No to Remdesivir
The guidelines issued by the Directorate General of Health Services (DGHS) under the health ministry doesn’t recommend the use of Remdesivir (an emergency use authorization drug) among children.
"There is a lack of sufficient safety and efficacy data with respect to Remdesivir in children below 18 years of age," the guidelines said.
Rational use of CT Scan
High-resolution CT (HRCT) scan of the chest provides better visualisation of the extent and nature of the infection. Therefore, the guidelines suggest CT scan only for critical cases especially with high risk of invasive fungal infection.
“Treating pediatricians should exercise caution while advising HRCT imaging of the chest,” the guidelines said.
6-Minute Walk Test
Children above 12 years are suggested to take a six-minute walk test under supervision of parents/guardians. The test is recommended to assess cardio-pulmonary exercise tolerance, and is used to unmask hypoxia.
Attach pulse oximeter to his/her finger and ask the child to walk in the confines of their room for 6 minutes continuously
Positive test: any drop in saturation < 94%, or absolute drop of more than 3–5% or feeling unwell (lightheaded, short of breath) while performing the test or at end of 6 minutes
Children with positive 6-minute walk test may progress to become hypoxic and early admission to hospital is recommended (for observation and oxygen supplementation)
- The test can be repeated every 6 to 8 hours of monitoring in home setting; avoid the test in patients with uncontrolled asthma
Guide for asymptomatic and mild cases
Use of steroids is prohibited for asymptomatic and mild Covid cases.
As of now, no specific medication is recommended for asymptomatic children. However, it is advised to promote Covid-appropriate behaviour (mask, strict hand hygiene, physical distancing) and nutritious diet among them.
In case of mild infection, 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.
Guide for moderate and severe infection
In case of moderate infection, initiating immediate oxygen therapy is recommended.
"Corticosteroids are not required in all children with moderate illness; they may be administered in rapidly progressive disease and anticoagulants may also be indicated," the guidelines said.
In case of severe infection, if Acute Respiratory Distress Syndrome (ARDS) develops, necessary management is to be initiated.
"In case shock develops, necessary management should be initiated. Antimicrobials to be administered if there is evidence/strong suspicion of superadded bacterial infection. May need organ support in case of organ dysfunction, e.g. renal replacement therapy," the guidelines said.
Who should and shouldn't wear the mask?
Children aged 5 and below may not wear masks, whereas those between 6-11 years may wear under parental supervision.
However, those aged 12 and above should wear a mask under the same conditions as adults.