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A clinical report published in Frontiers examined five children who were sick with COVID-19 in Wuhan, China.

The children did not initially show issues with their breathing, appearing at the emergency room with digestive issues.

The authors said their study suggests that children may have different COVID-19 symptoms than adults.

This report is more evidence that children can get critically ill with the new coronavirus, although it is still much more rare than it is in adults.

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Digestive issues were the first symptom of coronavirus for five children admitted to the emergency department in Wuhan, China, according to a new clinical report published in the journal Frontiers.

None of the children experienced coughing or difficulty breathing, symptoms once thought to be ubiquitous all patients with COVID-19, the respiratory disease caused by the novel coronavirus.

The report is more evidence that children can get critically ill with the new coronavirus, just like adults — although the likelihood of it occurring is still rare in children — and suggests that children’s COVID-19 symptoms may differ from adults’.

Three of the children, who were all between the ages of 2 months to five years, required emergency operations during the early onset of the disease. Four of the five children had fevers, while one had no fever or cough. For three of the children, the researchers could not clearly trace where or how they had been exposed to COVID-19.

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“The five cases were interesting because the patients initially had no respiratory symptoms at presentation; instead, they had to seek medical advice for unrelated problems in the emergency department,” the study authors wrote.

Gastrointestinal systems may be an additional route of infection, the authors theorized. Previous studies have shown the virus attaches itself to the ACE2 receptor, which is found in cells in the lung and the intestines. 

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There are clear limitations to the study include. It only involved five children, and COVID-19 tests can occasionally produce false positives.

The researchers concluded that doctors should consider the possibility of COVID-19 infection if children show digestive issues, especially if they also have fever or have been exposed to the virus.

This study adds to a growing body of evidence that children can get critically ill with COVID-19

While children have a relatively low rate of infection, accounting for just 2% of all coronavirus cases in America, this report is part of a growing pile of evidence exploring the ways children can get critically ill from the virus.

Many of those critically ill children had pre-existing symptoms like cancer and cerebral palsy. A recent JAMA study examined 48 children who got critically ill, and found that 40 of them had pre-existing symptoms.

For some children, COVID-19 seems to be linked to an unidentified syndrome that has symptoms similar to those of Kawasaki disease. At least 100 children in Europe, 93 children in New York, and six children in Connecticut are being treated for what the doctors are calling a “multisystem inflammatory disease.” Five of the New York children have died. The symptoms include red eyes and lips, rashes and swollen hands and feet.

There is a lot the medical establishment doesn’t understand about the new coronavirus’ effect on children. A group of doctors have established a new registry for keeping track of pregnant patients with COVID-19, and the NIH has launched a new study exploring how the new coronavirus affects children.

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