Background: Serological testing is urgently required since COVID-19 is the pandemic that is spreading the fastest in recent times, Although RT-PCR is an effective and specific method for diagnosing acute patients, serological tools are urgently required for examining antibody responses and evaluating both individual and prospective herd immunity. The aim of this study was divided into primary objectives were to assess serum IgM antibodies for SARS-Cov-2 in febrile children attending ER in Tanta University Hospital and secondary objectives were to assess computed tomography (CT) findings in febrile SARS-Cov-2 IgM antibody-positive individuals. Methods: This cross-section study was carried out on sixty children presented by fever with any respiratory symptom as cough and dyspnea and fever with non-respiratory and cutaneous symptoms. The patients were divided into three equal groups: group 1: included healthy children, group 2: included febrile children with respiratory symptoms as cough and dyspnea and group3: included febrile children with fever alone or with non-respiratory symptoms as Gastrointestinal symptoms as vomiting and diarrhea, cutaneous manifestations as rash, and CNS manifestations. Results: IgM were significantly higher in group II compared to other groups, significantly higher in group III compared to group I (P value <0.001).CO-RADS 2,4 and 5 were significantly higher in group II compared to other groups, CO-RADS 3 was insignificantly different between groups II and III. Patients with positive CXR at time of presentation were significantly higher in group II compared to other groups. (P value 0.005). Conclusions: In children with COVID-19, Serum IgM to SARS-COV-2 was significantly higher in febrile children in Tanta University during the period from March 2021 to February 2022. According to CT findings, CO-RADS 2,4 and 5 were significantly higher in febrile patients with positive SARS-Cov-2 serum Igm Ab.