Diarrhoea and vomiting could be an important sign of Covid-19 in children, researchers say, leading to calls for the official NHS list of symptoms to be updated.

The checklist for coronavirus in children currently includes just three symptoms: a high temperature, a new, continuous cough, and a loss or change to the sense of smell or taste. The latter was added to the list in May.

A number of studies in adults have flagged symptoms including muscle pain, fatigue, confusion, chest pains and stomach trouble. Among them, a yet-to-be-peer-reviewed study by researchers at King’s College London, based on data from the Covid symptom study app, found that symptoms fall into six main clusters in adults, one of them being mainly gastrointestinal problems.

Now researchers at Queen’s University Belfast say they have confirmed that an upset stomach is a symptom of Covid-19 in children, and revealed it appears to be a key sign of the disease.

“In our group, diarrhoea and vomiting were more predictive than, say, cough or even changes in smell and taste,” said Dr Tom Waterfield, the first author of the research. “If you want to actually diagnose infection in children, we need to start looking at diarrhoea and vomiting, not just upper respiratory tract symptoms.”

Waterfield said that going by the current three recognised symptoms, testing symptomatic children would identify 76% of cases, assuming a perfectly accurate test, while adding gastrointestinal symptoms to the checklist would bring the figure to 97%.

The study took place between 6 April and 3 July and involved more than 990 children of healthcare workers from across the UK aged between two and 15. None had been admitted to hospital with Covid-19.

All had a blood sample taken, which was tested for antibodies to coronavirus, and data was also gathered on whether they had experienced any symptoms – crucially this was done before antibody results were revealed.

The team found that 68 children – 6.9% of the total – had antibodies for the disease, suggesting they had had Covid-19, and half of these reported having had symptoms.

Some symptoms were particularly common, with 31% of the 68 children reporting fever, 18% reporting headache and 19% reporting gastrointestinal symptoms such as diarrhoea, vomiting and stomach cramps. For children without antibodies the figures were 11%, 4% and 3% respectively.

While only 34 children were symptomatic in the study, Waterfield said the findings were important, not least as diarrhoea and vomiting were clear and obvious problems to spot.

He said the study should also reassure parents. “Lots of children will have a running nose this winter [and] sneezing – that is not a sign,” he said.

Prof Tim Spector, of King’s College London, said the findings chimed with research by his team. “Our data on nearly 250,000 children from the Covid symptom study app suggest that children who test positive have a wide range of symptoms and that a cough is not as common in children as it is adults,” he said.

“We are also seeing gut symptoms and loss of appetite appear commonly as well as the classical fever,” Spector said, adding that while gastrointestinal problems were seen in both adults and children, they were slightly more common in children compared with other symptoms.

Danny Altmann, a professor of immunology at Imperial College London, said it might be useful to feed the findings into symptom checklists. “This is an important study, which together with the earlier data from the Kings College app users starts to build the case for including gastrointestinal symptoms among the Covid-19 case-defining criteria,” he said.

“It is becoming increasingly clear that we face a difficult grey area of defining case symptoms for those who do not obtain a positive PCR result during the window of virus positivity. The more confidence we can establish in the set of criteria, the better we can do this. This will become incredibly important over the coming weeks as we will need the highest level of scrutiny for any outbreaks among children returning to school.”

The Guardian

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