Clinical characteristics of children with COVID-19: a rapid review and meta-analysis

Background: Most guidelines on COVID-19 published so far include recommendations for patients regardless of age Clinicians need a more accurate understanding of the clinical characteristics of children with COVID-19 Methods: We searched studies reporting clinical characteristics in children with COVID-19 published until March 31, 2020 We screened the literature, extracted the data and evaluated the risk of bias and quality of evidence of the included studies We combined some of the outcomes (symptoms) in a single-arm meta-analysis using a random-effects model Results: Our search retrieved 49 studies, including 25 case reports, 23 case series and one cohort study, with a total of 1,667 patients Our meta-analysis showed that most children with COVID-19 have mild symptoms Eighty-three percent of the children were within family clusters of cases, and 19% had no symptoms At least 7% with digestive symptoms The main symptoms of children were fever [48%, 95% confidence interval (CI): 39%, 56%] and cough (39%, 95% CI: 30%, 48%) The lymphocyte count was below normal level in only 15% (95% CI: 8%, 22%) of children which is different from adult patients 66% (95% CI: 55%, 77%) of children had abnormal findings in CT imaging Conclusions: Most children with COVID-19 have only mild symptoms, and many children are asymptomatic Fever and cough are the most common symptoms in children Vomiting and diarrhea were not common in children The lymphocyte count is usually within the normal range in children