Coronavirus in children: Everything parents and guardians need to know

By now we know that COVID-19 presents differently in adults and in children. The signs and symptoms in anyone below 18 years are usually mild but can sometimes be confusing. The government of Pakistan has released guidelines about how COVID-19 presents in children and what parents should expect from treatment.

These were put together by the Aga Khan University, Pakistan Paediatric Association, King Edward Medical University, The Children’s Hospital & The Institute of Child Health and UNICEF Pakistan.

These guidelines are preliminary and the authors give a disclaimer in the beginning: “At this time, there are no specific vaccines or evidence-based treatment for COVID-19, particularly in children. Data has been extrapolated from adults, for use in children in need of treatment.”

They are subject to change as research evolves. SAMAA Health has simplified them for your understanding, as well as added what other experts are saying worldwide.

When should you suspect your child has COVID-19?

If the child has fever and cough and/or difficulty breathing and one of the following:

• No other disease that explains the symptoms
• Contact with a confirmed or suspected case in the last 14 days
• History of attending a mass gathering/ contact with someone who attended a mass gathering

A Lancet study of 582 children adds that gastrointestinal symptoms such as diarrhoea are also common in children as compared to adults. The US Centres for Disease Control and Prevention list a few more along with diarrhoea: nasal congestion/runny nose, sore throat, nausea/vomiting, headache, muscle aches and poor appetite.

What should you do if you suspect coronavirus infection?

Get in touch with your paediatrician or family doctor who will advise you about the next steps. You can also call these helplines.

What to expect?

If your healthcare provider suspects COVID-19, your child will need to get a PCR test. Usually a nasopharyngeal swab (from both nostrils) is taken for the test. However, in children this might be difficult so an orapharyngeal swab (from the throat and tonsils) is taken instead.

The general condition of the child will be assessed to see if they are stable or unstable.

A stable child is one who has low grade fever, cough, body aches, flu-like symptoms, sore throat but no difficulty breathing. This child will most likely be advised home therapy which involves isolation, rest, monitoring temperature and hand hygiene.

The patient will be prescribed medicines for fever and fluids for energy. You should not give your child any other medication unless the doctor advises it.

A list of items that should be available for home care:

• Thermometer
• Pulse oximeter
• Face masks
• Paracetomol
• Gloves
• Disinfectants (bleach, Dettol)
• ORS

The isolation period is for 14 days and it is important that you stay in touch with your healthcare provider throughout this time. If the child gets sicker and develops certain danger signs, they need to be rushed to the hospital.

An unstable child is one who has the symptoms mentioned earlier and any one of the following danger signs:

• Difficulty breathing
• Low oxygen levels (less than 92%)
• Lethargy
• Bluish discolouration of lips, hands or feet
• Altered state of consciousness
• Fits/seizures
• Signs of respiratory distress

A sick/unstable child will be managed in the hospital HDU or ICU. They will be given IV fluids, supportive treatment and monitored closely. Oxygen therapy might become necessary if breathing worsens.

It is important to note that the majority of children will either be asymptomatic or have mild disease and will not need to be hospitalised.

Watch out for inflammatory syndrome after recovery

Some children around the world have been hospitalised after recovery from the novel coronavirus with what is now known as paediatric inflammatory multisystem syndrome (PIMS) or multisystem inflammatory syndrome in children (MIS-C).

This is a rare immune disorder (similar to Kawasaki disease) associated with COVID-19 in children where the blood vessels of the body are inflamed causing inflammation in multiple organs. It can affect the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs, according to the CDC.

The World Health Organisation and Royal College of Paediatrics and Child Health list these signs and symptoms:

• Persistent fever
• Shock (cold extremities, loss of consciousness)
• Rash on mouth, hands and feet
• Digestive issues (vomiting, diarrhoea, pain)
• Swollen lymph nodes
• Conjunctivitis (red eyes)
• Inflammation (increased white blood cells)
• Positive PCR test for coronavirus
• Abnormal cardiac tests

Several cases have also been reported in Pakistan.

The treatment includes hospitalisation, IVIG (intravenous immunoglobulin), steroids, high dose aspirin as well as supportive measures for the heart and lungs. If detected early, the disease is treatable.

This article is for information only and not a substitute for professional medical advice. For any medical problems, consult a licensed medical practitioner.

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