The Central Government has issued comprehensive guidelines for the Covid-19 management among children below 18 years of age. Doses of Remdesivir has not been recommended for children, rather rational use of HRCT has been suggested.
As per the guidelines issued by the Directorate General of Health Services (DGHS) under the Health Ministry, steroids are suggested to be harmful in asymptomatic and mild cases of infection. The DGHS in the guidelines recommended the use of steroids only in those patients who are hospitalized, moderately severe and critically ill in Covid-19 cases under strict supervision.
It said, “Steroids should be used at the right time, in the right dose and for the right duration. Self-medication of steroids must be avoided.”
Regarding the use of Remedesivir, the guidelines from the centre said that Remedesivir is an emergency use authorization drug and is not recommended in children.
The guidelines further said, “There is lack of sufficient safety and efficacy data with respect to Remdesivir in children below 18 years of age.
On the use of CT scans, the guidelines suggested rational use of High-resolution CT (HRCT) for seeing the extent and nature of lung involvement in patients with Covid-19. “However, any additional information gained from HRCT scan of the chest often has little impact on treatment decisions, which are based almost entirely on clinical severity and physiological impairment.”
“Therefore, treating physicians should be highly selective in ordering HRCT imaging of the chest in COVID-19 patients,” stated the guidelines.
For asymptomatic and mild cases, the guidelines issued by the Central Government said that antimicrobials are not recommended for therapy or prophylaxis while for moderate and severe cases, antimicrobials should not be prescribed unless there is clinical suspicion of a superadded infection.
For asymptomatic infection among children, The guidelines recommended no specific medication and promoted Covid-appropriate behaviour (mask, strict hand hygiene, physical distancing) and suggested giving nutritious diet for asymptomatic infection among children.
For mild infection, the guidelines suggested that paracetamol 10-15mg/kg/dose may be given every 4-6 hours for fever and throat soothing agents, and warm saline gargles in older children and adolescents have been recommended for cough.
In the case of moderate infection, the guidelines suggest initiating immediate oxygen therapy from the nearest Covid Care Center.
The guidelines said, “Corticosteroids are not required in all children with moderate illness; they may be administered in rapidly progressive disease and anticoagulants may also be indicated.”
For severe Covid-19 among children, the guidelines said if Acute Respiratory Distress Syndrome (ARDS) develops in the patients, necessary management must be initiated.
It said, “In case shock develops, necessary management should be initiated. Anti-microbials to be administered if there is evidence/strong suspicion of superadded bacterial infection. Patients may need organ support in case of organ dysfunction, e.g. renal replacement therapy.”
The guidelines further recommended a six-minute walk test for children above 12 years under the supervision of parents or guardians.
“It is a simple clinical test to assess cardiopulmonary exercise tolerance and is use to unmask hypoxia. Attach a pulse oximeter to his/her finger and ask the child to walk in the confines of their room for six minutes continuously,” it said.