cohort study. CMAJ Open. 2023;11(1):E152-e9.
20. Channon-Wells S, Vito O, McArdle AJ, et al. Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: A propensity-weighted cohort study. The Lancet Rheumatology. 2023;5(4):e184-e99.
21. Bentes AA, Dos Santos Junior WR, Pessoa NL, et al. Neuro-COVID-19 with or without the multisystem inflammatory syndrome (MIS-C): A single-center study : COVID-19: Neurologic manifestations in children. Journal of molecular neuroscience : MN. 2023.
22. Bellini T, Bustaffa M, Caorsi R, et al. Clinical data on how variants have affected multisystem inflammatory syndrome in children with COVID-19 have been limited and conflicting. Acta Paediatr. 2023;112(1):164-5.
23. Bahl A, Mielke N, Johnson S, et al. Severe COVID-19 outcomes in pediatrics: An observational cohort analysis comparing alpha, delta, and omicron variants. Lancet regional health Americas. 2023;18:100405.
24. Ayyala RS, Hayatghaibi S, Dillman JR, et al. Impact of coronavirus disease 2019 on pediatric intestinal intussusception in the United States. Pediatr Radiol. 2023:1-5.
25. Avcu G, Arslan A, Arslan SY, et al. Misdiagnosis of multisystem inflammatory syndrome in children: A diagnostic challenge. Journal of paediatrics and child health. 2023.
26. Alolayan A, Aldamegh AS, Alkhayrat A. Use of continuous intravenous anakinra infusion in multisystem inflammatory syndrome in children. Case reports in critical care. 2023;2023:8530060.
27. Zhu F, Ang JY. COVID-19 infection in children: Diagnosis and management. Curr Infect Dis Rep. 2022;24(4):51-62.
28. Unny AK, Rajashree P, Sundararajan L, et al. Abdominal manifestations of multisystem inflammatory syndrome in children: A single-center experience. Indian Pediatr. 2022;59(12):936-8.
29. Stephenson T, Shafran R, Ladhani SN. Long COVID in children and adolescents. Curr Opin Infect Dis. 2022;35(5):461-7.
30. Snooks K, Scanlon MC, Remy KE, et al. Characteristics and outcomes of critically ill children with multisystem inflammatory syndrome. Pediatr Crit Care Med. 2022;23(11):e530-e5.
31. Şık N, Özdemir D, Duman M. Return visit characteristics of SARS-COV-2 PCR-positive cases in a pediatric emergency department. Turk J Med Sci. 2022;52(1):21-31.
32. Seo MJ, Yum MS, Park JS. Comparison of febrile seizures in children with or without COVID-19: A single-center observational study. Pediatrics international : official journal of the Japan Pediatric Society. 2022:e15461.
33. Pegoraro F, Trapani S, Indolfi G. Gastrointestinal, hepatic and pancreatic manifestations of COVID-19 in children. Clin Res Hepatol Gastroenterol. 2022;46(4):101818.
34. Nijman RG, Honeyford K, Farrugia R, et al. Presentations of children to emergency departments across Europe and the COVID-19 pandemic: A multinational observational study. PLoS Med. 2022;19(8):e1003974.
35. Melit LE, Marginean O, Fleșeriu T, et al. Cardiological monitoring – a cornerstone for pediatric inflammatory multisystem syndrome temporally associated with COVID-19 outcome: A case report and a review from the literature. J Crit Care Med (Targu Mures). 2022;8(4):273-8.
36. Mataloni F, Colais P, Pinnarelli L, et al. The impact of the SARS- COV-2 pandemic on pediatric accesses in ED: A healthcare emergency information system analysis. PLoS One. 2022;17(8):e0272569.
37. Mangus CW, Parker SJ, DeLaroche AM, et al. Impact of COVID-19 on the associated complications of high-risk conditions in a statewide pediatric emergency network. Journal of the American College of Emergency Physicians open. 2022;3(6):e12865.
