As the third Covid-19 wave is projected to impact children in a bigger way, the Government has issued guidelines for Covid-care management for kids. According to the guidelines, drugs such as ivermectin, hydroxychloroquine, favipiravir and antibiotics like doxycycline and azithromycin, which are prescribed for adult patients, should not be recommended for treating the minor.
The Union Health Ministry’s recommendations include augmenting existing Covid-care facilities to provide care to children with acute coronavirus infection.
“Similarly, issues of optimal treatment for multisystem inflammatory syndrome in children ( MIS-C ) need to be addressed by clinical trials, such as comparison of low dose with high doses steroids, comparison of steroids with IVIG and others,” it added.
Various States like Delhi, UP and Maharashtra on their own have already started taking measures — from ramping up paediatric beds to prioritising vaccination for parents of kids below 12 years.
Covid drugs used to treat adults not fit for kids: Govt guidelines
They are formulating children-specific protocol to set up oxygen plants and establishing more testing labs.
According to the Central guidelines, once vaccines are approved for children, those with comorbid conditions having more severe manifestations of Covid-19 and poorer outcomes should be a priority group for immunisation.
About the treatment of children, the guidelines said most drugs used in adults such as ivermectin, hydroxychloroquine, favipiravir and antibiotics such as doxycycline or azithromycin have not been tested on children for prevention or treatment of Covid infection among them. “Therefore, these are not recommended in children.”
Stating that there may be intermittent surges in the number of coronavirus cases, the guidelines said, “A combined effort from the private and public sector is needed to handle any surge (in cases) in the future after the withdrawal of the lockdown, school reopening or as a third wave over the next three to four months. The basic principles of equity and dignity of care should be followed.”
The guidelines said estimates for additional bed capacity for pediatric care may be calculated based on peak daily cases in different districts during the second wave of the Covid-19 infections.
From this, projections for pediatric cases and the number of admissions required can be derived, it said.
“It is desirable to augment the existing Covid-care facilities to provide care to children with acute Covid. This will need additional pediatric-specific equipment, infrastructure and pediatric formulations. “Also, an adequate number of trained manpower -- both doctors and nurses -- should be provided. The health authorities should initiate capacity building programmes for appropriate pediatric care. In standalone paediatric hospitals, separate arrangements, for example, separate beds for paediatric Covid care need to be set up,” the guidelines said.
It is desirable to designate specific areas in the Covid facilities for pediatric care and parents should be allowed to accompany the child there.
“For children with Multisystem Inflammatory Syndrome who test negative for acute Covid, care has to be provided by the existing pediatric facilities. These facilities also need augmentation, especially HDU and ICU services,” it said.
Noting that a majority of children have asymptomatic or mild illness and can be managed at home by parents, it said treatment for symptomatic patients include paracetamol for fever and monitoring conditions such as measuring respiratory rates, difficulty in respiration, oral intake and oxygen saturation.
“In a community setting, ASHA and MPW should be involved for management of children at home and also monitor to assess the need for referral and admission,” the guidelines said.
The document stressed on imparting training to community health workers for picking up the red flag signs. Also, all stakeholders, including the community, should be educated by information education communication.
“A few centres may be designated as regional centres of excellence for Covid care and research. These centres can provide leadership in clinical management and training. Telemedicine could be harnessed for reaching out to a large number of facilities,” it said.
The guidelines said that based on sero-surveillance reports, Covid-19 infection in children above 10 years of age occurs in a similar frequency to that of adults, even though among the confirmed cases less than 12 per cent are individuals less than 20 years of age.