COVID-19 in Babies and Toddlers
Content reviewed against published CDC, AAP, CDC, AAP guidelines
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COVID-19 is caused by the SARS-CoV-2 virus and generally causes mild illness in most infants and young children, often resembling a common cold or mild flu. However, some children — particularly those under 1 year old or with underlying health conditions — can develop severe disease. A rare but serious complication called Multisystem Inflammatory Syndrome in Children (MIS-C) can occur 2-6 weeks after infection, causing widespread inflammation affecting the heart, lungs, kidneys, brain, and other organs. Vaccines are available for children 6 months and older.
Key takeaways
- COVID-19 is caused by the SARS-CoV-2 virus and generally causes mild illness in most infants and young children, often resembling a common cold or mild flu.
- Duration: Most children recover in 3-7 days. Cough and mild congestion may linger for 1-2 weeks. Some children may experience fatigue for several weeks. Watch for MIS-C symptoms for 6 weeks following infection.
- Go to ER if: Difficulty breathing — fast breathing, chest retractions, nasal flaring, or grunting
- A vaccine or immunization is available
Symptoms
How It Presents by Age
0-6 months
May present with fever, poor feeding, irritability, and nasal congestion. Breathing difficulties are more concerning at this age. Infants cannot be vaccinated and rely on maternal antibodies and caregiver vaccination for protection. Neonates infected during birth may have more prolonged illness.
Risk level: Moderate — highest risk age group in pediatrics
6-12 months
Typically presents as a mild cold-like illness with fever, runny nose, and cough. May have GI symptoms including diarrhea. Eligible for COVID-19 vaccination starting at 6 months. Watch for signs of dehydration from poor feeding.
Risk level: Low to moderate
1-3 years
Usually mild cold symptoms. Croup-like presentation (barky cough) has been reported. May have fever for 2-3 days. GI symptoms are common. Most recover fully within 1-2 weeks. MIS-C risk exists 2-6 weeks after infection.
Risk level: Low
3-5 years
Generally mild illness resembling a cold or mild flu. May complain of headache, sore throat, or muscle aches. Loss of taste and smell less commonly reported in young children compared to adults. Eligible for vaccination.
Risk level: Low
Treatment
Supportive care
Most children with COVID-19 need only supportive care. Rest, fluids, and fever management are the mainstays of treatment. The vast majority of pediatric cases resolve without specific treatment.
Fever and pain management
Acetaminophen for all ages; ibuprofen for children 6 months and older. Both are safe to use with COVID-19. Follow age-appropriate dosing guidelines.
Hydration
Encourage frequent small sips of fluids. Continue breastfeeding or formula feeding. Watch for signs of dehydration, especially if vomiting or diarrhea is present.
Antiviral therapy (high-risk)
Remdesivir may be considered for hospitalized children or those at high risk of severe disease (immunocompromised, complex medical conditions). Paxlovid is authorized for children 12+ weighing at least 40 kg. Consult pediatrician for high-risk children.
Hospital care (severe cases)
Supplemental oxygen, IV fluids, and close monitoring for children with respiratory distress. MIS-C treatment includes IVIG, corticosteroids, and aspirin under specialist care in a hospital setting.
Home Care
- Offer fluids frequently — breast milk, formula, water, or electrolyte solutions
- Use a cool-mist humidifier to ease congestion and cough
- Saline nasal drops and gentle suctioning for nasal congestion
- Ensure plenty of rest and extra sleep
- Monitor oxygen levels with a pulse oximeter if available and recommended by your doctor
- Keep a symptom log noting fever readings, fluid intake, and wet diapers
When to Worry
Go to the ER if:
- Difficulty breathing — fast breathing, chest retractions, nasal flaring, or grunting
- Blue or gray color around lips, face, or fingernails
- Unable to keep any fluids down or signs of severe dehydration
- Child is unresponsive, extremely lethargic, or confused
- Persistent chest pain or pressure
- Signs of MIS-C — persistent fever with rash, red eyes, abdominal pain, vomiting, and lethargy
- Seizure
Call your doctor if:
- Child under 3 months with any fever (100.4°F or higher)
- Fever lasting more than 3 days or fever over 104°F
- Signs of dehydration — fewer than 3 wet diapers in 24 hours, dry mouth, no tears
- New or worsening cough after initial improvement
- Child is not drinking enough fluids
- Persistent abdominal pain or repeated vomiting
- Rash, red eyes, or swollen hands/feet 2-6 weeks after COVID-19 (concern for MIS-C)
Keep an eye on:
- Fever lasting more than 3-4 days
- Child seems to improve then suddenly gets worse
- Decreased activity level or unusual lethargy
- New rash developing, especially 2-6 weeks after COVID-19 infection (possible MIS-C)
- Persistent vomiting or diarrhea causing decreased wet diapers
Prevention
- COVID-19 vaccination for children 6 months and older (updated annually)
- Frequent handwashing with soap and water for at least 20 seconds
- Keep up to date with recommended vaccine doses and boosters
- Ensure household members and caregivers are vaccinated
- Stay home when sick and avoid close contact with infected individuals
- Improve ventilation in indoor settings
- Test and isolate when symptomatic or after known exposure
Contagion & Incubation
Incubation
2-14 days, with most symptoms appearing 3-5 days after exposure (shorter incubation with Omicron and later variants)
Contagious for
Typically 2 days before symptoms to 10 days after symptom onset. Young children and immunocompromised individuals may shed virus for longer. Most children are no longer contagious after 5-7 days if symptoms are improving and fever-free for 24 hours.
Duration
Most children recover in 3-7 days. Cough and mild congestion may linger for 1-2 weeks. Some children may experience fatigue for several weeks. Watch for MIS-C symptoms for 6 weeks following infection.
Frequently asked questions
How long does covid-19 last?
How does sars-cov-2 infection spread?
When should I take my baby to the ER?
Can sars-cov-2 infection be prevented?
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Sources
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources
Related Illnesses
Bottom line
COVID-19 is a viral illness that typically resolves on its own. Seek emergency care if difficulty breathing — fast breathing, chest retractions, nasal flaring, or grunting.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.