Friday, May 15, 2020



Dr K K Aggarwal
President Confederation of Medical Associations of Asia and Oceania, HCFI, Past National President IMA, Chief Editor Medtalks

With inputs from Dr Monica Vasudev

851: Children — Symptomatic infection in children appears to be relatively uncommon; when it occurs, it is usually mild, although severe cases have been reported


1.         Cui Y, Tian M, Huang D, et al. A 55-Day-Old Female Infant infected with COVID 19: presenting with pneumonia, liver injury, and heart damage. J Infect Dis 2020.
2.         Cai J, Xu J, Lin D, et al. A Case Series of children with 2019 novel coronavirus infection: clinical and epidemiological features. Clin Infect Dis 2020.
3.         Liu W, Zhang Q, Chen J, et al. Detection of Covid-19 in Children in Early January 2020 in Wuhan, China. N Engl J Med 2020; 382:1370.
4.         Qiu H, Wu J, Hong L, et al. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis 2020.

852:  Pediatric multisystem inflammatory syndrome associated with COVID-19 pandemic : Shares clinical features with Kawasaki disease (KD), KD shock syndrome, and toxic shock syndrome. Clinical features include persistent fever, gastrointestinal symptoms, hypotension, myocarditis, and elevated inflammatory markers (CRP, ferritin, D-dimers). 

853: Clinical features of COVID-19 in children: As of early April, children accounted for 1.7 percent of nearly 150,000 laboratory-confirmed cases of COVID-19 in the United States [1]. Among the few children with complete clinical data, the median age was 11 years (range 0 to 17 years); about 90 percent of cases were associated with household or community exposure. Fewer children than adults reported symptoms. Fever and cough were the most common symptoms in children. Infants <12 months and children with underlying medical conditions (eg, chronic pulmonary disease including asthma, cardiovascular disease, immunosuppression) were at increased risk for severe illness and should be monitored closely for progression of symptoms.

Reference: Weiss SR, Navas-Martin S. Coronavirus pathogenesis and the emerging pathogen severe acute respiratory syndrome coronavirus. Microbiol Mol Biol Rev 2005; 69:635.

854:   Children of all ages can get COVID-19, although they appear to be affected less frequently than adults.

855: COVID-19 in children is usually mild. The most common symptoms in children are fever and cough. Other symptoms include sore throat, fatigue, rhinorrhea/nasal congestion, diarrhea, and vomiting. Additional symptoms that have been reported in adults include chills or shaking chills, myalgia, headache, and new loss of taste or smell. Laboratory findings are often normal but may include leukopenia, lymphocytopenia, and elevated procalcitonin or C-reactive protein.

855:  Children with COVID-19 and severe or critical lower respiratory tract disease generally require hospital admission. Severe disease is defined by a new requirement for supplemental oxygen or increased requirement from baseline without new or increased need for ventilatory support (noninvasive or invasive). Critical disease is defined by new or increased need for noninvasive or invasive mechanical ventilation, sepsis, multiorgan failure, or rapidly worsening clinical trajectory.

856: Supportive care (eg, respiratory support, fluid and electrolyte support, monitoring for cytokine release syndrome) is the mainstay of therapy for children with severe or critical COVID-19.

857: Recommendations from the multicenter initial guidance on the use of antiviral agents for children with COVID-19 and other experts that antiviral therapy for COVID-19 should occur in the context of a clinical trial.

858: Decisions regarding antiviral therapy should be individualized according to disease severity, clinical trajectory, and underlying conditions that may increase the risk for progression. When a decision is made to use antiviral therapy, prefer remdesivir to other agents. Hydroxychloroquine (without azithromycin) is an alternative for children who are not candidates for remdesivir or if remdesivir is unavailable.

859: Children with documented or suspected COVID-19 and mild symptoms (eg, fever, cough, pharyngitis, other respiratory symptoms) generally should be managed at home unless they have a chronic condition that increases their risk of severe disease. Management is focused on prevention of transmission to others (ie, isolation), monitoring for clinical deterioration (eg, difficulty breathing, cyanosis, symptoms of shock), and supportive care.

860: Symptomatic care for COVID-19 in the outpatient setting is similar to that for other upper respiratory or gastrointestinal clinical syndromes.

861: Prevention of transmission focuses on hygiene and social distancing.

862: Hand sanitizer safety: Although washing hands with soap and water, when available is preferred for hand hygiene, alcohol–based hand sanitizer is safe for use in children. However, because ingestion of even a small amount of liquid hand sanitizer can cause alcohol poisoning in children (including hypoglycemia), children younger than six years should be supervised when using alcohol-based hand sanitizers, and alcohol-based hand sanitizers should be kept out of the reach and sight of children.

863:  Should play dates and playgrounds be avoided? — Given the possibility of transmission from asymptomatic individuals (or presymptomatic individuals within the incubation period) CDC recommends that children not have play dates with children from other households and that when playing outside, they remain ≥6 feet from people from other households

864: Use of cloth face masks — The CDC recommends that individuals ≥2 years of age wear a cloth face covering (eg, homemade masks or bandanas) when they are in public settings where social distancing may be difficult to achieve (eg, grocery stores, clinician offices), especially in areas with substantial community transmission. Cloth masks are not recommended for children <2 years of age because of concerns about suffocation.

865: Hygiene and social distancing

Having friends or family members bring necessary items to the home (to be retrieved outside)

Having the child (and other sick family members) wear a mask if leaving the home cannot be avoided. At the time of discharge, if supplies allow, providing patients with a pair of gloves and several masks may help to prevent transmission to household contacts. In addition, for patients without access to private transportation, arranging medical transportation, if possible, is preferable to the use of public transportation or ride-sharing services to minimize exposure to the public.

As much as possible, keeping ill family members ≥6 feet away from other people, especially family members who are ≥65 years of age or have serious medical conditions
If such separation is not possible, have the ill family member wear a facemask when they are in the same room or vehicle as other people.

Keeping ill family members separated from pets in the household

Having family members who have fever or cough sleep in separate rooms and use separate bathrooms

Avoiding sharing items (eg, pillows, blankets, utensils, cups)

866: The age distribution of cases in the United States was as follows

<1 year – 15 percent

1 to 4 years – 11 percent

5 to 9 years – 15 percent

10 to 14 years – 27 percent

15 to 17 years – 32 percent

Although infants <1 year of age accounted for 15 percent of confirmed cases, the proportion of all cases that have occurred in infants (0.27 percent) is less than the proportion of the United States population that is <1 year of age

MMWR Morb Mortal Wkly Rep. 2020;69(14):422.

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