Coronavirus cases: What is the protocol for looking after children with COVID-19?

New Delhi, Apr 30: Amid the surge in coronavirus cases, the Union ministry of health and family welfare has issued protocol for managing children with the coronavirus with separate guidelines for those who are asymptomatic and those with mild, moderate and severe illness.

According to reports, asymptomatic children do not require any treatment, except monitoring for development of COVID-19 symptoms and subsequent treatment according to assessed severity.

On Thursday, the health ministry said, "Majority of children with covid infection may be asymptomatic or mildly symptomatic. Common symptoms include fever, cough, breathlessness or shortness of breath, fatigue, myalgia, rhinorrhea, sore throat, diarrhea, loss of smell, loss of taste etc. Few children may present with gastrointestinal symptoms and atypical symptoms. A new syndrome with name of multi system inflammatory syndrome has been described in children. Such cases are characterized by: unremitting fever > 38oC, epidemiological linkage with SARS CoV-2 and clinical features suggestive of Multi System Inflammatory Syndrome."

What is the protocol for managing children with coronavirus?

Accoridng to the health ministry, children with COVID-19 infection may be asymptomatic, mildly symptomatic, moderately sick or severe illness. "Asymptomatic children are usually identified while screening, if family members are identified. Such children do not require any treatment except monitoring for development of symptoms and subsequent treatment according to assessed severity," it said.

"Children with mild disease may present with sore throat, rhinorrhea or runny nose, cough with no breathing difficulty and a few children may have gastrointestinal symptoms," the ministry added. The guidelines also stated that such children do not need any investigation and can be managed at home with home isolation and symptomatic treatment.

How are children with mild illness in home isolation treated?

The guidelines recommend that for fever the treating doctor prescribe paracetamol (10-15 mg/kg/dose), which may be repeated every four to six hours. They recommend throat soothing agents such as warm saline gargles for cough and oral fluids to maintain hydration and a nutritious diet. Antibiotics are "not indicated" for treating mild illness in children, they said.

How does the protocol categorise severe disease in children?

Children with oxygen saturation level less than 90 per cent have severe degree of COVID-19 infection. Such children may have severe pneumonia, Acute Respiratory Distress Syndrome (ARDS), septic shock, Multi-Organ Dysfunction Syndrome (MODS), or pneumonia with cyanosis or bluish discoloration caused by deoxygenation.

"Randomized controlled trials of this drug in patients above 18 years of age has not shown significant survival benefits. An emergency use authorization for children has been granted. Till more data are available, it should be used in restricted manner in children with severe illness within three days of onset of symptoms after ascertaining that child's renal and liver functions are normal and they are monitored for side effects of medicine," according the protocol.