Pediatric Management

Last updated: 10-04-2020

Epidemiology

  • There is limited data on the epidemiology of COVID-19 infections in children.

  • A recent review of 72,314 cases by the Chinese Center for Disease Control and Prevention showed that less than 1% of the cases were in children younger than 10 years of age, and 1% of cases were in children between age 10 to 19 years of age [4]

  • In another study of 2143 pediatric patients in China, one child of 14 years of age died, while most cases were mild, with much fewer severe and critical cases (5.9%) than adult patients (18.5%) [5]

  • Korean literature suggests 4.8% of cases were in the 0 to 19 year old population [3]

  • Based on US numbers for persons aged ≤19 years [6]:

    • 5% of cases had COVID infection

    • No fatalities

    • 1.6-2.5% hospitalization rate

    • No ICU admissions 

 

Signs and Symptoms: [7, 8]

  • Cough (48.5%)

  • Pharyngeal erythema (46.2%)

  • Fever of at least 37.5 degrees C (41.5%)

  • Tachycardia (42.1%)

  • Tachypnea (28.7%)

  • Diarrhoea (8.8%)

  • Fatigue (7.6%)

  • Rhinorrhea (7.6%)

  • Vomiting (6.4%)

  • O2 saturation less than 92% (2.3%)

  • Accompanied by:

    • myalgia

    • nasal congestion

    • sneezing

    • sore throat

    • headache

    • dizziness

    • vomiting

    • abdominal pain

  • A few children do not exhibit fever, but only manifest cough or diarrhea, and even fewer can be asymptomatic carriers

  • Atypical symptoms:

    • vomiting, diarrhea, and other gastrointestinal symptoms, or only symptoms of shortness of breath

 

**Symptoms may be indifferentiable from infections like RSV, influenza A/B, or other viral infections, therefore nasopharyngeal swabs may be used for testing for multiple potential viruses.

Lab/Imaging Findings [7]

  • Lab:

    • Neutrophilia (4.6%)

    • Neutropenia (6.0%)

    • Lymphocytopenia (3.0%)

    • C-reactive protein elevated (13.6%)

    • Procalcitonin elevated (10.6%)

  • Imaging:

    • Ground glass opacity (33.3 %)

    • Local patchy shadowing (18.7%)

    • Bilateral patchy shadowing (12.3%)

    • No symptoms of infections or radiological features of pneumonia (15.8%)

Management

  • Generally, children with COVID-19 infection require only supportive care, unless they may have exacerbated symptoms due to underlying medical conditions.

  • Supportive therapy can include:

    • low flow oxygen

    • antipyretic and analgesics. There is currently no evidence that NSAID use should be avoided in patients with suspected or confirmed Covid-19 infection over 6 months of age.

    • maintenance of hydration status and electrolyte balance

    • optimizing nutrition especially with prolonged hospitalizations

    • escalation of care on an as-needed basis for high flow oxygen, BIPAP/CPAP with appropriate protective measures against aerosol generating procedures.

  • Ensure patients with comorbid conditions such as asthma are adequately treated as per their asthma action plan. The Canadian Thoracic Society has recommendations that can help guide alternate therapies for patients facing MDI medication shortages.[9]

  • Newborns with COVID suspected or confirmed positive mothers, may be choose to breastfeed and practice skin-to-skin care with precautions including washing hands with soap and water and donning a surgical/procedure mask to reduce the risk of droplet transmission during breastfeeding. They may also choose to use a pump, taking care to clean equipment between uses.

  • Infants who present with respiratory distress symptoms at or within minutes of birth are most likely to have a non-Covid illness with the usual differential diagnoses and management.

  • There is little evidence to vertical transmission, and few cases of horizontal transmission in the neonatal population.

  • No antivirals specific to Covid-19 infection are available. According to the CDC, Lopinavir/ritonavir and interferon-alpha have been used for treatment in children with COVID-19, however safety and efficacy of these drugs are unknown [2]

 

 

Additional Resources from the Canadian Pediatric Society are available at the link below. These include statements regarding best practices for pediatric office spaces, resources for anxiety and mental health for children and adolescents, parents of children with ADHD, as well as statements addressing needs of children with immune suppression, asthma, type 1 diabetes and other chronic medical conditions.

https://www.cps.ca/en/tools-outils/covid-19-information-and-resources-for-paediatricians

 

References

  1. Coronavirus Disease-2019 (COVID-19) and Children [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; 2020 [cited 2020Mar19]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/prepare/children-faq.html

  2. Information for Pediatric Healthcare Providers [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; 2020 [cited 2020Mar19]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html

  3. Korean Society of Infectious Diseases; Korean Society of Pediatric Infectious Diseases; Korean Society of Epidemiology; Korean Society for Antimicrobial Therapy; Korean Society for Healthcare-associated Infection Control and Prevention; Korea Centers for Disease Control and Prevention. Report on the epidemiological features of coronavirus disease 2019 (COVID-19) outbreak in the Republic of Korea from January 19 to March 2, 2020. J Korean Med Sci 2020;35(10):e112.

  4. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020 February 24 (Epub ahead of print)

  5. Epidemiological Characteristics of 2143 Pediatric Patients ... [Internet]. [cited 2020Mar20]. Available from: https://pediatrics.aappublications.org/content/pediatrics/early/2020/03/16/peds.2020-0702.full.pdf

  6. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) - United States, February 12–March 16, 2020 [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; 2020 [cited 2020Apr7]. Available from: https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm

  7. Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults [published online ahead of print, 2020 Mar 23]. Acta Paediatr. 2020;10.1111/apa.15270. doi:10.1111/apa.15270

  8. Jiatong S, Lanqin L, Wenjun L. COVID-19 epidemic: disease characteristics in children [published online ahead of print, 2020 Mar 31]. J Med Virol. 2020;10.1002/jmv.25807. doi:10.1002/jmv.25807

  9. Lougheed MD, Leniere C, Ducharme FM, et al. Canadian Thoracic Society 2012 guideline update: Diagnosis and management of asthma in preschoolers, children and adults; Executive summary. Can Respir J 2012;19(6):e81-8.

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