COVID-19 in Infants Under 1: Symptoms, Risks, and Protection Guide

COVID-19 can affect anyone, including infants and newborns. While children generally experience milder symptoms than adults, babies under 1 year old face unique risks and require special attention. Understanding how COVID-19 impacts infants, recognizing symptoms early, and knowing how to protect your little one are essential for every parent and caregiver.

Understanding COVID-19 Risk in Infants Under 1 Year

Infants under 1 year old represent a particularly vulnerable population when it comes to COVID-19. Research has shown that babies in this age group may face higher risks of serious illness compared to older children, though severe cases remain relatively uncommon.

Several factors contribute to increased vulnerability in infants:

• Immature immune systems: Babies’ immune systems are still developing, making it harder to fight off infections effectively.
• Smaller airways: Infants have narrower respiratory passages that can become blocked more easily when inflamed or filled with mucus.
• Inability to communicate: Babies cannot tell you how they feel, making it challenging to detect symptoms early.
• Premature birth: Babies born before their due date face the highest risk of complications from COVID-19.

Despite these concerns, most infants who contract COVID-19 experience mild symptoms and recover fully with appropriate care. Between 2020 and early 2024, children under 17 accounted for approximately 1.5% of COVID-19 hospitalizations in the United States, with infants representing a portion of these cases.

How Do Infants Get COVID-19?

Understanding transmission patterns helps parents protect their babies more effectively. The virus that causes COVID-19 spreads primarily through respiratory droplets when an infected person coughs, sneezes, talks, or breathes.

For newborns and young infants, the most common transmission routes include:

Postnatal transmission: The vast majority of infant COVID-19 cases occur after birth through contact with infected caregivers, family members, or visitors. Babies can contract the virus from anyone who handles them, including parents, siblings, grandparents, and healthcare providers.

Prenatal and perinatal transmission: While possible, transmission from pregnant person to unborn baby remains rare. Most studies indicate that the virus does not commonly cross the placental barrier. However, newborns can be exposed during delivery or immediately after birth if the birthing parent is infected.

Environmental surfaces: Though less common, babies can contract COVID-19 by touching contaminated surfaces and then touching their face, especially their mouth, nose, or eyes.

COVID-19 Symptoms in Infants and Babies

Recognizing COVID-19 symptoms in infants presents unique challenges since babies cannot verbalize discomfort. Parents and caregivers must watch carefully for both typical and subtle signs of illness.

Common Symptoms in Infants

Symptoms typically appear 2 to 14 days after exposure to the virus. The most frequently observed symptoms in infants include:

• Fever: Temperature of 100.4°F (38°C) or higher, particularly concerning in babies under 3 months
• Cough: May be dry or produce mucus; sometimes includes a barking sound similar to croup
• Difficulty feeding: Reduced appetite, refusing bottle or breast, or feeding less than usual
• Irritability and fussiness: Excessive crying or inability to be soothed
• Lethargy: Unusual sleepiness, difficulty waking, or decreased alertness
• Nasal congestion: Stuffy or runny nose that may interfere with feeding
• Digestive issues: Vomiting, diarrhea, or reduced bowel movements
• Skin rash: Various types of rashes have been reported in infants with COVID-19

Less Common but Important Symptoms

Some infants may experience additional symptoms that warrant attention:

• Changes in breathing patterns or noisy breathing
• Wheezing or grunting sounds
• Decreased wet diapers indicating possible dehydration
• Changes in skin color or temperature
• Red or irritated eyes

It is important to note that some infants with COVID-19 may show no symptoms at all, making regular testing important if exposure is suspected.

