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BackgroundThere have been no population-based studies of SARS-CoV-2 testing, PCR-confirmed infections and COVID-19-related hospital admissions across the full paediatric age range. We examine the epidemiology of SARS-CoV-2 in children and young people (CYP) aged <23 years. MethodsWe used a birth cohort of all children born in Scotland since 1997, constructed via linkage between vital statistics, hospital records and SARS-CoV-2 surveillance data. We calculated risks of tests and PCR-confirmed infections per 1000 CYP-years between August and December 2020, and COVID-19-related hospital admissions per 100,000 CYP-years between February and December 2020. We used Poisson and Cox proportional hazards regression models to determine risk factors. ResultsAmong the 1226855 CYP in the cohort, there were 378402 tests, 19005 PCR confirmed infections and 346 admissions, corresponding to rates of 770.8/1000 (95% confidence interval 768.4-773.3), 179.4 (176.9-182.0) and 29.4/100,000 (26.3-32.8) CYP-years respectively. Infants had the highest COVID-19-related admission rates. Chronic conditions, particularly multiple types of conditions, was strongly associated with COVID-19-related admissions across all ages. The hazard ratio for >1 chronic condition type was 12.2 (7.9-18.82) compared to children with no chronic conditions. 89% of admitted children had no chronic conditions recorded. ConclusionsInfants, and CYP with chronic conditions are at highest risk of admission with COVID-19, however the majority of admitted CYP have no chronic conditions. These results provide evidence to support risk/benefit analyses for paediatric COVID-19 vaccination programmes. Studies examining whether maternal vaccine during pregnancy prevents COVID-19 admissions in infants are urgently needed. FundingUK Research and Innovation-Medical Research Council