In the wake of rising coronavirus infection and mortality among 0-20 age group, the health ministry on Monday for the first time held a virtual conference with the participation of a record 4,000 paediatricians, nurses, medical officers and healthcare workers across India and discussed the treatment protocols.
The ministry said at present the cases of infection below 20 years in the country is 12% and death rate is 3%. There is a need to be prepared in case the numbers increase and all HCW should be oriented to the clinical protocols and management of COVID-19 in newborn age group. However, the ministry officials and experts were unanimous on one thing that the children should be given very judicious treatment. No unnecessary drug prescriptions of Remdesivir, Tocilizumab, Hydroxychloroquine, plasma infusion as done in case of adults.
The community should be educated that children can be managed at home if asymptomatic/mildly symptomatic while moderate and severe illnesses are managed in a patient facility. They emphasised the need for a rational use of medications. Trials of vaccines in children are underway but guidance is likely to be based on documentation of safety and efficacy and availability of vaccines. The message was to educate the parents not to panic but focus on proper treatment, counselling and keeping the child’s morale high.
‘’Number of children are more due to lowering of the guard, complete state of unlock, mass gathering, lack of distancing and mask use and more importantly mutant strains," they said. ‘’After diagnosis of COVID-19, no additional blood tests or chest imaging is recommended," they added.
Majority of the children may have minor symptoms and they can be treated by keeping them in home isolation. However, the social eligibility criteria for home isolation include the patient having a requisite facility for isolation at his or her residence and also for quarantining the family contacts. Caregiver is available to provide care on a 24x7 basis. If available, using a country specific app for tracking COVID-19 positive cases and the parents/caregiver has agreed to monitor health of the child and regularly inform his or her health status to the surveillance officer or doctor. They will have to follow home isolation quarantine guidelines.
However, the experts have said the home quarantine is not feasible if there is a small house, overcrowding at home, high-risk patients staying at home and inadequate facility and regular monitoring is not possible. If a child has high-risk factors including chronic disease then home isolation is not advisable. ‘’All children at home isolation/COVID-19 care facilities or hospital should be cared in child-friendly environment and parents/attendant may be allowed to take care with proper PPE and precautions,’’ said Prof Dr. Rakesh Lodha, Department of Paediatrics, AIIMS, New Delhi.
The respiratory virus is transmitted through contact transmission, droplet transmission and airborne transmission.
According to the ministry and experts, the parents should be trained for home care to monitor oxygen saturation, maintain a monitoring chart, counting of respiratory rates 2-3 times a day, communication to doctor and whom to contact in case of emergency. ‘’If a child develops breathing difficulty, bluish discoloration, nasal flaring, chest indrawing, rapid respiratory rate shows reduced activity or lethargy, poor feeding in such situation the parents should take the child to the hospital,’’ said Prof Dr. SK Kabra, Department of Paediatrics, AIIMS, New Delhi.
In case of moderate disease and oxygen saturation less than 94%, the child can be treated in hospital, the doctor added.