38. Ling KM, Dougan M. Monoclonal antibodies for the treatment of COVID-19 infection in children. Expert Rev Anti Infect Ther. 2022;20(12):1529-35.
39. Levy N, Koppel JH, Kaplan O, et al. Severity and incidence of multisystem inflammatory syndrome in children during 3 SARS-COV-2 pandemic waves in Israel. Jama. 2022;327(24):2452-4.
40. Jarvill T, Lauber P, Umaru S, et al. Challenges in evaluating pediatric fever and rash in the era of COVID-19 and multisystem inflammatory syndrome in children (MIS-C). Cureus. 2022;14(1):e21764.
41. Hernández-Calle D, Andreo-Jover J, Curto-Ramos J, et al. Pediatric mental health emergency visits during the COVID-19 pandemic. Scand J Child Adolesc Psychiatr Psychol. 2022;10(1):53-7.
42. Gupta M, Gupta N, Esang M. Long COVID in children and adolescents. Prim Care Companion CNS Disord. 2022;24(2).
43. Grama A, Căinap SS, Mititelu A, et al. Multisystemic inflammatory syndrome in children, a disease with too many faces: A single-center experience. J Clin Med. 2022;11(18).
44. Folga BA, Karpenko CJ, Grygiel-Górniak B. SARS-COV-2 infection in the context of Kawasaki disease and multisystem inflammatory syndrome in children. Med Microbiol Immunol. 2022:1-10.
45. Duman M, Şık N, Tekşam Ö, et al. COVID-19 disease in presenting to the pediatric emergency department: A multicenter study of 8886 cases. Am J Emerg Med. 2022;59:133-40.
46. de Jorna C, Liber M, Khalifi SE, et al. Changes in pediatric emergency department visits during a COVID-19 lockdown period: An exhaustive single-center analysis. Arch Pediatr. 2022;29(8):604-9.
47. Cetin BS, Kısaarslan AP, Tekin S, et al. Evaluation of baseline characteristics and prognostic factors in multisystemic inflammatory syndrome in children: Is it possible to foresee the prognosis in the first step? J Clin Med. 2022;11(15).
48. Alteri C, Scutari R, Costabile V, et al. Epidemiological characterization of SARS-COV-2 variants in children over the four COVID-19 waves and correlation with clinical presentation. Sci Rep. 2022;12(1):10194.
49. Akcan Yildiz L, Karaca Vural O, Tehci AK, et al. Pediatric emergency revisits of children with COVID-19. Postgraduate medicine. 2022:1-7.
50. Abbati G, Attaianese F, Rosati A, et al. Neurological involvement in children with COVID-19 and MIS-C: A retrospective study conducted for more than two years in a pediatric hospital. Children (Basel, Switzerland). 2022;9(12).
51. Venn AMR, Schmidt JM, Mullan PC. Pediatric croup with COVID-19. Am J Emerg Med. 2021;43:287.e1-.e3.
52. Türe E, Korkmaz MF, Aksoy FD, et al. Point-of-care lung ultrasound findings in the pediatric emergency clinic during the COVID-19 pandemic. J Clin Ultrasound. 2021;49(2):85-90.
53. Fernandes DM, Oliveira CR, Guerguis S, et al. Severe acute respiratory syndrome coronavirus 2 clinical syndromes and predictors of disease severity in hospitalized children and youth. J Pediatr. 2021;230:23-31.e10.
54. Bailey LC, Razzaghi H, Burrows EK, et al. Assessment of 13 794 pediatric patients tested for severe acute respiratory syndrome coronavirus 2 across the United States. JAMA Pediatr. 2021;175(2):176-84.
55. Zheng F, Liao C, Fan QH, et al. Clinical characteristics of children with coronavirus disease 2019 in Hubei, China. Curr Med Sci. 2020;40(2):275-80.