Emergency Warning Signs Requiring Immediate Medical Attention

Certain symptoms indicate a medical emergency requiring immediate professional care. Call 911 or go to the nearest emergency department if your infant shows any of these signs:

• Severe breathing difficulties: Grunting with each breath, flaring nostrils, chest pulling in at the ribs or collarbone, rapid breathing, or pauses in breathing
• Inability to feed: Cannot suck, swallow, or complete a feeding; excessive drooling in young infants
• Color changes: Blue, gray, or pale skin, lips, or nail beds indicating low oxygen levels
• Extreme lethargy: Cannot be awakened or does not respond to stimulation
• Severe dehydration: Fewer than three wet diapers in 24 hours for babies under 3 months, sunken soft spot on head, dry mouth and lips, crying without tears
• High fever in newborns: Any fever of 100.4°F (38°C) or higher in babies under 3 months old
• Persistent vomiting or diarrhea: Continues despite attempts to hydrate
• Seizures or convulsions: Any new seizure activity
• Unresponsiveness: Baby seems confused or does not recognize parents

Trust your parental instincts. If something seems seriously wrong with your baby, seek medical help immediately. Inform healthcare providers about any known COVID-19 exposure or positive test results.

Testing Infants for COVID-19

Prompt testing helps identify COVID-19 quickly, enabling appropriate care and preventing spread to others. Several testing options are available for infants:

When to Test Your Infant

Consider testing your baby if:

• Your infant shows any symptoms consistent with COVID-19
• Your baby has been exposed to someone with confirmed COVID-19
• A household member tests positive for COVID-19
• Your infant will undergo a medical procedure requiring pre-screening
• Community transmission rates are high in your area

Types of Tests Available

PCR (Polymerase Chain Reaction) tests: These molecular tests are highly accurate and considered the gold standard. For infants, a healthcare provider typically collects a nasal swab sample. Results usually take 1-3 days but can sometimes be available within hours.

Rapid antigen tests: These tests provide results within 15-30 minutes but may be less sensitive than PCR tests, especially in asymptomatic individuals. They work best when viral loads are higher, typically when symptoms are present.

Testing Procedure for Infants

Testing an infant requires gentle technique and patience. Healthcare providers trained in pediatric care can collect samples most effectively. The nasal swab, while uncomfortable, causes only brief discomfort. Parents can comfort their baby during and after the procedure by holding, rocking, or feeding.

Treatment and Care for Infants with COVID-19

Most infants with COVID-19 can be cared for safely at home with supportive measures. However, medical guidance is essential, especially for babies under 3 months old or those with underlying health conditions.

Home Care Guidelines

If your healthcare provider recommends home care for your infant with COVID-19:

• Monitor symptoms closely: Check temperature regularly, watch breathing patterns, and note any changes in behavior or feeding
• Keep your baby hydrated: Continue breastfeeding or formula feeding on demand; adequate hydration helps thin mucus and prevents dehydration
• Use a humidifier: Cool-mist humidifiers can help ease congestion and make breathing more comfortable
• Clear nasal passages: Use saline drops and a bulb syringe to gently remove mucus before feedings
• Maintain comfortable positioning: Slightly elevating your baby’s head during sleep may ease breathing (never use pillows for babies under 1 year; instead, place a towel under the mattress)
• Ensure adequate rest: Allow your baby extra sleep while ensuring they wake for regular feedings
• Maintain isolation: Keep your infected infant away from other children and vulnerable family members when possible

When Professional Treatment Is Needed

Some infants require hospitalization for COVID-19 treatment. Hospital care may include:

• Oxygen therapy to support breathing
• Intravenous fluids to maintain hydration
• Monitoring of vital signs and oxygen levels
• Respiratory support if breathing becomes severely compromised

Medical treatments vary based on each infant’s specific situation. Always consult with your pediatrician or healthcare provider before giving any medication to your infant, even over-the-counter products. Many common medications are not safe for babies under certain ages.

Multisystem Inflammatory Syndrome in Children (MIS-C)

While rare, MIS-C is a serious condition that can affect infants and children following COVID-19 infection. This syndrome involves widespread inflammation affecting multiple organ systems, including the heart, lungs, kidneys, brain, skin, eyes, and digestive system.

