COVID-19 in children: symptoms, prevention and treatment

By Dr Sunil Kumar Kota*

Many quarters have expressed fear that the third wave of COVID-19 may hit the children up to 18 years age in a harder way in near future. So Governments across have been working on a war footing to come up with special directives for this age group. Most of the infections are spread from infected adults. Among studies of household contacts, chances of infection in children are significantly less than elderly.

According to a statement by IAP (Indian Academy of Paediatrics) in May 2021, Children are less prone to develop COVID-19 infection and its severity due to following factors

1. Strong immune system: This gives rise to early control of infection at the site of entry

2. Better Vascular Health: Because of lesser prevalence of comorbid conditions like Diabetes; Hypertension; Chronic lung, liver, heart or kidney diseases and absence of smoking, alcohol intake, children have healthier blood vessels.

3. Lesser expression specific receptors to which the virus binds to enter the host

4. Excellent regeneration capacity of Lung tissue may also be contributing to early recovery from COVID-19 in Children.

Modes of Transmission

It’s a respiratory virus. It mainly gets transmitted in three ways.

1. Droplet transmission: Large and small respiratory droplets that contain the virus. This would occur when a child is near an infected person.

2. Contact transmission: When a child comes in contact with infected surface

3. Airborne transmission: This is for smaller droplets and particles that remain suspended in the air over longer distances and time than droplet transmission.

Clinical Features

The incubation period (From entry of virus to first manifestation of symptoms) is 2-14 days. But majority of them manifest within 5 -7 days. The child may be infectious during pre-symptomatic period. Up to 70-80% children are asymptomatic. Amongst symptomatic patients, 90% children would be of mild variety.

1. Respiratory symptoms: Fever, cough, cold, running nose, sore throat, shortness of breath (breathlessness).

In severe cases, it can present with bluish discoloration of body, grunting, severe chest indrawing/ retractions, lethargy, sleepiness (somnolence), fits etc.

2. Gastrointestinal symptoms: Seen in 5-10% children including Diarrhea, nausea, vomiting and abdominal pain. It may occur without respiratory symptoms in children

3. Cutaneous manifestations: Seen in <3% . Rashes on body, fingers, toes sometimes along with red eyes. Sometimes COVID toes (Reddish-purple nodules on distal digits) can also manifest

4. Others: Body aches/ head ache, weakness, loss of sense of smell or taste

Monitoring

Maintain monitoring chart including

1. Oxygen Saturation using pulse oximeter (Once in every 4-6 hours, it should be > 94% in room air)

2. Counting of respiratory rate 2-3 times a day. It is the number of times chest moves up and down during normal breathing

Rapid respiration is defined as per the following age based criteria
(a) <2 months: RR >60/min;
(b) 2-12 months: RR >50/min;
(c) 1-5 years: RR >40/min;
(d) >5 years: RR >30/min

3. Chest indrawing/ retraction of muscles in between rib cages

4. Bluish discoloration of body

5. Cold extremities

6. Reduced Urine output, Fluid intake and Activity level

7. Additionally, children above 12 years of age can undertake 6 minutes’ walk test once in every 6-8 hours under supervision of parents/guardian. This is basically done in asymptomatic and mild cases of COVID-19 to see for impending hypoxia (Low oxygen saturation).

The test has to be avoided in patients with uncontrolled asthma

(a) Measure baseline oxygen saturation by attaching pulse oximeter to his/her finger

(b) Ask the child to walk in the confines of their room for 6 minutes continuously

(c) Positive test: any drop in saturation < 94%, or absolute drop of more than 3–5% or feeling unwell (lightheaded, short of breath) while performing the test or at end of 6 minutes

Classification of COVID-19

Mild: Symptoms along with oxygen saturation ≥ 94% on room air Moderate: Symptoms with Oxygen saturation of 90-93 % on room air or Rapid respiration (As per age specific cut offs)

Severe: Oxygen saturation of less than 90% on room air or Signs of severe pneumonia, acute respiratory distress syndrome, septic shock, multi-organ dysfunction syndrome, or pneumonia with bluish discoloration, grunting, severe retraction of chest, lethargy, somnolence (sleepiness), seizure (fits)

Prevention:

1. Droplet precaution: Social Distancing of 6 feet/ 2 meters

2. Aerosol Precaution: Usage of triple layer masks by child above 5 years of age and N 95 mask by the caregivers. Adults may use face shield in addition. Reduction of crowding and time spent indoors.

3. Contact precautions and hand hygiene: Repeated hand wash using a soap or alcohol based sanitiser for 20 seconds and cleaning and disinfecting the commonly used, frequently touched surfaces

4. Cough/ sneezing etiquette: Cough or sneeze into back of elbow/ kerchief

5. Well ventilated rooms

6. Safe disposal of infected materials

7. Timely inoculation of all age wise vaccines and annual flu vaccine.

Treatment:

1. All asymptomatic and mild COVID-19 cases can be treated under home isolation. Mild cases with Diabetes, Hypertension, Congenital heart diseases, Chronic lung, kidney, liver disease, Immunocompromised states and Obesity might be observed more frequently while undergoing treatment under home isolation.

2. Nutritious food with more of vegetables, fruits, protein and adequate oral fluids

3. No investigations are required in asymptomatic and mild cases. In moderate to severe cases few blood tests and chest X ray may be required as per the advice of doctor

4. No routine use of HRCT Chest, unless advised by doctor. Treatment is done based on clinical and physiological assessment of the children. Nearly two-thirds of persons with asymptomatic COVID-19 have abnormalities on HRCT chest imaging which are nonspecific, and most of them do not progress clinically

5. Paracetamol, Throat soothing agents, and warm saline gargles for older children can be done

6. No role of routine use of antibiotics (including Azithromycin, Ivermectin, Doxycycline) and antivirals like Favipiravir, Remdesivir

7. Steroids are only reserved for rapidly progressive variety of moderate and all cases of severe disease as per the advice of treating doctor inside hospital. Steroids are not indicated and are harmful in asymptomatic and mild cases of COVID-19. Self-medication of steroids and anticoagulants (blood thinners) must be avoided

Multi Inflammatory Syndrome in Children: (MIS-C):

1. It is a syndrome in children characterized by fever >38°C and epidemiological linkage with SARS-CoV-2. It usually occurs after 2–4 weeks of recovery from acute COVID-19

2. It is characterized by occurrence in Children and adolescents 0–18 years of age with fever ≥3 days along with some of the following features

(a) Involvement of eyes, mouth and rashes on hands and feet

(b) Acute gastrointestinal problems (diarrhoea, vomiting, or abdominal pain)

(c) Fall in blood pressure

(d) Elevated blood clotting parameters (PT, PTT, D-Dimer)

(e) Absence of COVID-19 positive result or any other bacterial infection

3. If treated on time with steroids, immunoglobulins and broad spectrum antibiotics under supervision, it has excellent prognosis/ outcome.

 

[The writer is a Berhampur-based medical practitioner with specialisation in medicine and endocrinology.]

 

DISCLAIMER: The views expressed in the article are solely those of the author and do not in any way represent the views of Sambad English.