Indian health ministry releases guidelines to identify Covid symptoms in children

For parents worried about not detecting the symptoms of coronavirus disease (Covid-19) in their children at early stages, the Indian health ministry has released a set of guidelines. As Covid-19 symptoms in children are often mild, they initially go undetected, which results in more severe cough, fever, or breathlessness, in some cases.

According to the Indian health ministry, there are a few characteristics of the virus in children that their guardians should be on the lookout for.

Symptoms to track

Though a majority of the children who contract the virus may be asymptomatic or mildly symptomatic, fever, cough, breathlessness, fatigue, myalgia, rhinorrhoea, sore throat, diarrhoea, loss of smell, loss of taste are common symptoms. A few children may also have gastrointestinal issues, the ministry said.

A new syndrome called multi-system inflammatory syndrome has been observed in children. This syndrome is characterised by fever, abdominal pain, vomiting, diarrhoea, rash, and cardiovascular and neurological problems.

In case the child is asymptomatic

If a child tests positive for the virus but is asymptomatic, there is a need to constantly track their health for development of symptoms. Early detection of symptoms will lead to early treatment, say health experts. Meanwhile, if children have mild symptoms such as sore throat, cough and rhinorrhoea but no breathing difficulty, they can be taken care of at home, the ministry said.

Children with underlying comorbid conditions including congenital heart disease, chronic lung disease, chronic organ dysfunction or obesity may also be treated at home.

Treatment of mild cases of Covid-19 in children

To treat fever in children, a paracetamol (10-15mg) may be used every 4 to 6 hours. For cough, gargles with warm, saline water will help, the health ministry said. Intake of fluids and a nutritious diet is mandatory.

The ministry also clarified on the role of antiviral medication in treatment of Covid-19 in children. "There is no role of hydroxychloroquine, Favipiravir, Ivermectin, Iopinavir/Ritonavir, Remdesivir, Umifenovir, immunomodulators including Tocilizumab, Interferon B1a, convalescent plasma infusion or Dexamethosone," the guidelines read.

It was important to maintain a monitoring chart for respiratory rates and oxygen levels. These should be checked 2-3 times a day. Chest indrawing, discolouration of body, urine output, fluid intake and activity level should also be monitored, especially in young children. Parents should contact doctors in case they notice anything out of the ordinary.

Treatment of moderate cases of Covid-19 in children

If the respiratory rate is below 60 per minute in children less than two months old, below 50 per minute for children less than one year old, below 40 per minute for children up to five years and below 30 per minute for those over five, they may be suffering from a moderate case of Covid-19. The oxygen saturation level in all these age groups should be above 90%.

No regular lab tests will be required unless the children have comorbid conditions and those conditions demand regular tests. But there is a need for children with moderate Covid-19 to be admitted to dedicated Covid health centres and monitored for clinical progress. In these cases, there was a need to encourage oral feeds (breast feeds in infants) and maintenance of fluid and electrolyte balance. Intravenous fluid therapy should be initiated if oral intake is poor, the ministry said.

Treatment of severe cases of Covid-19 in children

Children with severe Covid-19 SpO2 (oxygen saturation) level of less than 90% and grunting, severe retraction of chest, lethargy, somnolence, seizure are some of the symptoms of severe Covid-19. Such children should be admitted to a dedicated Covid-19 healthcare facility and some of them may require HDU/ICU care. They should also be checked for thrombosis, hemophagocytic lymphohistiocytosis (HLH) and organ failure.

Complete blood counts, liver and renal function tests and chest X-rays are mandatory for such cases. Corticosteroids (0.15 mg per dose) twice a day or antiviral drugs (such as Remdesivir granted for emergency use authorisation) should be used in a restricted manner after three days of onset of symptoms and after making sure that the child's liver and renal functions are normal.