How to take care of children with COVID-19 symptoms?

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During this ongoing pandemic, people are speculating more and consulting less, resulting in panic. To tackle such situations, the Ministry of Health has always come forward with a set of guidelines that would ease the level of consternation.

In the case of Covid cases in children, naturally, parents have been quite worried. In the wake of this, the Health Ministry has laid out few important guidelines to identify, distinguish and treat a child infected with COVID-19.

Health Minister Dr Harsh Vardhan through his recent tweet advised people to be mindful of COVID19 symptoms in children. He mentioned that early detection & proper management can boost the chances of a speedy recovery.

Dr Harsh Vardhan shared a few guidelines and urged people to adhere to these simple guidelines on how to treat asymptomatic cases or cases with mild symptoms at home.

How to identify the virus in children?

As per the Health Ministry, an asymptomatic child is usually identified while screening, if other family members are identified.

In such a case, the child would require monitoring for the development of symptoms and subsequent treatment according to assessed severity.

Mild Cases:

The child with mild cases may show symptoms like sore throat, rhinorrhea or cough with no breathing difficulty.

Few children may have gastrointestinal symptoms. They do not need any investigation.

Children who are asymptomatic or have mild COVID-19 infection can be managed with home isolation and symptomatic treatment, including those with underlying comorbid conditions like congenital heart disease, chronic lung disease, chronic organ dysfunction and obesity.

However, one must always consult with the doctor before taking any step.

Mild Cases Treatment:

In case of mild symptoms, it is not necessary to rush for a bed in the hospital. Home isolation is best for the treatment of both asymptomatic and mild COVID-19 patients, including children.

For Fever: Paracetamol 10-15 mg/kg/dose, may repeat every four to six hours

For Cough: Throat soothing agents like warm saline gargles in older children and adolescents

Diet: Ensure oral fluids to maintain hydration and a nutritious diet

Things to Note:

-There is no role of Hydroxychloroquine, Favipiravir, Ivermectin, lopinavir/ritonavir, Remdesivir, Umifenovir, immunomodulators including Tocilizumab, Interferon B 1 a, Convalescent plasma infusion or dexamethasone.

-Parents or the caregiver can maintain a monitoring chart for counting respiratory rates two-three times a day when a child is not crying, chest indrawing, blueish discolouration of body, cold extremities, urine output, oxygen saturation via pulse oximeter, fluid intake and activity level, especially for young children.

-Besides, always update your doctor and stay connected.

Moderate Cases:

A child to be categorized as moderate Covid-19 Case
if he/she has the following:

Rapid Respiration (Age-based) as follows:

Respiratory rate >60/ min for less than 2 months

Respiratory rate >50/min for less 2 to 12 months

Respiratory rate >40/min for 1 to 5 years

Respiratory rate >30/min for more than 5 years

To Note: Oxygen saturation in all these age groups to be above 90%
The child may be suffering from pneumonia which may not be clinically apparent

Treatment:

For the investigation, no lab tests are required routinely unless indicated by associated co-morbid conditions.

Children with moderate Covid-19 disease must be admitted to Dedicated Covid Health Centre or Secondary level Healthcare Facility and monitored for clinical progress.

Always ensure to maintain fluid and electrolyte balance in the body.

-Encourage oral feeds (breastfeeds in infants).

• If oral intake is poor, intravenous fluid therapy should be initiated.

-Children with moderate Covid – 19 diseases can be given the following medication only after consulting a doctor:

i. For fever: Paracetamol 10-15 mg/kg/dose. May be repeated every 4-6 hours. (temperature > 38oC, i.e. 100.4oF).

ii. Amoxycillin to be administered, if there is evidence/ strong suspicion of bacterial infection.

iii. For SpO2 below 94%, oxygen supplementation is required.

Clinical Cases:

The majority of children may have asymptomatic or have mild COVID-19 symptoms.

Some of the common symptoms seen are Fever, cough, shortness of breath, fatigue, myalgia, rhinorrhea, sore throat, diarrhoea, loss of smell/taste, etc.

A few children may show gastrointestinal symptoms and atypical symptoms as well.

However, a new syndrome called Multi-System Inflammatory Syndrome has been described in children.

These are characterized by unremitting fever >38°C, epidemiological linkage with SARS CoV-2, and clinical features suggestive of Multi-System Inflammatory Syndrome.

In such cases consulting a doctor should be the first step.

These are the guidelines issued by the Ministry of Health and Family Welfare, Government of India to treat identify and treat the children with COVID-19. One needs to stay calm and informed always to avoid panic. Medical advice is a vital part of treating the disease from the core. Along with the treatments, necessary precautions and care must be given to the child for a speedy recovery.