The Health Department has framed new guidelines for the management of COVID-19 in children, in anticipation that a third wave of COVID could manifest in a surge in paediatric cases.
Paediatricians point out that in the first and the second wave, COVID had manifested only as a mild and often asymptomatic disease in children. But among those who got hospitalised with COVID, one in three required ICU care.
“The absolute number of children getting COVID has gone up in the second wave but as a proportion, less than 12% got affected . Among this, the proportion of those below 10 years was 3-4%. It is rare for children to end up with acute COVID or COVID pneumonia. As for symptoms, children seemed to have diarrhoea and vomiting as main symptoms, unlike adults,” says A. Santhoshkumar, former Superintendent, SAT Hospital.
However, Multisystem Inflammatory Syndrome in Children (MISC), which occurs in some children three to four weeks after symptomatic or asymptomatic COVID is a serious condition with high mortality. Early identification and treatment is critical for an optimal outcome.
Most of the children with MISC might have coronary involvement and hence periodic check-ups are a must to to watch out for the resolution of myocarditis or the development of any new symptoms, guidelines say.
Though SAT Hospital has had some 75 cases of MISC so far, there have been no deaths.
The new guidelines are about the treatment and referral protocol for acute COVID and MISC in children, including case triage and management of individual cases inside different settings, including a Paediatric ICU.
Children with moderate COVID should be cared for in a taluk hospital or higher institutions.
The guidelines also tell primary care physicians how to recognise and treat children with COVID. Fever lasting over five days , fast breathing or in general, if any of the symptoms worsen, children should be referred to a district hospital or above.
Care of neonates born to mothers with suspected or confirmed COVID or newborns who may have been exposed to those with COVID infection has also been dealt with in detail in the new guidelines
The State has also directed that special newborn care units, newborn ICUs be set up.
The guidelines also give separate set of instructions for health sector field workers on how they should follow up paediatric cases in the field and how they should be in touch with the parents on a regular basis, especially those on home care.
Hospitals have been told to step up surveillance of children presenting with symptoms similar to acute COVID and follow the guidelines for management.
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