Govt issues guidelines for COVID management in kids

The Centre has issued comprehensive guidelines for management of Coronavirus disease (Covid-19) among children that prohibit use of antiviral drug remdesivir, suggest an HRCT scan only if symptoms aggravate, and recommend only basic anti-fever medicines and throat smoothening agents for mildly symptomatic cases.

The guidelines have been issued by Directorate General of Health Services, the technical wing of Union ministry of health and family welfare. “There is lack of sufficient safety and efficacy data with respect to remdesivir in children below 18 years of age. HRCT chest to be done ONLY if there is worsening of symptoms…,” read the guidelines issued on Wednesday.

Also, use of steroids and anti-coagulants is to be prescribed only under strict medical supervision in a hospital. “Exercise caution and see use of corticosteroids and anti-coagulants guide,” it said.

For asymptomatic cases under home isolation
The guidelines recommend infants and younger children to stay under immediate care of parents or guardians. No specific medication is required for the infection but children should continue medications for other conditions, if any. The infected should strictly follow Covid appropriate behaviour (mask, strict hand hygiene, physical distancing). They suggest oral fluids to maintain hydration and a nutritious diet, and advise older children and family to stay connected and engage in positive talks through phone, video calls, etc. In case of deterioration of symptoms, family should immediately consult a doctor. No investigations (tests) are needed.

For mildly symptomatic cases
The guidelines strongly recommend that children also follow Covid appropriate behaviour (mask, strict hand hygiene, physical distancing). For fever, paracetamol 10-15mg/kg/dose that can be repeated every 4-6 hours; and for cough throat soothing agents and warm saline gargles in older children and adolescents is recommend. Children should be given oral fluids to maintain hydration and put on a nutritious diet. No other Covid-19 specific medication is needed, especially no antimicrobial medicines. Parents or attendants need to maintain a monitoring chart including counting of respiratory rate 2-3 times a day, and keep a watch for chest indrawing, bluish discolouration of body, cold extremities, urine output, oxygen saturation, fluid intake, activity level, especially for young children. Parents or caregivers must contact a doctor in case of deterioration of symptoms. No investigations are required.

For moderately sick cases
Moderately sick children should immediately be put on oxygen therapy; maintaining fluid and electrolyte balance, especially oral fluids (breast feeds in infants) or initiating intravenous fluid therapy if oral intake is poor. Corticosteroids are not required in all children with moderate illness; they may be administered in rapidly progressive disease, and anticoagulants may also be indicated, the guidelines advise.

For fever (temperature >38°C or 100.4°F) a child should be given paracetamol 10-15mg/kg/dose that may be repeated every 4- 6 hours. Anti-microbials to be administered if there is evidence or strong suspicion of superadded bacterial infection, and supportive care for comorbid conditions, if any.

The guidelines prescribe a set of tests but suggest rational use of HRCT scan.

For severe cases
Initiate immediate oxygen therapy; maintain fluid and electrolyte balance; corticosteroids therapy; and anticoagulants may also be indicated. In case Acute Respiratory Distress Syndrome (ARDS) or shock develops, necessary management to be initiated; anti-microbials to be administered if there is evidence or strong suspicion of superadded bacterial infection. The child may need organ support in case of organ dysfunction such as renal replacement therapy etc.

Guide for using mask in children
Children aged 5 years and under should not be required to wear masks. Children aged 6-11 years may wear a mask depending on their ability to use it safely and appropriately under direct supervision of parents or guardians; those aged 12 years and over should wear a mask under the same conditions as adults; and should ensure hands are kept clean with soap and water, or an alcohol based hand rub, while handling masks. Hindustan Times