What are the health impacts of COVID-19 on young children?

What are the health impacts of COVID-19 on young children? How does the burden of COVID-19 compare to other vaccine-preventable diseases?

COVID-19 is usually mild and short-lived in young kids. Yet, a small fraction of cases result in severe outcomes like Multisystem Inflammatory Syndrome, long-term symptoms, or even death. These tragedies strike children with and without pre-existing health conditions. The burden of COVID-19 on young children exceeds that of many other vaccine-preventable diseases like chickenpox (varicella).

A Centers for Disease Control and Prevention (CDC) presentation at the recent FDA meeting on vaccines for young children shed light on the substantial toll of COVID-19 on young children in the United States.

Here are some key stats:

Since 2020, COVID-19 has caused the following in US children aged 6 months to 4 years:

At least 2 million cases* (1,913,969 age 1-4 and 567,535 under 1 year)
202 deaths (1.7% of all deaths in this age group)
1,990 cases of Multisystem Inflammatory Syndrome in Children (MIS-C)
120 hospitalizations per 100,000 US kids (~1.2 in 1,000 young kids!)
*Cases are most certainly an underestimate due to under-testing / under-reporting

During the US Omicron wave, COVID-19 caused:

535 hospitalizations in children aged 6 months to 4 years
49% of these children had no pre-existing health conditions
23% of these children ended up in the intensive care unit (ICU)

Post-COVID impacts:

In the UK, where the long term impacts of COVID-19 are being closely tracked, roughly 7-8% of children report symptoms beyond 12 weeks. The CDC did not provide a US-based estimate of the long-term burden of COVID-19 in kids.

Common post-COVID symptoms include fatigue, trouble concentrating, insomnia, muscle and joint pain, and more. These issues can dramatically alter quality of life, spanning physical activity, mental health, and school attendance / participation.

How does the burden of COVID-19 compare to other diseases that we vaccinate children against?

Hospitalizations per year among US children aged 6 months to 4 years:

COVID-19: 89 per 100,000 kids
Invasive Pneumococcal Disease: 40 per 100,000 kids (prior to vaccines)
Varicella (Chickenpox): 29-42 per 100,000 kids (prior to vaccines)
Hepatitis A: 1 per 100,000 kids (prior to vaccines)* in ages 5-14
Flu (influenza): Hospitalization rates from the worst flu year in the last 5 years were similar to COVID-19 hospitalization rates from Oct 2021 to Apr 2022. All other recent flu years had lower hospitalization rates than this.

Deaths per year among US children aged 6 months to 4 years:

COVID-19: 86 deaths
Hepatitis A, Meningococcal, Varicella, Rubella, and Rotavirus: 3-20 deaths each (prior to vaccines)

* See figure for breakdown by disease

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The Bottom Line:

The risks posed by COVID-19 are small in most young children – but not so small that they should be dismissed. These risks are similar or greater than those that young children face from other diseases that we routinely vaccinate against.

Serious illness and death in children is always tragic, and is even more so when it’s preventable. Since exposure to COVID-19 is virtually guaranteed for most young children, a decision not to vaccinate is a decision to gamble with the known and unknown harms of this virus.

Our goal is not to scare you – it’s to empower you to make informed choices from vaccinations, to school, to birthday parties and visits with grandparents.