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No Remdesivir, Limit CT Scan: Govt’s COVID Treatment SOPs for Kids

Should all kids infected with COVID-19 wear masks? What is the treatment SOP in moderate cases? Read on.

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Amid concerns that the possible third wave of COVID-19 in India could affect children below the age of 18, the Union Ministry for Health and Family Welfare (MoHFW) on Wednesday, 9 June, released a set of guidelines for treatment.

However, experts have maintained that it is unclear whether the third wave will only affect children.

In a detailed document titled 'Comprehensive Guidelines for Management of COVID-19 in Children', the Ministry said that the antiviral drug Remdesivir is not recommended for children, and that doctors should limit the use of CT scan and steroids.

Here’s a breakdown of what the guidelines say, in order to treat children infected by COVID-19.

My child has tested positive for COVID-19 but is asymptomatic. What should I do?

  • Infants and younger children are to stay under immediate care of parents/guardians.
  • No specific medication required for COVID-19 infection.
  • Continue medications for other conditions, if any.
  • Promote COVID-appropriate behaviour – wearing masks, maintaining strict hand hygiene, and adhering to physical distancing rules.
  • Fluids and feeds: Ensure intake of oral fluids to maintain hydration and give a nutritious diet.
  • Do not self-medicate. Consult a physician.

Should I give the child Zinc or Vitamin C tablets?

Not necessarily. The Health Ministry does not recommend any medication other than monitoring of symptoms in asymptomatic and mildly symptomatic children.

What about Remdisivir?

Remdesivir (an emergency use authorisation drug) is NOT recommended in children. There is lack of sufficient safety and efficacy data with respect to Remdesivir in children below 18 years of age, the Health Ministry has said.

Should all children infected with COVID-19 wear masks?

  • Children aged 5 years and under should not be required to wear masks.
  • Those aged 6-11 years may wear a mask depending on the ability of the child to use it safely and appropriately under direct supervision of parents/guardians.
  • Children aged 12 years and above should wear a mask under the same conditions as adults.
  • Ensure hands are cleaned with soap and water, or an alcohol-based hand rub, while handling masks.
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What are the SOPs if the child is mildly symptomatic?

  • Steroids are harmful in asymptomatic and mild cases of infection – avoid them.
  • Antimicrobials are not recommended for therapy or prophylaxis.
  • Rational use of HRCT imaging has been recommended.
  • For mild infection, a paracetamol 10-15mg/kg/dose can be given every 4 to 6 hours for fever and throat soothing agents.
  • Warm saline gargles in older children and adolescents have been recommended for cough.

Does the child need to be hospitalised if they have moderate symptoms?

No, the child can be monitored in home isolation.

Who can be administered steroids?

  • Steroids are not indicated and are harmful in asymptomatic and mild cases of COVID-19.
  • Indicated only in hospitalised, moderately severe, and critically ill COVID-19 cases under strict supervision.
  • Steroids should be used at the right time, in right doses, and for the right duration.
  • Self-medication of steroids is harmful and must be avoided.

What does the government recommend for those with moderate infection?

  • Initiate immediate oxygen therapy.
  • Maintain fluid and electrolyte balance to encourage oral fluids (breastfeeding in infants).
  • Initiate intravenous fluid therapy if oral intake is poor.
  • Anticoagulants may also be indicated.
  • For fever (temperature >38°C or 100.4°F): Paracetamol 10-15mg/kg/dose; may be repeated every four to six hours.
  • Antimicrobials to be administered if there is evidence/strong suspicion of superadded bacterial infection.
  • Supportive care for co-morbid conditions, if any.
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Who should get a CT scan?

Suspected or confirmed cases of moderate COVID-19 who continue to deteriorate clinically even after initiation of appropriate therapy, especially with high risk of invasive fungal infection. In view of the above, treating pediatricians should exercise caution while advising HRCT imaging of chest, the guidelines say.

When can kids be vaccinated in India?

There is no update on this yet. Watch out this space for more information.

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