The truth is we don’t know exactly how COVID-19 presents in children because there have only been rare cases reported in the literature so far. But, here is the list of the known symptoms of COVID-19: Fever – frequent Dry Cough – frequent Shortness of Breath – frequent (especially adults/older patients) Sore throat – sometime Headache – sometimes Achiness – sometimes Fatigue – sometimes Nasal Congestion – rare (but can happen in kids) Stomach upset/Diarrhea – rare (but more common in kids, rare in adults but may predict worse symptoms in adults) Bilateral Conjunctivitis – rare *Any patient with loss of smell or loss of taste should be tested – very specific weird presentation The difficulty is that the symptoms of COVID-19 are very similar to the symptoms of almost all viral illnesses. At this time of year there are many viral illnesses in circulation. It is difficult to know exactly what viral syndrome a child has and in many ways it does not help our clinical management. Viral syndromes are treated with what we call supportive care – hydration, rest, fever reducers like tylenol for the patient’s comfort. At this time our recommendation is that anyone who is ill should act as if they could have COVID-19. They should stay home and avoid social contact. In fact this is the crux of why the social distancing strategy is so important right now. STAY AWAY FROM ELDERLY AND IMMUNOCOMPROMISED RELATIVES ESPECIALLY. Because of the lack of testing available – at this time the CDC recommends testing only if you meet the following criteria: You have to have symptoms including fever and: You have traveled outside the country to a known hot spot in the past 2 weeks You have a known exposure to someone who tested positive with COVID-19 You are a health care worker who is symptomatic You have a pre-existing condition or are over 65 years old and are therefore high-risk This means that most of our patients do not meet testing criteria – which can be frustrating for us and for parents. Remember that so far the evidence shows that the vast majority of younger patients with COVID-19 have mild illness. Also studies from China and Italy so far show that younger patients were less likely to be diagnosed (although it’s unclear if it was because they don’t catch the disease or just that they have such mild symptoms they don’t always get tested for the disease.) Remember that you are watching for exactly the same red flag symptoms we always discuss: Shortness of Breath/Difficulty breathing, dehydration, altered mental status/lethargy, extremely high fever – These are reasons to go to the Emergency room for further evaluation and possible testing. If you go to the Emergency Room you MUST call ahead to allow them to take the appropriate precautions to take care of your child