(With inputs from Dr Monica Vasudev)

851: Children — Symptomatic infection in children seems to be relatively uncommon. When it occurs, it is usually mild; however, there have been reports of severe cases.

References

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 encompass persistent fever, gastrointestinal symptoms, hypotension, myocarditis, and raised levels of inflammatory markers (CRP, ferritin, D-dimers). 

853: Clinical features of COVID-19 in children: As of early April, children constituted 1.7% of nearly 150,000 laboratory-confirmed cases of COVID-19 in the United States. Among the children for whom complete clinical data was available, the median age was 11 years (range 0 to 17 years). Nearly 90% of the cases were associated with household or community exposure. Fewer children than adults reported symptoms. The most common symptoms in children were fever and cough. Infants <12 months and children with underlying medical conditions (eg, chronic pulmonary disease including asthma, cardiovascular disease, immunosuppression) had a heightened risk for severe illness. These children should be closely monitored for progression of symptoms.

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

855: COVID-19 in children is usually mild. The most common symptoms inlude fever and cough. Other symptoms include sore throat, fatigue, rhinorrhea/nasal congestion, diarrhea, and vomiting. Other 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 require hospitalization. Severe disease refers to a new requirement for supplemental oxygen or increased requirement from baseline without new or increased need for ventilatory support (noninvasive or invasive). Critical disease refers to new or increased need for noninvasive or invasive mechanical ventilation, sepsis, multiorgan failure, or rapidly worsening clinical trajectory.

856: Supportive care including respiratory support, fluid and electrolyte support, monitoring for cytokine release syndrome, is the principal 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 state that antiviral therapy should occur in the context of a clinical trial.

858: Decisions regarding antiviral therapy must be individualized based on disease severity, clinical trajectory, and underlying conditions that may heighten the risk for progression. When it is decided to use antiviral therapy, remdesivir should be preferred 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 should be managed at home unless there is a chronic condition that tends to augment 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 in the outpatient setting is on the same lines as care for other upper respiratory or gastrointestinal clinical syndromes.

861: Prevention of transmission is focused on hygiene and social distancing.

862: Hand sanitizer safety: Washing hands with soap and water, if available, is preferred. Alcohol-based hand sanitizer is also safe for use in children. However, ingestion of even a small amount of liquid hand sanitizer can cause alcohol poisoning in children (including hypoglycemia). Therefore, children below six years of age should use alcohol-based hand sanitizers under adult supervision, and alcohol-based hand sanitizers should be kept out of the reach and sight of children.

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

864: Use of cloth face masks — The CDC recommends that individuals ≥2 years of age should wear a cloth face covering, such as a homemade mask or bandana, while 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 owing to concerns of suffocation.

865: Hygiene and social distancing

Friends or family members can bring necessary items to the home (to be retrieved outside)

The child (and other sick family members) should wear a mask if leaving the home is absolutely necessary. At the time of discharge, if supplies allow, provide patients with a pair of gloves and several masks to help prevent transmission to household contacts. For patients who don’t have access to private transportation, arrange medical transportation, if possible, to minimize exposure to the public.

Try to keep ill family members ≥6 feet away from other people, especially family members who are ≥65 years of age or have serious medical conditions.

If it is not possible, have the ill family member wear a facemask when they are in the same room or vehicle as other people.

Keep ill family members separated from pets in the household.

Family members who have fever or cough should sleep in separate rooms and use separate bathrooms.

Avoid sharing items such as pillows, blankets, utensils, cups, etc.

[Source: Uptodate]

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 constituted 15 percent of confirmed cases, the proportion of all cases in infants (0.27 percent) is less than the proportion of the United States population that is <1 year of age.

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

Dr KK Aggarwal

President CMAAO, HCFI, Past National President IMA, Chief Editor Medtalks