Centre issues guidelines for Management of COVID-19 in Children; Read details here

Amid concerns over possible third wave of COVID-19, which is likely to target those aged below 18, the Union Health Ministry on Wednesday, June 9, has issued clinical guidelines for the management of coronavirus among children.

The guidelines issued by the Directorate General of Health Services (DGHS) under the health ministry mentioned:

• Remdesivir has not been recommended for kids. There is a lack of sufficient safety and efficacy data with respect to Remdesivir in children below 18 years of age.
  
  
• Rational use of High-resolution CT (HRCT) has been suggested for seeing the extent and nature of lung involvement in patients with COVID-19. “However, any additional information gained from HRCT scan of the chest often has little impact on treatment decisions, which are based almost entirely on clinical severity and physiological impairment. Therefore, treating physicians should be highly selective in ordering HRCT imaging of the chest in COVID-19 patients,” the guidelines said.
  
  
• The DGHS recommended steroids only in hospitalised moderately severe and critically ill COVID-19 cases under strict supervision. Steroids are harmful in asymptomatic and mild cases of infection, hence, should be used at the right time, in the right dose and for the right duration. Self-medication of steroids must be avoided.
  
  
• The guidelines also recommended a six-minute walk test for children above 12 years under the supervision of parents/guardians. Attach pulse oximeter to his/her finger and ask the child to walk in the confines of their room for six minutes continuously. Positive test: any drop in saturation < 94%, or absolute drop of more than 3–5% or feeling unwell (lightheaded, short of breath) while performing the test or at the end; Children with positive six-minute walk test may progress to become hypoxic and early admission to hospital is recommended (for observation and oxygen supplementation), it said.
  
  
• The guidelines also stated that children aged 5 years and under should not be required to wear masks while those aged 6-11 years may wear a mask depending on the ability of the child to use a mask safely and appropriately under the direct supervision of parents/guardians. Children aged 12 years and over should wear a mask.
  
  
• For asymptomatic infection among children, the guidelines recommended no specific medication and promoted COVID-appropriate behaviour (mask, strict hand hygiene, physical distancing) and suggested giving a nutritious diet.
  
  
• For mild infection patients, paracetamol 10-15mg/kg/dose may be given every 4-6 hours for fever and throat soothing agents and warm saline gargles in older children and adolescents have been recommended for cough.
  
  
• In case of moderate infection, the guidelines suggested initiating immediate oxygen therapy. Corticosteroids are not required in all children with moderate illness; they may be administered in rapidly progressive disease and anticoagulants may also be indicated.
  
  
• For severe COVID-19 among children, the guidelines said if Acute Respiratory Distress Syndrome (ARDS) develops, necessary management to be initiated. In case shock develops, necessary management should be initiated. Antimicrobials to be administered if there is evidence/strong suspicion of superadded bacterial infection. May need organ support in case of organ dysfunction, e.g. renal replacement therapy, it said.

Also Read: COVID-19 second wave witnesses higher hospitalization rate for children