Protocol for Management of COVID-19 in Children

 What is the Protocol for 

Management of COVID-19 
in Children?

Mild illness

Common Symptoms 

Sore throat, rhinorrhea, cough with no breathing difficulty, & gastrointestinal symptoms (in some cases)

The child can be managed at home with home isolation & symptomatic treatment Children with underlying co-morbid conditions may also be managed at home if there is easy access to health facilities in case of any deterioration.

For recommending home isolation, the feasibility of the same would be assessed.

What to do?

> For Fever: Paracetamol 10-15 mg/kg/dose; may repeat every 4-6 hours.

> For Cough: Throat soothing agents like warm saline gargles- in older children and adolescents.

> Fluids & feeds: Ensure oral fluids to maintain hydration and a nutritious diet.

> Antibiotics: Not indicated 

There should be regular monitoring at home & communication to doctors or health care workers. Report if worsening of danger signs.

Moderate illness

Common Symptoms

> Rapid respiration as follows- 

1. below 2 months: respiratory rate >60/min, 
2. 2-12 months: respiratory rate >50/min,
3. 1-5 yrs: respiratory rate >40/min,
4. above 5 yrs: respiratory rate >30/min.

> Spo2 > 90%;

> May have pneumonia with no signs of severe pneumonia/illness

No lab tests are required routinely unless indicated by associated co-morbid conditions.

What to do?

> Admit in Dedicated Covid Health Centre or Secondary level Healthcare Facility and monitor for clinical progress.

> Maintain fluid and electrolyte balance.

> For Fever: Paracetamol 10-15 mg/kg/dose; may repeat every 4-6 hours. (temperature >38°C, i.e. 100.4°F)

> Amoxycillin if suspicion of bacterial infection.

> If SpO2<94%, start oxygen. Add steroids only if very rapid progression.

Severe illness

Common Symptoms

Severe pneumonia, ARDS Sepsis, Septic Shock, MODS 

Pneumonia with any of these:

> Cyanosis

> SpO2 <90%

> Increased respiratory efforts (grunting, severe retraction)

> Lethargy, somnolence, seizure 

Investigations: Complete blood counts, liver and renal function tests, Chest X-ray.

What to do?

Admit in Dedicated Covid Hospital/Secondary/ Tertiary level healthcare facility & should be assessed for: thrombosis, hemophagocytic lymphohistiocytosis (HLH), and organ failure.

> Steroids+ Remdesivir: Dexamethasone 0.15 mg/kg per dose (max. 6 mg) twice a day for 5-14 days (duration depending on clinical response)

is preferred. An equivalent dose of methylprednisolone/prednisolone may be used.

There is no trial data in children for Remdesivir. Its use is to be restricted to severe cases presenting within 72 hrs of the onset of symptoms

provided liver & kidney function parameters are normal.

> Empiric antimicrobials

> Oxygen therapy: nasal prong, face mask, HENC, and NIV

> SpO2 target>94% during resuscitation (once stable>90%)

> Consider awake prone positioning (in older children)

> Restrictive fluid therapy

> Organ support, example-Renal Replacement Therapy.

Management of Acute Respiratory Distress Syndrome (ARDS):

Mild ARDS: HENO/NIV trial

Severe ARDS: Mechanical ventilation- Low tidal volume (6 ml/kg), high PEEP, cuffed endotracheal tube; Fluid restriction; & Sedation

If poor response- may try prone ventilation, HFOV.

Management of Shock:

In case of Septic shock/Myocardial dysfunction.

Crystalloid bolus administration: 10-20 ml/kg over 30-60 min, fast if hypotensive; careful administration & avoid if myocardial dysfunction suspected.

Early inotropic support with monitor for fluid overload.