The Union Ministry of Health and Family Welfare updated its COVID-19 treatment protocol for children in April. While India was battling its deadly second wave, health experts warned the administration and the people of an impending third wave, which is likely to affect children. Also, speculations about Multisystem Inflammatory Syndrome in Children (MIS-C) occurring as a post-COVID-19 complication in this age group prompted health experts to prepare guidelines to reduce the effects of COVID-19 in children.
Pediatric COVID-19 treatment guidelines in India have been grouped under three categories:
Treatment protocol for children with mild COVID-19 disease
The majority of children infected with COVID-19 were found to be asymptomatic or have mild symptoms. The symptoms of COVID-19 in children are similar to those in adults, including fever, cough, breathlessness, fatigue, shortness of breath, sore throat, diarrhoea and loss of taste and smell. Asymptomatic COVID-19 cases can only be detected using screening when a family member has been diagnosed with the infection. Most of these children do not show any symptoms and therefore, do not require treatment.
However, they must be monitored for any symptom development, especially if they have any comorbidities like congenital heart conditions, asthma, chronic lung diseases, etc. Children with mild COVID-19 disease usually present with a running nose, cough, sore throat and sometimes, an upset stomach. They do not have breathing difficulties and these cases can be easily managed with home isolation and symptomatic treatment.
According to the latest COVID-19 Treatment Protocol For Children, the treatment given at home must include:
- Prescribed medication for fever (if the child presents with the symptom).
- Warm salt-water gargles are effective for cough.
- Ensure the child is hydrated and provide oral fluids.
- A nutritious diet.
The parents or the caregiver must ensure appropriate isolation facilities at home and must constantly monitor the child. Stay in touch with the child’s doctor and update them regularly about the child’s condition.
Treatment protocol for children with moderate COVID-19 disease
A child is a moderate case of COVID-19 if they show one or more symptoms of COVID-19 along with rapid respiration, but their oxygen saturation remains over 90%. Rapid respiration varies for different age groups:
- Less than 2 months: Respiratory rate >60/min
- 2 to 12 months: Respiratory rate >50/min
- 1 to 5 Years: Respiratory rate >40/min
- >5 years: Respiratory rate >30/min
In many moderate COVID-19 cases in children, pneumonia may be present, but symptoms may not be evident. A routine RT-PCR test is done to confirm COVID-19 moderate cases. However, if a child has comorbidities, additional tests may be necessary. As per the latest COVID-19 Treatment for children, the treatment for moderate COVID-19 infection must be provided in a dedicated COVID-19 facility or hospital.
Treatment of a child with moderate COVID-19 includes:
- Symptomatic treatment to relieve fever, with regular temperature monitoring.
- Supplemental oxygen may be provided if the oxygen saturation falls below 94%.
- Medications may be given for bacterial infections.
- Continued care for existing comorbid conditions.
- Fluid and electrolyte balance is maintained orally or by intravenous fluid therapy if oral intake is poor.
- Oral feeds are advised for breastfeeding infants.
- Stronger medications may be given in rapidly progressing moderate COVID-19 cases.
Also Read: Post Covid-19 Complication In Kids
Treatment protocol for children with severe COVID-19 disease
Severe COVID-19 cases in children are characterised by:
- Pneumonia with less than 90% oxygen saturation, increased respiratory effort or severe retractions.
- Lethargy, fatigue, seizures, etc.
- Severe gastrointestinal symptoms including diarrhoea, vomiting and abdominal pain.
If these symptoms are not managed immediately, the child can go into Acute Respiratory Distress Syndrome (ARDS), shock, acute thrombosis or multiorgan failure. A child with severe COVID-19 must be admitted to a tertiary hospital, preferably in the ICU. To provide treatment to a child with severe COVID-19, some investigations including CBC, RFT, LFT, CRP, ECG, ABG, CXR, LDH, Ferritin and ECHO, among others.
Treatment for severe COVID-19, as per Pediatric COVID-19 treatment guidelines India, includes:
- Oxygen therapy
- Prone position
- Medications based on body parameters.
- Symptomatic relief
Though the number of COVID-19 cases among children has been relatively low, the lack of vaccines for this age group increases their risk of developing the infection. COVID-19 Treatment for children with mild disease can be managed at home, with a doctor monitoring them. Moderate to severe cases of the disease requires immediate medical attention and a hospital setting where adequate treatment can be provided.
Self-medication is not advised as it can lead to more complications. Parents and caregivers need to be attentive to the various symptoms that can appear in the child post-COVID-19 recovery. Children must follow all precautionary measures such as wearing masks, practising hand hygiene and social distancing to protect themselves from COVID-19. Parents must ensure children are safe and protected at all times.
Disclaimer: The information included at this site is for educational purposes only and is not intended to be a substitute for medical treatment by a healthcare professional. Because of unique individual needs, the reader should consult their physician to determine the appropriateness of the information for the reader’s situation.