Study warns Covid-19 in children might not start with a cough

12 May 2020

Image: © hedgehog94/

Scientists in China are calling for further research after they discovered that respiratory symptoms might not be the first sign of Covid-19 in children.

While there is much still to understand about how Covid-19 affects children, researchers from the Department of Pediatrics at Tongji Hospital in Wuhan, China, have said respiratory symptoms may not be the first sign of infection.

While a cough is one of the most common symptoms reported in adults, the researchers, writing in Frontiers in Pediatrics, said that children with gastrointestinal issues – such as diarrhoea – coupled with a fever or history of coronavirus exposure should be suspected of having Covid-19.

The findings suggest that the gastrointestinal symptoms experienced by some children hints at potential infection through the digestive tract. This is because angiotensin-converting enzyme 2 (ACE2) receptors targeted by the coronavirus are found in the intestines, as well as the heart, lungs and other parts of the body.

However, as only five children were included in the study, the researchers warned that significantly more research is needed before a firm conclusion can be made.

“Most children are only mildly affected by Covid-19 and the few severe cases often have underlying health issues,” said researcher Dr Wenbin Li. “It is easy to miss its diagnosis in the early stage, when a child has non-respiratory symptoms or suffers from another illness.

“Based on our experience of dealing with Covid-19 in regions where this virus is epidemic, children suffering from digestive tract symptoms, especially with fever and/or a history of exposure to this disease, should be suspected of being infected with this virus.”

Gastrointestinal symptoms

The children included in the study had all presented to the emergency department with non-Covid-19 issues, such as a kidney stone or head trauma. Chest CT scans confirmed they had pneumonia before or soon after admission, and were subsequently diagnosed with Covid-19.

Their symptoms were initially mild or hidden, but Wenbin said that four out of five cases had digestive tract symptoms as the first manifestation of the disease.

“The gastrointestinal symptoms experienced by these children may be related to the distribution of receptors and the transmission pathway associated with Covid-19 infection in humans,” Wenbin said.

“This suggests that Covid-19 might infect patients not only through the respiratory tract in the form of air droplets, but also through the digestive tract by contact or faecal-oral transmission.”

Colm Gorey was a senior journalist with Silicon Republic