COVID-19 AND

CHILDREN

Mr. H.K.KUMAWAT
TCN, PMU, Udaipur
Coronavirus
• Corona viruses are RNA viruses with glycoprotein spikes that give them a crown like
appearance. Four species have been in circulation for a long time and cause mild
respiratory disease.
• They have a lot of genetic diversity and have jumped the species barrier leading to
severe respiratory disease (SARS virus in 2002-2003 and the MERS virus in 2012-2013).
• Human corona viruses were first identified in the mid-1960s.
• In December 2019, a novel coronavirus emerged in Wuhan City of Hubei Province; this
was later termed as SARS-CoV-2 or COVID-19.
• There are four main sub-groupings of corona viruses, known as alpha, beta, gamma,
and delta.

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 Spread of infection
-Spreads by droplets from infected people during sneezing & coughing. ⚫
-Large droplets that travel for 1-2 m. Settle on surfaces on which they remain alive
for hours or days.
-Infected person can also spread the infection even before the onset of symptoms.
Infection is acquired by either inhalation of infected droplets or touching surfaces/
fomites contaminated with the infected droplets and then touching the eyes, nose
and mouth.
-Incubation period varies from 2-14 days.
-The average number of people infected by one infected individual is between 2-3.
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COVID-19 in children
◈ Mostly middle aged (>30 years) and elderly.
◈ Symptomatic infection in children appears to be uncommon,
and when it occurs, it is usually mild.
◈ No significant gender difference in children .
◈ Most infected children recover one to two weeks after the
onset of symptoms.

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COVID-19 in children

◈ According to the recent report of the -WHO Joint Mission Expert

Group, the current domestic case data show that children under 18
years of age account for 2.4% of all reported cases, and no deaths
reported.

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Why COVID-19 is less affected in
children

- The time period of the outbreak, is the winter vacation time of

the university, middle school and kindergarden. It is a good time
to avoid the collective cluster disease by chance.
- Secondly, humoral and cellular immune development in children
is not fully developed.
- This may be one of the mechanisms that lead to the absence of
severe immune responses after viral infection 6
Why COVID-19 is less affected in
children
- As COVID-19 virus exploits the ACE2 receptors to gain entry
inside the cells, under expression, immaturity of ACE2 receptors
in children is another hypothesis in this regard.
- Recurrent exposure to viruses like respiratory syncytial virus in
winters can induce more immunoglobulin's levels against the new
virus infection compare to adults.
There is no direct evidence of vertical mother-to-child
transmission, but newborns can be infected through close contact. 7
 Clinical features
In Children In Adult
◈ Dry cough -Dry cough
◈ Dyspnoea or tachypnoea - Fatigue
◈ Pharyngeal congestion - Myalgias

◈ - Dyspnea
Sore throat
- Pneumonia severe manifestation of infection.
◈ Vomiting or diarrhoea
- Breathing difficulty developed after median of
◈ Fever (body temperature five days of illness.
>37°C) - Acute respiratory distress syndrome developed.
◈ Headache -Fever
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Investigations

 White Blood Cell Count- Leukopenia, leukocytosis, and lymphopenia have

been reported. However thrombocytopenia is considered as a poor prognostic
sign.

 Inflammatory Markers-Serum Procalcitonin Serum (procalcitonin is often

normal at the time of admission; however it increases in patients who require
ICU care.

CRP- CRP levels are raised.

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Conti….
◈ Some children have increased liver enzymes, lactate de-hydrogenase (LDH),
muscle enzymes, and myoglobin.

◈ Some critically ill patients have increased troponin, D-dimer and ferritineand the
number of peripheral blood lymphocytes have progressively reduced.

◈ Like adults, the children with severe and critical illness may be accompanied by
elevated levels of inflammatory factors such as interleukin (IL)-6, IL-4, IL-10.
Conti….
◈ Radiology- There is no abnormal finding in early stage.

◈ Chest –CT.
 Conti…
◈ SARS-COV-2 RNA is detected by real-time Reverse Transcription-Polymerase Chain
Reaction (rRT-PCR)

Rapid tests

◈ COVID-19 Rapid Test qualitatively detects IgG and IgM antibodies to SARS-COV-2.
Swab (For RT-PCR)
Oropharyngeal swab (e.g. throat swab):
◈ Tilt patient's head back 70 degrees.
◈ Rub swab over both tonsillar pillars and posterior oropharynx and avoid touching the tongue, teeth,
and gums.
◈ Place tip of the swab into sterile viral transport media tube and cut off the applicator stick.

