An update on COVID-19 in children (12/2025)
- Johanna
- Dec 14, 2025
- 8 min read
The waiting rooms of pediatricians' offices are full, many children are coughing, sneezing, or feverish, and many parents are worried. Is it an upper respiratory infection? RSV? Influenza? Or is it COVID-19? Yes, COVID-19 is currently circulating again.
This update is intended to help you better understand the current situation.
Why are there currently more Covid-19 cases? The current situation
Viruses love the cold season. People spend more time indoors, making it easier for viruses to spread.
SARS-CoV-2 has now joined the ranks of typical winter viruses, alongside RSV, influenza, and other cold viruses. While the currently circulating variants (mostly omicron derivatives) are highly contagious, they are mild in the vast majority of cases in children. Infections are particularly difficult to avoid in daycare centers and schools.
Symptoms: How does COVID-19 currently manifest itself in children?
While at the beginning of the pandemic the loss of smell or taste was often the main focus, with the current variants we see a much broader, less specific picture and it resembles other viral infections.
In pediatric practice, we primarily see:
Fever: Often sudden, sometimes high. Temperatures up to 40°C can occur in children and are not automatically dangerous.
Respiratory symptoms: dry cough, runny nose, sore throat or a scratchy throat.
Gastrointestinal problems: Children with COVID-19 are more likely than adults to experience abdominal pain, nausea, or diarrhea.
General feeling of illness: fatigue, headache and body aches, reduced resilience.
If your child has cold symptoms and you are planning a visit to the pediatrician, please test your child beforehand! Rapid tests are now readily available in pharmacies and drugstores, often asmulti-tests that simultaneously check forCOVID-19, influenza, and RSV. Most pediatricians no longer perform these tests themselves.
Positive test – now what?
A positive test result can initially be worrying, especially when it brings back memories of the early years of the pandemic. It's important to know, however, that in the vast majority of cases, COVID-19 is no longer a cause for panic in children. From a pediatrician's perspective, it's often something quite different: it brings clarity.
When a child has a fever, doctors and nurses are always alert. Unexplained fever , meaning fever without a clear cause, raises alarm bells; then we have to take a closer look, examine the child, and sometimes initiate further diagnostic tests.
A positive COVID-19 test can significantly ease this situation. Then we know why the child has a fever. This provides reassurance and helps us better assess the course of the illness. In many cases, doctors are therefore more reassured than alarmed when a test is positive, because we are familiar with the disease and know what to expect.
Does a child who tests positive need to see a doctor?
In short: No, not usually. A child who tests positive but is otherwise doing well does not automatically need to see a doctor. There is no medical reason for a doctor's visit.
Red flags - When should you contact your doctor's office?
Even though the illness often has a mild course, there are symptoms that must be taken seriously and require a medical examination. See a doctor if:
If your child’s condition worsens noticeably
When red flags appear:
Shortness of breath: Very rapid breathing, flaring of the nose, retractions under the ribs or in the neck.
Signs of dehydration: No need to go to the toilet/No wet diaper for 6-8 hours, dry mucous membranes, no tears when crying.
Significantly altered general condition: Your child appears apathetic, difficult to wake, or "not like usual".
Fever in infants: Any fever above 38.0°C rectally in newborns, and 38.5°C in babies under one year of age, should be investigated by a doctor immediately.
Course: Fever in children over one year of age lasting longer than 3-4 days or renewed fever after a fever-free period.
If you are very uncertain and need reassurance
Please trust your gut feeling here, and don't hesitate to seek medical advice.
In these cases, please contact your pediatrician's office by phone or online first. Do not bring a child who has tested positive to the office unannounced. Pediatricians' offices also care for healthy children for routine checkups, as well as newborns and young babies, every day. Prior consultation helps protect everyone, and the practice team can work with you to decide if and when a specific appointment is appropriate and what further steps are necessary.
A positive test result does not automatically mean "alarm". It often means: We know what we are dealing with.
How is COVID-19 treated in children? Here's how you can support your child!
If the test is positive or you suspect COVID-19, the first thing to do is stay calm. Important: A positive rapid test can help identify the cause, but often doesn't change the treatment . The child will be treated for their symptoms.
A sick child primarily needs security, closeness, and relief. Treatment is generally symptom-oriented, just as with other viral infections.
1. Fever management
Fever is not an illness, but a useful defense mechanism of the body.
Look at your child, not just at the thermometer: Is he or she drinking? Is he or she responsive? Is he or she interested in its surroundings?
Fever does not automatically need to be reduced.
When to reduce? If your child is suffering, in pain, or refusing to drink.
Paracetamol or ibuprofen are suitable; please always dose according to weight .
2. Drink, drink, drink
Fever significantly increases the need for fluids.
Offer water or tea regularly.
For babies: breastfeed more frequently or offer a bottle.
Practical tip: Small sips from a spoon or popsicles can help.
3. Closeness
Peace and closeness are very important.
Physical closeness promotes the release of oxytocin, calms the nervous system and supports regeneration.
Listening to an audiobook on the sofa, reading aloud, or resting together is often more helpful than strict bed rest, which puts additional stress on many children.
4. If necessary
Pain is relieved with paracetamol or ibuprofen if needed.
Use decongestant nasal spray if needed.
*Antibiotics are ineffective because it is a virus.