Understanding MIS-C Risk in Infants

MIS-C typically develops 2 to 6 weeks after COVID-19 infection, sometimes in children who had mild symptoms or were asymptomatic. The condition affects children of all ages, including infants, though cases remain uncommon. In 2023, only 117 cases were reported in the entire United States.

Recognizing MIS-C Symptoms

Key symptoms of MIS-C include:

• Persistent fever lasting several days
• Severe abdominal pain
• Vomiting and diarrhea
• Skin rash or color changes
• Red, bloodshot eyes without discharge
• Unusual irritability or confusion
• Dizziness or lightheadedness

Emergency warning signs requiring immediate medical attention include:

• Difficulty breathing or rapid breathing
• Persistent chest pain or pressure
• New confusion or inability to stay awake
• Pale, gray, or blue-colored skin, lips, or nail beds
• Severe, unexplained abdominal pain

If you suspect MIS-C, contact your healthcare provider immediately or seek emergency care. Most children who receive prompt treatment for MIS-C recover fully without long-term complications.

Long-Term Effects and Post-COVID Syndrome in Infants

While research on long-term COVID-19 effects in infants is still emerging, some children develop ongoing symptoms after initial infection, known as post-COVID syndrome or “long COVID.”

Potential Long-Term Symptoms

In older children who can communicate symptoms, long COVID may include fatigue, breathing difficulties, cognitive problems, and other issues. For infants, detecting these conditions proves challenging since babies cannot describe how they feel.

Parents and caregivers should watch for:

• Persistent irritability or changes in temperament
• Ongoing feeding difficulties
• Developmental delays or regression of achieved milestones
• Continued breathing irregularities
• Chronic digestive issues
• Sleep disturbances

If your infant continues experiencing symptoms weeks after COVID-19 infection, consult your pediatrician. Early intervention may help address developmental concerns and ensure appropriate support.

COVID-19 Vaccination and Infant Protection

Vaccination represents one of the most effective tools for preventing severe COVID-19 illness in eligible children and protecting vulnerable infants.

Vaccines for Infants 6 Months and Older

COVID-19 vaccines are available for infants starting at 6 months of age. The specific vaccines, dosing schedules, and recommendations may evolve, so consult your pediatrician for current guidelines.

Current vaccines approved for young children include formulations from Moderna and Pfizer-BioNTech. Infants receiving their first COVID-19 vaccine typically need multiple doses spaced several weeks apart to achieve optimal protection.

Benefits of vaccination for infants include:

• Reduced risk of severe COVID-19 illness
• Lower likelihood of hospitalization
• Protection against MIS-C
• Decreased risk of long-term complications
• Contributing to community immunity

Protecting Infants Under 6 Months

For babies too young to receive COVID-19 vaccines, protection strategies include:

Maternal vaccination during pregnancy: Research suggests that when pregnant people receive COVID-19 vaccines, protective antibodies can pass to the developing baby and continue providing some protection after birth through breastfeeding.

Cocoon strategy: Ensuring all eligible household members and caregivers are vaccinated creates a protective barrier around the infant.

Limiting exposure: Minimize your baby’s contact with people outside the household, especially in areas with high COVID-19 transmission.

Vaccine Safety

COVID-19 vaccines have undergone extensive testing for safety and effectiveness in children. Serious side effects remain extremely rare. Common mild side effects may include temporary fussiness, low-grade fever, or tenderness at the injection site, which typically resolve within a day or two.

Risk Factors for Severe COVID-19 in Infants

While any infant can develop serious COVID-19 complications, certain factors increase risk:

• Premature birth: Babies born before 37 weeks gestation face the highest risk among infants
• Congenital heart conditions: Heart defects or other cardiac issues increase vulnerability
• Chronic lung disease: Including bronchopulmonary dysplasia common in premature infants
• Neurological conditions: Disorders affecting the brain, spinal cord, or nervous system
• Immunodeficiency: Weakened immune systems due to inherited conditions or medical treatments
• Metabolic disorders: Including genetic or inherited metabolic diseases
• Sickle cell disease: Children with this blood disorder face increased risk

Infants with multiple risk factors or poorly controlled medical conditions face even greater vulnerability. If your baby has any chronic health conditions, work closely with your healthcare team to develop a comprehensive COVID-19 protection plan.

