Background: Although less severe than in adults, children can experience a range of COVID-19 symptoms, from asymptomatic to life-threatening, including respiratory and gastrointestinal symptoms. Medical conditions may also increase the severity of the disease in infected children. Methods: A study was performed at a single center, comparing cases and controls, and involving 253 pediatric patients who had been diagnosed with COVID-19. Two different outcomes were assessed. The first categorized symptomatic individuals who were hospitalized with COVID-19 (Hospital) from those who were not (Nonhospital). The second categorized admitted individuals who spent at least one day in the intensive care unit (ICU) from those who did not require ICU (Floor). Results: Ninety individuals (36%) had at least one underlying medical condition, with the most common being pulmonary disorders, such as asthma (12%), followed by neurodevelopmental disorders (8%), gastrointestinal disorders (6%). The Hospital group was more likely to have any comorbidity such as obstructive sleep apnea (OSA), diabetes mellitus, seizure disorder, hypertension, sickle cell disease, neurodevelopmental disorder, and immunocompromising conditions including cancer, bone marrow transplant, and other immunodeficiencies, compared to the Nonhospital group. Abdominal pain was more common in the Hospital group. shortness of breath (SOB) and diarrhea were significantly more common in the ICU group than in the Floor group. Conclusions: Early identification of pediatric patients with severe COVID-19 is important to improve outcomes. In our single center case control study, we found that the presence of G symptoms on presentation was more commonly associated with severe COVID-19 in children.