Masks not needed for children below 5 years, says health ministry

Guidelines based on their ability to handle masks safety; it does not mean they are not at risk of Covid infection

Amid fears over possible vulnerability of children if there is a third Covid wave, the government has said that children aged five or less are not required to wear a mask; and those aged between 6 and 11 should use a mask under the supervision of their parents.
 
The guidelines issued by the Directorate General of Health Services (DGHS) also advise against the use of remdesivir in children below 18 years of age due to lack of sufficient safety and efficacy data.
 
For asymptomatic and mild infections among children, no test or any specific medication has been recommended. For such cases, DGHS has, however, advised teleconsultation with a doctor, besides recommending nutritious diet and Covid-appropriate behaviour.
 
Doctors say these guidelines are meant for both the public and medical fraternity, and that it is important to understand the basics of wearing masks and hygiene. “Considering it may be impossible for children below five to adhere to these basics, it can lead to higher chances of infection. That’s why DGHS has said that kids this young should not wear a mask. It does not mean that they are not at risk,” says Gauri Agarwal, director of Delhi-based Yashoda hospitals.
 
Doctors also say that since children below five would not be wearing masks, their guard­ians have to take additional care and precautions. DGHS’s advice is in keeping with the World Health Organization guidelines (see box).

 
In the second wave, a larger number of chil­d­ren have got infected, and many have complained of post-Covid symptoms, too. Experts say this could be because of a larger number of overall infections.
 
The government and virolo­g­ists have said there is no data or evidence yet to indicate that the third wave would impact children more. “Those who have supported this theory say that because children have been protected so far. They could have more infections proportionally in the next wave. There is no evidence yet to support this argument,” Randeep Guleria, director, All India Institute of Medical Sciences, Delhi, said recently.
 
The government is, meanwhile, conducting an audit of paediatric infrastructure in the country to ramp up facilities for the worst-case scenario.
 
In its guidelines, DGHS has also said that the use of steroids and anticoagulants in children is harmful and should only be considered under strict supervision in hospitalised moderately severe and critically ill Covid-19 cases.
 
“We were already following these guidelines,” says Sisir Paul, clinical director and head of paediatrics, Madhukar Rain­bow Children’s hospital in Delhi. “Most children need supportive care not treatment. There is practically no role of antivirals in treating children.”
 
DGHS has also advised pediatricians to exercise caution while advising high-resolution CT (HRCT) ima­g­ing of the chest. In an earlier guideline, too, the health servi­ces body had said that the radiation exposure due to repeated HRCT imaging may be associated with risk of cancer later. Nearly two-thirds of persons with asymptomatic Covid-19 have abnormalities on HRCT chest imaging, which are not assignable to a particular cause.
 
For acute respiratory distress syndrome in children, DGHS has prescribed high-flow nasal oxygen, non-invasive ventilation in mild cases and lung protective mechanical ventilation in moderate to severe infections.
 
The guidelines also talk about the multisystem inflammatory syndrome in children, which usually occurs after 2–4 weeks of recovery from acute Covid-19, with patients getting continuing fever, hypotension, shock or acute gastrointestinal problems. Children in such cases would require ICU treatment of cardiac dysfunction, shock, coronary involvement and multi-organ dysfunction.
 
DGHS has also said that antimicrobials have no role in prevention or treatment of uncomplicated Covid-19 infection.