The effect of COVID-19 by SARS-CoV-2 on the paediatric population remains an evolving mystery. Early reports from China stated that children seem to be unharmed by its dangerous effects, yet more recently there has been evidence of a systemic inflammatory response in a small number of children who are affected. We discuss a 5-week-old male infant who presented atypically with severe COVID-19 infection. To our knowledge, he is the youngest reported case in the UK to require mechanical ventilation and intensive care treatment as a direct result of COVID-19 following horizontal transmission. This case has generated several learning points with regard to atypical presentations of COVID-19 and identifying a potential cohort of 'at risk' infants. We also highlight a number of new challenges that have arisen for paediatricians and anaesthetists providing airway management for infants with SARS-CoV-2.