LAUSR

Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) variants and re‐emergence of other respiratory viruses highlight the need to understand the presentation of and factors associated with SARS‐CoV‐2 in pediatric populations over time. The objective of this study was to evaluate the sociodemographic characteristics, symptoms, and epidemiological risk factors associated with ambulatory SARS‐CoV‐2 infection in children and determine if factors differ by variant type. We conducted a retrospective cohort study of outpatient children undergoing SARS‐CoV‐2 polymerase chain reaction testing between November 2020 and January 2022. Test‐positive were compared with test‐negative children to evaluate symptoms, exposure risk, demographics, and comparisons between Omicron, Delta, and pre‐Delta time periods. Among 2264 encounters, 361 (15.9%) were positive for SARS‐CoV‐2. The cohort was predominantly Hispanic (51%), 5–11 years (44%), and 53% male; 5% had received two coronavirus disease 2019 (COVID‐19) vaccine doses. Factors associated with a positive test include loss of taste/smell (adjusted odds ratio [aOR]: 6.71, [95% confidence interval, CI: 2.99–15.08]), new cough (aOR: 2.38, [95% CI: 1.69–3.36]), headache (aOR: 1.90, [95% CI: 1.28–2.81), fever (aOR: 1.83, [95% CI: 1.29–2.60]), contact with a positive case (aOR: 5.12, [95% CI: 3.75–6.97]), or household contact (aOR: 2.66, [95% CI: 1.96–3.62]). Among positive children, loss of taste/smell was more predominant during the Delta versus Omicron and pre‐Delta periods (12% vs. 2% and 3%, respectively, p = 0.0017), cough predominated during Delta/Omicron periods more than the pre‐Delta period (69% and 65% vs. 41%, p = 0.0002), and there were more asymptomatic children in the pre‐Delta period (30% vs. 18% and 10%, p = 0.0023). These findings demonstrate that the presentation of COVID‐19 in children and most susceptible age groups has changed over time.