COVID-19 Symptoms in Children Often Mild But Questions Remain

Friday, Dec. 04, 2020

COVID-19 can both progress and improve rapidly in children, as illustrated with a rich series of chest X-ray and CT images presented at RSNA 2020.

Turkan Ikizceli, MD


"Luckily, kids are mildly infected with COVID-19 and often recover without hospitalization," said Turkan Ikizceli, MD, an assistant professor of radiology at the University of Health Sciences Haseki Training and Research Hospital in Istanbul.

"However, we still have to take all necessary measures to protect children from this disease," she said. "Information about COVID-19 in scientific literature is continually evolving, as are clinical practices."

While COVID-19 infection tends to be milder in children than in adults, the situation can change very quickly, Dr. Ikizceli said. In her education exhibit, she presents a spectrum of radiologic imaging findings to help attendees understand characteristic manifestations of COVID-19 in pediatric patients.

"What surprised us most was that even if the pulmonary parenchymal involvement was severe, hospitalized children with clinically mild cases recovered very quickly compared to the course in severe bacterial or viral pneumonia," Dr Ikizceli noted.

The cohort included pediatric patients, ranging from infants to teenagers, with a positive COVID-19 RT-PCR test who underwent chest X-ray and/or CT imaging at their hospital. Symptoms ranged from mild fever to severe fever, cough, shortness of breath and respiratory distress.

CT Recommended Only in Severe Cases

A clinical diagnosis of pneumonia was made in most of the children in the cohort. Often, frontal chest X-ray showed no evidence of pneumonia, but axial lung window CT imaging revealed consolidations and unilateral or bilateral ground-glass opacities in the lower lobes.

Dr. Ikizceli warned that imaging should not be performed systematically on all pediatric patients, and that CT in particular should be restricted to severe cases with respiratory symptoms.

"Clinical-radiological discordance must be kept in mind," Dr. Ikizceli said. "If the child is hospitalized, the frequency of follow-up may be increased. Radiologists should evaluate radiography images with the pediatrician and avoid unnecessary CT exams to minimize radiation exposure in children."

The cases included in the exhibit demonstrate rapid recovery in many of the children, illustrating on follow-up imaging, that most children recovered completely within one to two weeks.

Although the number of reported pediatric cases is less than that of adults, and although most infected children have a milder disease course and better prognosis, children are remain vulnerable to infection, Dr. Ikizceli said. She noted children can easily become infected when a family member is infected.

"There are significant differences between how we practiced early in the pandemic and how we practice today," Dr. Ikizceli said. "Before children return to on-campus education and regular activities, we need more information."

For More Information:

View the RSNA 2020 session, Spectrum of Imaging Findings in Children with COVID-19 Infection — PD158-ED-X at