Preventing COVID-19 in Infants: Comprehensive Protection Strategies

Protecting your infant from COVID-19 requires a multi-layered approach combining vaccination, hygiene, environmental controls, and behavioral modifications.

Vaccination for Family Members

Ensure all eligible household members stay current with COVID-19 vaccinations. This includes parents, siblings, grandparents, and regular caregivers. Vaccinated individuals are less likely to contract and spread the virus, creating a safer environment for vulnerable infants.

Hand Hygiene

Rigorous hand hygiene is essential when caring for infants:

• Wash hands thoroughly with soap and water for at least 20 seconds before touching your baby, preparing bottles, or handling baby items
• Use alcohol-based hand sanitizer containing at least 60% alcohol when soap and water aren’t available
• Wash hands after coughing, sneezing, or touching your face
• Clean hands before and after diaper changes
• Teach older siblings proper handwashing techniques and supervise them before they interact with the baby

Environmental Cleaning and Disinfection

Maintain a clean environment for your infant:

• Regularly clean and disinfect high-touch surfaces including doorknobs, light switches, phones, and remote controls
• Clean baby gear frequently, including changing tables, high chairs, toys, and play mats
• Wash bottles, pacifiers, and teething toys thoroughly after each use
• Launder baby clothes, blankets, and bedding regularly in hot water
• Use EPA-approved disinfectants on appropriate surfaces, ensuring they dry completely before baby contact

Improving Indoor Air Quality

Better ventilation reduces virus concentration in indoor air:

• Open windows and doors when weather permits to increase fresh air circulation
• Use portable air purifiers with HEPA filters in rooms where your baby spends time
• Ensure your home’s HVAC system has clean filters and operates efficiently
• Run bathroom and kitchen exhaust fans to improve overall air circulation
• Consider upgrading to higher-efficiency air filters (MERV 13 or higher) if your system can accommodate them

Social Distancing and Limiting Exposure

Minimize your infant’s exposure to potential sources of infection:

• Limit visitors to your home, especially during periods of high community transmission
• Require visitors to wash hands before holding or touching your baby
• Politely ask anyone feeling unwell to postpone their visit
• Avoid crowded indoor spaces with your infant when possible
• Maintain distance from obviously sick individuals in public settings
• Consider timing essential outings during less crowded hours
• Use contactless services like curbside pickup when available

Mask Wearing

In areas with high COVID-19 transmission or when around vulnerable individuals:

• Parents and caregivers should wear well-fitting masks in public indoor spaces
• Request that visitors and caregivers wear masks around your infant
• Never place a mask on a baby under 2 years old due to suffocation risk
• Choose high-quality masks (N95, KN95, or surgical masks) for best protection

Monitoring Community Transmission Levels

Stay informed about COVID-19 activity in your area:

• Check local health department websites for current transmission rates
• Adjust precautions based on community levels, being more cautious during surges
• Be aware of outbreaks in childcare facilities, schools, or workplaces that might affect your household

Breastfeeding and COVID-19

Current evidence strongly supports continuing breastfeeding even if a mother has COVID-19 or has been exposed to the virus.

