In spite of the overwhelmingly high number of COVID-19 infections being reported during the second wave of the pandemic in India, the number of children (below the age of 18 years) being infected are far less than the number of adults.
The good news is that most infected children are asymptomatic or mildly symptomatic, and only a small proportion of symptomatic children may need hospitalisation.
Children who are asymptomatic are a cause of concern for the elderly and the immunocompromised in the family, hence, adequate care should be taken to ensure that children do not contract the infection.
Symptoms of COVID-19 in Children
Children who have COVID-19 infection can be asymptomatic or can have some symptoms.
Asymptomatic cases (infection confirmed on laboratory testing when family members are infected) have no symptoms and oxygen saturation at room air of more than 94%.
All asymptomatic children and children with mild severity of COVID-19 infection can be managed with home isolation.
Children with underlying comorbidities such as congenital heart disease (heart disease present from birth), chronic lung diseases, chronic organ dysfunction, or obesity (excessive body fat) may also be managed at home, if they have symptoms of mild severity and have been thoroughly examined by the doctor.
Management at Home
Home isolation for children with COVID-19 is permitted only after the following criteria are fulfilled on investigation:
Have the requisite facility for home isolation [a separate room (with an attached bathroom) that is well-lit].
Have a dedicated adult caregiver (preferably a parent) who is available to provide 24x7 care and can monitor the child’s health status and inform a doctor/hospital about the child’s condition regularly.
Caregivers should follow all protocols of home quarantine.
Do’s And Don’ts For Children
All parents/caregivers must keep the following tips and guidelines in mind for the care of COVID-19 infected children at home:
1. Isolate the child in a separate room. The child must be isolated in a separate room, physically away from other people at home, especially the elderly and those with comorbid conditions such as diabetes, hypertension and cardiovascular disease.
A young child (3 to 10 years of age) will not understand the reason for isolation and may refuse to stay away all by himself/herself in a room. He/she should be counseled by the parents about the seriousness of the infection and the need for isolation.
The child’s room should be equipped with toys, games, television and things that keep the child engaged, to make isolation easy on the child.
2. Encourage the child to wear a triple-layered medical mask. Similar to adults, the child should be encouraged to wear a 3-ply (layered) medical mask at all times, especially when the caregiver is in the same room.
Surgical masks should not be used for more than 6 to 8 hours. All used masks should be disinfected with 1% sodium hypochlorite before discarding them.
When the caregiver has to enter the room, the caregiver and the child may consider wearing N95 masks for additional protection.
3. Enforce hand and respiratory hygiene practices. The child should wash his/her hands frequently with soap and water for at least 40 seconds or clean hands with an alcohol-based (minimum 70% alcohol) sanitizer.
Teach the child the importance of respiratory hygiene as well. The child must cover his/her nose and mouth while coughing and sneezing. The used tissues or paper towels have to be discarded immediately.
4. Give lots of fluids and nutritious food. The child must take as much rest as possible and drink lots of fluids to stay hydrated. The child should also be provided with light, freshly-prepared home-cooked meals regularly, in their room.
5. Monitor the child’s vitals regularly. A monitoring chart should be maintained by the caregiver, where the following vitals are recorded accurately:
Respiratory rate (the number of breaths taken per minute) checked if the child is young, and when the child is not crying
Blood oxygen saturation (the amount of oxygen present in the blood at room air)
Pulse rate (the rate at which the heart pumps out blood in 1 minute)
Activity level should also be noted, especially for young children. The caregiver should also look for symptoms such as chest in-drawing, bluish discolouration of the body, and cold extremities. Any deterioration of symptoms should be carefully noted and shared with the doctor.
Additionally, the urine output and fluid intake of the child should be monitored to ensure the child is not dehydrated. If the caregiver notices that urine output is higher than fluid intake, they will have to make the child drink more water, fruit juices and electrolyte replacing drinks.
6. Treat mild symptoms as per the doctor’s recommendation. Symptoms of mild illness, such as fever, cough, and running nose, should be treated only after consulting the child’s peadiatrician or treating medical officer.
Medications for any other ongoing illnesses for the child, if any, should be continued, after consulting the concerned doctor.
7. Keep the child’s personal used items separate. Items such as utensils, bedding, towels and hygiene products etc., should be washed separately and not shared with other people in the household to avoid the spread of infection.
8. Disinfect frequently touched surfaces in the child’s room. Surfaces such as tabletops, doorknobs, handles, etc., should be wiped and disinfected regularly with 1% sodium hypochlorite solution.
9. Watch out for signs of deterioration. The child should be carefully monitored at all times, and the child should be immediately taken to a admitted in a hospital or a dedicated COVID treatment centre if there are worsening of symptoms, such as:
Difficulty in breathing
Cough which does not reduce even after 5 days
Dip in oxygen saturation levels
A child under homecare can end the isolation, without any testing required, after at least 10 days have passed from the onset of symptoms (or from the date of sampling for asymptomatic children) or if the child has had no fever for 3 days, whichever is earlier.
Watch out for any worsening symptoms or other concerning signs in the child and seek medical help immediately. Following these isolation and care guidelines correctly, along with prescribed OTC (over-the-counter) medications, can help the child recover from COVID-19 and prevent the spreading of infection to others.
1. Mohfw.gov.in. 2021. [online] Available at: <https://www.mohfw.gov.in/pdf/RevisedguidelinesforHomeIsolationofmildasymptomaticCOVID19cases.pdf> [Accessed 5 May 2021].
2. Mohfw.gov.in. 2021. [online] Available at: <https://www.mohfw.gov.in/pdf/ProtocolforManagementofCovid19inthePaediatricAgeGroup.pdf> [Accessed 5 May 2021].
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