Nasopharyngeal swab:
◈ Tilt patient's head back 70 degrees.
◈ Insert flexible swab through the nares parallel to the palate (not upwards) until resistance is
encountered or the distance is equivalent to that from the ear to the nostril of the patient.
◈ Gently, rub and roll the swab. Leave the swab in place for several seconds to absorb secretions
before removing.
◈ While sending swab see it is appropriately packed maintaining cold chain.
◈ Fill appropriate form and sent sample to center designated for your area .
Classification of Disease
Mild Disease
◈ Upper respiratory symptoms (eg, pharyngeal congestion, sore
throat, and fever) for a short duration or asymptomatic infection
◈ Positive RT-PCR test for SARS-COV-2
◈ No abnormal radiographic and septic presentation
Conti…
Moderate disease
◈ Mild pneumonia
◈ Symptoms such as fever, cough, fatigue, headache, and myalgia
◈ No complications and manifestations related to severe
conditions.
Conti…
Severe disease
◈ Mild or moderate clinical features, plus any manifestations that
suggestdisease progression:
◈ Rapid breath (260 breaths per min for 0-2 mths; 250 breaths per infants 2
mths to 11 months; 240 breaths per min for aged 1 yr to 5 years)
◈ Hypoxia (SpO2- <93%, PaO2/Fi02 <300)
◈ Lack of consciousness, depression, coma, convulsions
◈ Dehydration, difficulty feeding, gastrointestinal dysfunction etc…
Cont…
Critical illness
◈ Rapid disease progression, plus any other conditions
◈ Respiratory failure with need for mechanical ventilation
◈ Septic shock
◈ Organ failure that needs monitoring in the ICU
Management
◈ There is no specific antiviral treatment recommended for
COVID-19.
◈ Oxygen support
◈ Oxygen saturation to be maintained above 90%
◈ Conservative fluid management
◈ Give empirical antibiotics
◈ High dependency / ICU care when needed
Conti…
Pediatric (lopinavir/ritonavir combination):
Oral solution
◈ 14 days to 6 months old: based on lopinavir 16 mg/kg/dose PO 12hourly
orally
Oral tablet
◈ 15-25kg: LPV/r (200 mg/50 mg) per DOSE q12h PO
◈ 26-35 kg: LPV/r (300 mg/75 mg) per DOSE q12h PO
◈ >35 kg: LPV/r (400 mg/100 mg) per DOSE q12h PO
Conti…
Vitamin-C
◈ Administration of moderate dose of Vitamin-C could be
considered.
Anti bacterial therapy
◈ However antibiotics can be initiated to treat secondary bacterial
pneumonia.
Newborns and COVID-19
- In February a Chinese newborn was diagnosed with the new
coronavirus just 30 hours after birth.
- The baby's mother tested positive before she gave birth. It is
unclear how the disease was transmitted in the womb, or after
birth.⚫
- There was no evidence of vertical transmission of the infection
from mother to fetus/neonate.
- The virus was not detected in expressed breast milk.
Prevention

◈ The best way to prevent infection is to avoid being exposed to

this coronavirus. And….
◈ Hand hygiene. Wash hands often with soap and water for at
least 20 seconds; if water and soap are not available, use an
alcohol-based hand sanitizer.
◈ Keep hands off your face. Avoid touching the eyes, nose, and 
mouth with unwashed hands.
◈ Maintain social distancing. Avoid close contact with people at
least 3 feet (1 meter) who are sick, and stay at home when you
are sick and Avoiding going to social gathering.
Conti…
◈ Proper cough and sneeze etiquette. Cover your cough or
sneeze with a tissue, then throw the tissue in the trash. Covering
mouth with elbow while sneezing.
◈ Exercise. Yoga pranayam and exercise routinely
◈ Supportive care. People infected with COVID-19 should
receive supportive care to help relieve symptoms.
◈ Severe cases. For severe cases, treatment should include care to
support vital organ functions.
Nursing Management
◈ Monitor vital signs- Monitor the patient’s temperature; the
infection usually begins with a high temperature; monitor the
respiratory rate of the patient as shortness of breath is another
common symptom.
◈ Monitor O2 saturation- Monitor the patient’s O2 saturation
because respiratory compromise results in hypoxia.
◈ Maintain respiratory isolation- Keep tissues at the patient’s
bedside; dispose secretions properly; instruct the patient to cover
mouth when coughing or sneezing; use masks, and advise those
entering the room to wear masks as well; place respiratory
stickers on chart, linens, and so on.
Conti…
◈ Enforce strict hand hygiene- Teach the patient and tolks to
wash hands after coughing to reduce or prevent the transmission
of the virus.
◈ Educate the patient - Provide information on disease
transmission, diagnostic testing, disease process, complications,
and protection from the virus.
THANK
S!
Any questions?
DIAGRAMS AND INFOGRAPHICS

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