Benefits of Continued Breastfeeding

• Breast milk provides antibodies that may help protect infants from COVID-19
• Mothers who have had COVID-19 or received vaccination pass protective antibodies through breast milk
• The nutritional and immunological benefits of breast milk remain crucial during illness
• Breastfeeding provides comfort and bonding during stressful times

Safe Breastfeeding Practices During COVID-19

If you have COVID-19 or are awaiting test results:

• Wear a well-fitting mask while breastfeeding or providing care
• Wash hands thoroughly before touching your baby or pump parts
• Consider pumping and having a healthy caregiver bottle-feed if you’re very ill
• Clean pump parts thoroughly after each use
• Continue breastfeeding unless your healthcare provider advises otherwise

Childcare and Infant Development During the Pandemic

Balancing COVID-19 precautions with your infant’s developmental needs requires thoughtful planning.

Maintaining Developmental Activities

Even while limiting outside exposure, support your infant’s development through:

• Regular tummy time to strengthen muscles
• Age-appropriate toys and sensory experiences
• Reading, singing, and talking to promote language development
• Safe outdoor time in private spaces like yards or less crowded parks
• Virtual connections with extended family through video calls

Well-Child Visits and Routine Healthcare

Continue attending scheduled well-child appointments despite pandemic concerns:

• Pediatric offices implement safety protocols to minimize COVID-19 risk
• Routine vaccinations protect against serious diseases beyond COVID-19
• Regular check-ups monitor growth and development
• Early detection of health issues prevents more serious problems
• Call ahead if your child has symptoms to determine whether in-person or telehealth is appropriate

When to Contact Your Healthcare Provider

Reach out to your pediatrician or healthcare provider if:

• Your infant shows any symptoms of COVID-19, especially if under 3 months old
• Your baby has been exposed to someone with confirmed COVID-19
• Symptoms persist or worsen despite home care
• You have questions about testing, isolation, or care recommendations
• Your infant has a chronic health condition and develops any new symptoms
• You’re concerned about your baby’s feeding, breathing, or behavior
• Your infant shows signs of dehydration
• Symptoms return after initial improvement

Never hesitate to seek medical advice when concerned about your infant’s health. Healthcare providers prefer answering questions and checking symptoms that turn out to be minor rather than missing something serious.

Emotional Well-being for Parents and Caregivers

Caring for an infant during a pandemic creates additional stress for parents and caregivers. Protecting your own mental health enables you to better care for your baby.

Coping Strategies for Parents

• Stay informed through reliable sources but limit consumption of distressing news
• Maintain routines to provide structure and predictability
• Accept help from trusted family and friends while following safety precautions
• Connect with other parents virtually for support and shared experiences
• Practice self-care through adequate sleep, nutrition, and stress-reduction activities
• Seek professional mental health support if feeling overwhelmed or anxious
• Remember that you’re doing your best in challenging circumstances

Looking Forward: Ongoing Protection for Your Infant

COVID-19 continues evolving, with new variants emerging and recommendations updating based on the latest research. Staying informed and maintaining flexible protection strategies helps keep your infant safe.

Key principles for ongoing protection include:

• Staying current with vaccination recommendations for eligible children and household members
• Maintaining core prevention measures like hand hygiene and environmental cleaning
• Adjusting precautions based on current community transmission levels
• Continuing regular pediatric care and developmental monitoring
• Balancing protection with your infant’s developmental and social needs
• Building resilience and adaptability as conditions change

Remember that protecting your infant from COVID-19 is just one aspect of overall health and well-being. Providing love, security, appropriate nutrition, routine healthcare, and developmental support creates the foundation for your baby to thrive despite pandemic challenges.

By combining vaccination, prevention measures, early symptom recognition, and prompt medical care when needed, you can significantly reduce your infant’s risk of serious COVID-19 complications. Trust your instincts as a parent, stay connected with your healthcare provider, and know that with appropriate precautions and care, most infants who encounter COVID-19 will recover fully and continue developing normally.

Sources:

• Centers for Disease Control and Prevention – COVID-19 in Children and Teens
• American Academy of Pediatrics – COVID-19 Guidance
• World Health Organization – COVID-19 Information
• National Institutes of Health – Coronavirus Research
• CDC – Multisystem Inflammatory Syndrome in Children