Q1: Is second wave more serious than first wave last year? Why?
Yes, the number of people infected is much higher; proportionately, the total number of children infected has also increased. This is probably due to mutated (changed) virus in a setting where population was casual about precautions to be taken (social distancing, masking, and hand hygiene). It seems to spread very rapidly and we see whole family being affected in short time.
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Q2: How can I prevent coronavirus infection/COVID in my child?
There are no medicines or pills proven to prevent coronavirus infection in any person. Only recently, few vaccines are available, which mainly protect against disease. At present, the vaccines are approved for use in adults only. From 1st May 2021, it will be rolled in for adults above 18 years of age.
- Only strict precautions of handwashing, proper mask, and social distancing can prevent it.
- Avoid attending public functions, avoid social gathering, and avoid group play are only ways we can prevent coronavirus disease in children and household.
Q3: Can we know whether fever in child is COVID or otherwise?
No. For common man and even for doctor, it is difficult to know the difference, hence in every fever/cough, coronavirus disease (COVID) should be considered as a possibility especially if a family member is suffering/recently suffered from COVID.
Q4: What are the common features of corona infection in children?
Cold, mild cough, fever, and body pain are the common symptoms of corona infection. In the second wave, it has been noted that other symptoms such as pain in abdomen, loose motions, and vomiting are also present in children.
Q5: When do we test the child for coronavirus disease?
- Test if family members are positive.
- Test if child is symptomatic.
- Test if fever continues beyond 3 days.
Q6 : Which test we should do?
- Reverse transcription polymerase chain reaction (RT-PCR) for coronavirus disease 2019 (COVID-19) and PCR-based nucleic acid amplification test (NAAT) are the preferred tests.
- Rapid antigen test (RAT) is second option; a positive is confirmatory. However, a negative test result needs confirmation by PCR.
- Chest CT scan is not a routine test for COVID and should only be done when recommended by your doctor.
Q7: What may be the different situations in the family? How to manage them?
- Mother and child both positive: Let child be with mother unless mother is too sick and hospitalized. In infant, continue breastfeeding as far as possible and feasible.
- Mother positive and child negative: Mother can take care of child if no better option available for child and mother is not too sick/hospitalized. Mother has to follow best possible sanitization, proper mask, and social distancing (SMS) practices.
- Child positive parents negative: Still parents can take care of the child in or out of the hospital; however, in such scenarios, the parents should use proper mask/personal protective equipment (PPE) for their protection.
Avoid leaving children with COVID suspect status with grandparents. Elderly people are at very high risk of serious disease and unless child’s status is definitely corona negative, child should not be left with grandparents.
Q8: Is mask necessary to be worn for children?
Yes, masks need to be worn by all children above the age of 2 years [Indian Academy of Pediatrics (IAP) recommendation]. Children <2 years need not use the mask due to safety reasons.
Q9: Can children become serious with corona infection?
- A small proportion of children may develop serious disease, though much less commonly than adults and elderly.
- More than 60–70% of infected children are asymptomatic.
- Of the remaining symptomatic about 1–2% need ICU treatment. This number is far less than adults.
Q10: Which children are at risk of serious disease?
Those children with pre-existing major disease… heart, kidney, liver disease, etc., or children with low immunity such as cancers, immunity diseases from birth, etc., obese children are at high risk of serious disease.
Q11: How to take advice about care of my COVID positive child?
- It is good to take teleconsultation for your child from your doctor rather than taking him to clinic. This will prevent spread to others and also reduce pain of traveling and waiting for your child.
- You may access information from authentic institutional websites such as Indian Academy of Pediatrics (IAP) website org, WHO, AIIMS, PGI, etc.
- If any seriousness perceived, child should be taken to doctor.
Q12: What is home remedy that I can use for my child?
- Record temperature and oxygen saturation with a pulse oximeter if available at home, every 6 hours.
- If fever is >100°F, give paracetamol 10–15 mg/kg/dose.
- Give plenty of liquids.
- Give soft and light diet.
- Maintain hygiene.
- One may give vitamin C, zinc to boost overall health and immunity.
Q13: What about medicines such as azithromycin, ivermectin, doxycycline, hydroxychloroquine (HCQ), ayurvedic, homeopathic, etc.?
There is no scientific evidence to use these drugs for treatment of COVID in children. Few of these drugs are used when adults are hospitalized with serious disease. There is no role of these drugs in home treatment.
Q14: When do I consider my child serious?
This is very important to know and following five symptoms or signs need to be monitored at home.
- High fever lasting beyond 4 or 5 days
- Decreased oral intake by child
- Child becoming lethargic
- Increasing respiratory rate
- Oxygen saturation dropping below 95% at home (ensure proper recording with good displayed waves).
In such situation, you should rush your child to facility with COVID care.
Q15: My child is having chronic disease. Do I continue his steroid treatment/other treatment?
Most of the treatment of pre-existing diseases need not be altered unless your child contracts severe disease. In such children preventive care with SMS as mentioned above and some extra precautions at home to avoid infection is important.
If such child contracts infection, it is advisable to consult your doctor for specific advice about ongoing medications
Q16: Doctor, we heard about steroids, favipiravir, remdesivir, tocilizumab, etc., when do we use them?
These drugs have limited utility in childhood COVID patients. Some are used only in serious patients usually in ICU. So far, they are almost never needed in children with COVID.
Q17: My child has tested positive 1 week ago. He is due for his vaccine after 2 weeks. How do I go about?
- Routine immunization can be continued 2 weeks after child is asymptomatic (of COVID infection).
- If child needs some higher medications such as high-dose steroids or tocilizumab which suppresses the components of immunity of patient, immunization needs to be deferred for 3 months after the medication.
Q18: The mother is breastfeeding her baby, can she take COVID vaccine?
As per the present guidelines, the vaccine is not being given to pregnant and breastfeeding ladies.