The emergence of SARS-CoV-2 raised many questions for parents regarding its effects on the youngest population. This article focuses specifically on COVID-19 infection in infants aged 0 to 12 months, a group requiring distinct consideration due to their developing immune systems and inability to communicate symptoms. Understanding how the virus presents and the actual level of risk is important for informed caregiving.
Identifying Symptoms in Infants
COVID-19 symptoms in infants are often non-specific, resembling those of other common respiratory illnesses like the flu or RSV. Common presentations include upper respiratory symptoms such as a runny or stuffy nose, congestion, and a cough. A fever is frequently reported, though many infants experience only mild or asymptomatic infections.
Gastrointestinal issues are a notable feature, sometimes appearing without significant respiratory signs. These include vomiting, diarrhea, and poor feeding. Since infants cannot communicate discomfort, parents should monitor for behavioral changes, such as increased lethargy or unusual irritability.
Close monitoring of feeding and breathing is necessary due to the symptom overlap with other viruses. Parents should contact their pediatrician immediately if an infant under three months has a fever of 100.4°F (38°C) or higher, as this requires prompt medical evaluation. Any signs of labored breathing, such as nostril flaring or the chest pulling in below the ribs, also require immediate attention.
Assessing Risk and Severity
Infants under one year old, especially those under six months, have demonstrated a higher rate of COVID-19-associated hospitalization compared to older children. This elevated risk is partly due to the vulnerability of their small airways and the practice of hospitalizing young infants with fever to rule out serious bacterial infections. Hospitalization rates for infants under six months have sometimes been comparable to those seen in adults aged 65 to 74 years.
The severity of the illness is influenced by specific risk factors and underlying health conditions. Infants born prematurely are at a heightened risk for severe outcomes, as are those with certain congenital conditions. Other conditions that increase the risk include chronic lung disease, heart disease, and neurologic disorders.
Complications can include viral pneumonia or bronchiolitis, which is the swelling of the small airways in the lungs. A rare, serious post-infectious complication is Multisystem Inflammatory Syndrome in Children (MIS-C), typically developing two to six weeks after the initial infection. While infants can develop MIS-C, they generally have a milder clinical course compared to older children, with common symptoms including rash, diarrhea, and vomiting.
Home Care and Medical Treatment Protocols
Most infants with COVID-19 experience mild illness manageable at home with supportive care. The primary focus of home management is ensuring adequate hydration through frequent breastfeeds or formula feeds. For infants over six months, small, frequent sips of water can also be offered.
Parents must monitor for signs of dehydration, such as a dry mouth, lack of tears when crying, or fewer than six wet diapers in 24 hours. Fever management should be discussed with a pediatrician, as medications like acetaminophen or ibuprofen must be dosed precisely by weight and age. Ibuprofen is not recommended for infants under six months unless specifically advised by a healthcare provider.
Immediate medical attention is necessary if an infant exhibits signs of respiratory distress, such as rapid, shallow breathing, bluish or pale lips, or a persistent inability to keep fluids down. Hospital care focuses on support, which may involve oxygen therapy or intravenous fluids to manage dehydration. For high-risk infants 28 days and older weighing at least three kilograms, the antiviral medication remdesivir may be used to prevent progression to severe illness.
Strategies for Minimizing Exposure
Protecting infants relies heavily on control measures implemented by caregivers and household members, as infants under six months are not eligible for direct vaccination. The most effective step is for all eligible household members to remain up-to-date on their COVID-19 vaccinations, including boosters, to reduce infection and transmission risk. Vaccination of pregnant individuals also passes protective antibodies to the infant, offering passive immunity in the first months of life.
Strict hand hygiene is a powerful defense, requiring frequent washing with soap and water for at least 20 seconds, especially before touching the infant or handling feeding equipment. It is advisable to limit the infant’s contact with individuals who are sick or showing symptoms of illness. If a caregiver is ill, they should wear a well-fitted mask and maintain distance from the infant when possible. Increasing ventilation in the home by using air filters or opening windows helps reduce the concentration of airborne viral particles.