The goal is not to "stop the infection quickly," but to guide your child safely and lovingly through the illness until the immune system has done its job.
Typical course of COVID-19 in children
The course of the illness is mild and short-lived in most children. Not every child shows all symptoms.
Days 1–2: Sudden onset with fever, fatigue, headache or body aches, sore throat. Some children have abdominal pain or nausea.
Days 2–4: Fever, cough, runny nose, reduced appetite, general feeling of illness. As long as your child is drinking and responsive, this is usually normal.
Days 4–6: Slow improvement: Fever subsides, general well-being improves. Cough and runny nose may persist.
Days 7–10: Recovery phase: Most children are fit again, slight fatigue or residual cough is possible.
How contagious is COVID-19 currently?
COVID-19 is primarily transmitted via droplets and aerosols, i.e., through speaking, coughing, sneezing, or close contact in enclosed spaces, especially when there is little ventilation.
The current variants are highly contagious, comparable to other winter viruses. However, this does not automatically mean severe cases.
Many children become infected in school or Kindergarden. This cannot be prevented and is not a sign of a lack of caution.
What precautionary measures are advisable?
Today, what is needed is not a state of emergency , but a pragmatic, caring approach:
If your child is sick, they should stay home until they feel significantly better.
Regular handwashing and ventilation help to shorten the chain of infection.
Contact with particularly vulnerable people (e.g. very old or seriously ill people) should be avoided during the acute phase.
Masks can be useful in certain situations, but are not always practical or necessary in everyday life with small children.
Long COVID in children
Many parents are worried about possible long-term consequences. Current studies show that children are significantly less frequently and usually less severely affected by Long COVID than adults.
However, if your child continues to have COVID-19 weeks after a COVID-19 infection
is unusually exhausted
has difficulty concentrating
or experiences shortness of breath even with minimal exertion.
Then specifically ask your pediatrician about it.
PIMS - a very rare inflammatory reaction , occurring several weeks after a COVID-19 infection
Most children with PIMS had a mild or even unnoticed infection beforehand. PIMS is easily treatable if diagnosed. Most children recover fully.
New research shows that PIMS is not directly triggered by the coronavirus , but likely by the fact that a coronavirus infection temporarily disrupts the immune system in a small number of children. This can allow another virus already present in the body (the Epstein-Barr virus) to briefly reactivate and trigger a strong inflammatory response.
Side note: The Epstein-Barr virus (EBV) is extremely widespread. EBV is best known as the cause of infectious mononucleosis (glandular fever). Around 90–95% of people become infected with EBV at some point in their lives, often in childhood, frequently without even realizing it. Many children have no symptoms or only mild ones , sometimes resembling a minor infection.
What should parents pay attention to?
After recovering from a COVID-19 infection, special monitoring is usually not necessary. It's simply important to remain attentive and take your child seriously if they seem unusual.
Please seek medical advice if the following symptoms appear or persist several weeks after infection :
persistent or recurring high fever
severe fatigue or significant loss of performance
Abdominal pain , vomiting or diarrhea without any apparent cause
Skin rash, red eyes or swollen hands/feet
Chest pain, palpitations or shortness of breath
These signs do not automatically mean PIMS , but should be medically evaluated.
Conclusion: Calm, trust, and good support
COVID-19 is currently part of the winter infection cycle again, but it is a different virus in a different situation than at the beginning of the pandemic.
In the vast majority of cases, children recover well within a few days. Trust your instincts, observe your child carefully, and seek support if you are unsure.
*COVID-19 vaccination in children
Today, COVID-19 vaccination in children is viewed in a much more nuanced way than at the beginning of the pandemic. The focus is no longer on "vaccinating as many people as possible," but on an individual benefit-risk assessment.
For whom is the COVID-19 vaccination recommended?
There is no general vaccination recommendation for all healthy children.
The STIKO (Standing Committee on Vaccination) recommends the COVID-19 vaccination especially for:
Children and adolescents with relevant underlying medical conditions, e.g.
severe chronic lung diseases
congenital heart defects
severe neurological diseases
Immunodeficiencies
Children who have close contact with particularly vulnerable people
Why are recommendations being made so cautiously today?
Because several things have changed:
The currently circulating variants usually cause mild cases in children.
Many children have already had contact with the virus and therefore have a certain level of basic immunity.
Severe cases are rare in healthy children.
The vaccination offers very good protection against severe cases, but only limited protection against infection.
Vaccination is therefore not a must for every child, but a targeted protective measure for certain groups .
Is the COVID-19 vaccine safe for children?
Based on everything we know today from studies and millions of administered doses:
Yes, the vaccines are considered safe.
Most side effects are mild and temporary (e.g. pain at the injection site, fatigue, headache).
Serious side effects are very rare
Known risks (e.g., myocarditis) are closely monitored and incorporated into the recommendations.
As of December 2025
My sources & reading tips for you
This article is based on current recommendations from German professional societies:
German Society for Pediatric Infectious Diseases (DGPI) Current statements on COVID-19 in children and adolescents.
Kindergesundheit-info.de (BZgA)
Robert Koch Institute (RKI) data and assessments on the current spread of respiratory diseases.
Robert Koch Institute (RKI):
PIMS:
Pediatricians and adolescent medicine specialists online:
