COVID 19 in Children

Normally is all viral outbreaks the extremes of age are more vulnerable. But the COVID-19 pandemic is proving otherwise. The mortality rate is higher in the age group > 60 years and with co morbidities. But few cases have been reported in children. Data from paediatric cases of COVID-19 show milder symptoms among children compared with adults. Many theories have been postulated.

1. Lesser number of ACE2 receptors in lungs.
2. Co-infection with other Respiratory pathogens. Example – influenza, RSV, Mycoplasma etc.

The studies from CHINA show 94% having asymptomatic mild or moderate disease, 5% having serious disease and <1% having critical disease. Very few cases if deaths have been reported in children in the present pandemic of COVID-19 has been documented but vertical transmission has not been proved. Rather contact transmission from mother is the supposed route.

The incubation period for COVID-19 is 14 days with a median time of 4-5 days from exposure to symptoms onset.

Signs & symptoms:– Fever, cough, fatigue, anorexia, shortness of breath.

Atypical presentation:-Headache, rhino rhea, diarrhoea in <10% of children.

Illness Severity:–

Mild/moderate pneumonia 81% .

Severe :- (Dyspnoea, hypoxia or >50% lung involvement in imaging)—14%

Critical (resp. Failure, shode mod) —-5%

Case fatality ratio was higher in children with co-morbidities.

However children are an important link in the transmission chain of SARS-COV2 virus as viral RNA was detected in respiratory specimens up to 22 days, after symptoms began and in stools up to 30 days after symptoms began. Clinical recovery has been correlated with detection of IgG and Ig4 antibodies which signal the development of immunity.

Diagnostic test:–  RT-PCR from Naso pharynx , or pharynx, trachea, BAL samples.

Lab investigations:-  LDH, CRP, Lymphopenia, Ferritin, D-DIMER

Chest X-ray :- Patchy infiltrate consistent with viral pneumonia. Topically demonstrate bilateral air space consolidation.

Treatment:- Rest, supportive care, adequate water and nutrition intake, Paracetamol (10-15 mg/kg dose)

Important FAQS:-

1. For COVID (+)ve mother breast feeding is allowed.
2. Vaccination: – it possible can be given, maintaining safe practice. However rescheduling of vaccination can be done in view of the lockdown.