Infants under one year old, especially those under six months, are a vulnerable population. Prompt recognition and careful management of COVID-19 are important for caregivers. This guide provides practical steps for managing an infant with suspected or confirmed COVID-19, focusing on day-to-day care, identifying danger signs, and protecting the entire household.
Identifying Symptoms and Testing
COVID-19 symptoms in infants are highly variable and often resemble other common respiratory illnesses. Common presentations include fever, a persistent cough, runny or stuffy nose, sore throat, and general fatigue. Gastrointestinal issues like vomiting, diarrhea, and poor feeding are also common indicators. In infants under two months old, non-specific signs such as lethargy or a noticeable decrease in feeding may be the only initial symptoms. Contact a pediatrician immediately upon suspicion of a COVID-19 infection.
A healthcare provider will guide the decision on testing, choosing between a Polymerase Chain Reaction (PCR) test or a rapid antigen test. The PCR test is the gold standard due to its high accuracy in detecting the virus’s genetic material, though results take longer to process. Rapid antigen tests offer quick results but are less sensitive, meaning they have a higher chance of producing a false negative, especially early in the infection.
Most at-home rapid antigen tests are not designed for infants under two years old due to the difficulty in administering the nasal swab properly. A healthcare professional’s guidance is necessary to ensure accurate and safe test collection. Testing confirms the diagnosis and determines the appropriate isolation and care plan for the infant and the household.
Managing Symptoms at Home
Home care for a mild or moderate case of COVID-19 focuses on meticulous symptom management, hydration, and comfort. Fever management is a primary concern, but caregivers must consult a pediatrician before administering any medication. For infants younger than 12 weeks, any fever above 100.4°F (38°C) is considered a medical emergency and warrants an immediate call to the doctor.
If a fever is present, medication is based on the infant’s age and weight. Acetaminophen should not be given to infants under two months of age unless specifically directed by a healthcare provider. Ibuprofen is generally not recommended for infants younger than six months. Aspirin or cough and cold medicines should not be given to children under six years old.
Maintaining hydration is a priority, as infants can quickly become dehydrated, especially with fever, vomiting, or diarrhea. Offer breast milk or formula more frequently than usual, aiming for smaller amounts if the infant is reluctant to feed. An infant is considered well-hydrated if they have a minimum of four to six wet diapers in a 24-hour period; fewer than this signals a need for medical attention.
Nasal congestion interferes with an infant’s ability to breathe and feed, making gentle airway clearance important. Before each feeding, loosen thick mucus by placing saline drops or mist into each nostril. After a minute, use a bulb syringe or nasal aspirator to gently suction the mucus out. Limit suctioning to a maximum of four times per day to avoid irritating the nasal lining. A cool-mist humidifier in the room can also help thin secretions and ease breathing during sleep. Continuous monitoring of the infant’s demeanor is necessary. Changes such as extreme fussiness, unusual sleepiness, or a lack of energy must be communicated to the pediatrician immediately.
Warning Signs Requiring Immediate Medical Attention
While most infants recover with supportive home care, certain symptoms indicate a rapid progression to severe illness and require immediate medical attention. Difficulty breathing is the most concerning sign, and caregivers should look for specific physical indicators of respiratory distress.
Indicators of Respiratory Distress
Nasal flaring, where the nostrils widen with each breath.
Chest retractions, where the skin visibly pulls inward between the ribs, below the rib cage, or at the neck.
A persistent grunting sound at the end of exhalation, indicating the body is struggling to keep the lungs open.
If the infant’s breathing is unusually fast, shallow, or labored, immediate help is necessary.
Changes in skin color are a severe warning sign, particularly cyanosis, which appears as a bluish or grayish tint around the lips, on the tongue, or beneath the fingernails. This coloration suggests low oxygen levels. Any infant who cannot be easily roused, appears unresponsive, or is confused should be considered a medical emergency.
Severe dehydration is another concern, often evidenced by a sunken soft spot (fontanelle), a lack of tears when crying, or a refusal to feed for several hours. If the infant has not had a wet diaper for six to eight hours, or if the urine is dark yellow and concentrated, this signals significant fluid loss. Caregivers should also be aware of symptoms that could indicate Multisystem Inflammatory Syndrome in Children (MIS-C), a rare but serious complication occurring weeks after infection. These symptoms include a fever lasting 24 hours or more, severe abdominal pain, bloodshot eyes, or a new rash.
Protecting Caregivers and Household Members
Minimizing transmission risk requires strict adherence to hygiene and isolation protocols. If a caregiver is ill, they should wear a well-fitted mask whenever they are near the infant, especially during feeding and close contact. Hand hygiene is essential; caregivers must wash their hands with soap and water for at least 20 seconds before and after any interaction with the infant, including feeding and changing diapers.
Breastfeeding should continue, even if the mother has tested positive for COVID-19, as the virus is not transmitted through breast milk. Breast milk provides antibodies that help protect the infant. The mother should wear a mask and practice thorough hand hygiene immediately before and during feeding. If expressing milk, pump parts and bottles must be cleaned and disinfected after each use.
If possible, an uninfected, low-risk caregiver should be designated as the primary person caring for the infant. Shared surfaces in the home, such as doorknobs, light switches, and counters, should be cleaned and disinfected regularly. The infant’s toys and equipment should also be disinfected frequently. Infants under two years old must never wear a mask or face shield due to the risk of suffocation or Sudden Infant Death Syndrome (SIDS). Protecting vulnerable household members, such as the elderly or those who are immunocompromised, requires maintaining physical distance from both the sick infant and any infected caregiver. Household members should be vigilant for symptoms and get tested if exposed.