Going by sero-surveillance reports, COVID-19 infection in children above 10 years occurs in similar frequency to that of adults, notes the ‘Guidelines on Operationalization of COVID Care Services for Children and Adolescents’, released by the Health Ministry earlier this week.
While children have less severe disease compared to adults, intermittent surges in the number of cases are anticipated and so it is desirable to augment the existing facilities to provide care to children with acute COVID, it says.
The guidelines state that the majority of infections is asymptomatic or mildly symptomatic among children and it is uncommon to have moderate to severe COVID-19 in healthy children. Children with co-morbid conditions have more severe manifestations and poorer outcomes; they should be a priority group for vaccination, once vaccines are approved for children.
“A combined effort from private and public sector is needed to handle any surge in future after the withdrawal of the lockdown, school re-opening or as third wave strikes over next 3-4 months. The basic principles of equity and dignity of care should be followed. The estimates for additional bed capacity for paediatric care may be calculated based on the peak daily cases in different districts during the second wave,” said the guidelines.
The Ministry has said hospitals will need additional paediatric-specific equipment, infrastructure, and paediatric formulations. “Also, adequate number of trained manpower — both doctors and nurses — should be provided. The health authorities should initiate capacity building programs for appropriate paediatric care. In standalone paediatric hospitals, separate arrangements, for example separate bed for paediatric COVID care, need to be established. It is desirable to designate specific areas in the COVID facilities for paediatric care. These facilities should allow parents to accompany the child,” said the guidelines.
It added that most drugs used in adults such as Ivermectin/ HCQ/ Favipiravir/ Antibiotics such as Doxycycline or Azithromycin have not been tested in children for prevention or treatment of COVID infection. Therefore, these are not recommended.
“Majority of children have asymptomatic or mild illness and can be managed at home by parents. Treatment is symptomatic, including paracetamol for fever, good monitoring by measuring respiratory rates, difficulty in respiration, oral intake and oxygen saturation. In a community setting, healthcare staff should be involved for management of children at home and also monitor to assess the need for referral/ admission,” said the document.
The Ministry has said that data drives science and its importance cannot be over emphasised. “Therefore, it is important to ensure data collection at all levels and transmission from community to higher centers. A national registry should be launched for paediatric COVID. There is need to encourage and facilitate research in area of paediatric COVID; this could cover various aspects of management. Medical/clinical protocols are dynamic and continuously evolving and may change from time to time.”
