Clinical characteristics and diagnostic challenges of pediatric COVID-19: A systematic review and meta-analysis

J Formos Med Assoc. 2020 May;119(5):982-989. doi: 10.1016/j.jfma.2020.04.007. Epub 2020 Apr 16.


Background/purpose: Current studies on pediatric coronavirus disease 2019 (COVID-19) are rare. The clinical characteristics and spectrum are still unknown. Facing this unknown and emerging pathogen, we aimed to collect current evidence about COVID-19 in children.

Methods: We performed a systematic review in PubMed and Embase to find relevant case series. Because some reports were published in Chinese journals, the journals and publications of the Chinese Medical Association related to COVID-19 were completely reviewed. A random effects model was used to pool clinical data in the meta-analysis.

Results: Nine case series were included. In the pooled data, most of patients (75%) had a household contact history. The disease severity was mainly mild to moderate (98%). Only 2 children (2%) received intensive care. Fever occurred in 59% of the patients, while cough in 46%. Gastrointestinal symptoms (12%) were uncommon. There are 26% children are asymptomatic. The most common radiographic finding was ground glass opacities (48%). Currently, there is no evidence of vertical transmission to neonates born to mothers with COVID-19. Compared with the most relevant virus, SARS-CoV, SARS-CoV-2 causes less severe disease.

Conclusion: COVID-19 has distinct features in children. The disease severity is mild. Current diagnosis is based mainly on typical ground glass opacities on chest CT, epidemiological suspicion and contact tracing.

Keywords: COVID-19; Children; SARS-CoV-2.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Betacoronavirus
  • COVID-19
  • COVID-19 Testing
  • Child
  • Clinical Laboratory Techniques*
  • Contact Tracing
  • Coronavirus Infections / diagnosis*
  • Coronavirus Infections / epidemiology
  • Coronavirus* / genetics
  • Coronavirus* / isolation & purification
  • Cough / etiology
  • Fever / etiology
  • Humans
  • Lung / diagnostic imaging*
  • Pandemics
  • Pneumonia, Viral / diagnosis*
  • Pneumonia, Viral / epidemiology
  • Polymerase Chain Reaction
  • SARS-CoV-2
  • Severity of Illness Index
  • Tomography, X-Ray Computed / methods*