56. Xu Y, Li X, Zhu B, et al. Characteristics of pediatric SARS-COV-2 infection and potential evidence for persistent fecal viral shedding. Nat Med. 2020;26(4):502-5.
57. Wölfel R, Corman VM, Guggemos W, et al. Virological assessment of hospitalized cases of coronavirus disease 2019. medRxiv. 2020:2020.03.05.20030502.
58. Wei M, Yuan J, Liu Y, et al. Novel coronavirus infection in hospitalized infants under 1 year of age in China. JAMA. 2020;323(13):1313-4.
59. Sun D, Li H, Lu XX, et al. Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: A single center’s observational study. World J Pediatr. 2020;16(3):251-9.
60. Shekerdemian LS, Mahmood NR, Wolfe KK, et al. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to us and Canadian pediatric intensive care units. JAMA Pediatrics. 2020;174(9):868-73.
61. Centers for Disease Control and Prevention. Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19). Emergency Preparedness and Response. 2020.
62. Piccolo V, Neri I, Filippeschi C, et al. Chilblain-like lesions during COVID-19 epidemic: A preliminary study on 63 patients. J Eur Acad Dermatol Venereol. 2020;34(7):e291-e3.
63. Pereira MFB, Litvinov N, Farhat SCL, et al. Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome. Clinics (Sao Paulo). 2020;75:e2209.
64. Mak PQ, Chung KS, Wong JS, et al. Anosmia and ageusia: Not an uncommon presentation of COVID-19 infection in children and adolescents. Pediatr Infect Dis J. 2020;39(8):e199-e200.
65. Li W, Zhang B, Lu J, et al. Characteristics of household transmission of COVID-19. Clin Infect Dis. 2020;71(8):1943- 6.
66. Kaushik S, Aydin SI, Derespina KR, et al. Multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2 infection (MIS-C): A multi-institutional study from New York City. J Pediatr. 2020;224:24-9.
67. Jiehao C, Jin X, Daojiong L, et al. A case series of children with 2019 novel coronavirus infection: Clinical and epidemiological features. Clin Infect Dis. 2020;71(6):1547-51.
68. Ji LN, Chao S, Wang YJ, et al. Clinical features of pediatric patients with COVID-19: A report of two-family cluster cases. World J Pediatr. 2020;16(3):267-70.
69. Hong H, Wang Y, Chung HT, et al. Clinical characteristics of novel coronavirus disease 2019 (COVID-19) in newborns, infants and children. Pediatr Neonatol. 2020;61(2):131-2.
70. Götzinger F, Santiago-García B, Noguera-Julián A, et al. COVID-19 in children and adolescents in Europe: A multinational, multicentre cohort study. Lancet Child Adolesc Health. 2020;4(9):653-61.
71. Galván Casas C, Català A, Carretero Hernández G, et al. Classification of the cutaneous manifestations of COVID- 19: A rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol. 2020;183(1):71-7.
72. Duarte-Salles T, Vizcaya D, Pistillo A, et al. Baseline characteristics, management, and outcomes of 55,270 children and adolescents diagnosed with COVID-19 and 1,952,693 with influenza in France, Germany, Spain, South Korea and the United States: An international network cohort study. medRxiv. 2020.
73. Dong Y, Mo X, Hu Y, et al. Epidemiology of COVID-19 among children in China. Pediatrics. 2020;145(6).
74. Korean Society of Infectious Diseases. Report on the epidemiological features of coronavirus disease 2019 (COVID-19) outbreak in the Republic of Korea from January 19 to march 2, 2020. J Korean Med Sci. 2020;35(10):e112.
75. Clark BC, Sanchez-de-Toledo J, Bautista-Rodriguez C, et al. Cardiac abnormalities seen in pediatric patients during the SARS-COV-2 pandemic: An international experience. J Am Heart Assoc. 2020;9(21):e018007.
76. Health Canada. No scientific evidence that ibuprofen worsens COVID-19 symptoms. 2020.

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