Govt issues guidelines for COVID-19 Management in children, says no to Remdesivir, recommends 6-min walk test


The Directorate General of Health Services (DGHS) which comes under the Ministry of Health has released guidelines particularly for the COVID-19 management in children.

Under the comprehensive set of guidelines, DGHS has outlined the recommended treatment and test which should be done, in case a child is found to be positive of COVID-19.

The official health body has also mentioned some set of treatments such as steroids and Remdesivir that must be avoided in Children’s case, however, they were the most preferred to treat COVID-19 in adults.

Check the complete set of guidelines to treat COVID-19 in children below:

Guidelines for using steroid for children:

Is use of steroid recommended for children?

The self-medication of steroids for the treatment of COVID-19 in children must be avoided. They are not indicated and are harmful in asymptomatic and mild COVID-19 cases.

The steroids are indicated only in the hospitalized moderately severe and critical cases under strict supervision.

As per the DGHS guidelines, they must be used at the right time, in the right dose, and for the right duration.

Guidelines for Remdesivir in children:

The DGHS has not recommended the use of Remdesivir (an emergency use authorization drug) in children for the treatment of COVID-19.

As per the released guidelines, there is no sufficient safety and efficacy data with respect to Remdesivir in children below 18 years of age.

CT Scans of COVID-19 patients: Guidelines

The guidelines by the DGHS suggest rational use of High-resolution CT (HRCT) for seeing the extent and the nature of lung involvement in COVID-19 positive patients.

It further added that however, any additional information gained from the CT Scan of the chest has often little impact on the treatment decisions. They are based entirely on the clinical severity and the physiological impairment.

Therefore, the physicians treating the children must be highly selective in order the HRTC imaging of the chest.

Guidelines for using masks by children:

The children aged 5 years or under are not required to wear masks.

Children between the age of 6-11 years can wear a mask depending on the ability of the child to use the mask appropriately and safely under the direct supervision of parents.

Those aged 12 years or older must wear a mask under the same conditions as adults.

Children must ensure that hands are clean with soap and water, or with an alcohol-based hand rub while handling the mask.

Asymptomatic and mild cases in children: Guidelines

As per the guidelines, COVID-19 is a viral infection, and that antimicrobials have no role in the prevention or in the treatment of uncomplicated Coronavirus infection.

For mild or asymptomatic cases in children, the guidelines do not recommend antimicrobials for therapy. On the other hand, for moderate or severe cases, antimicrobials for children must not be prescribed unless there is a clinical suspicion of superadded infection.

For asymptomatic infection in children, the guidelines by DGHS have recommended no specific medication and promoted only COVID-appropriate behaviour (strict hand hygiene, physical distancing, masks) and have suggested a nutritious diet.

The guidelines, however, stated that for a mild infection, paracetamol 10-15 mg/kg/dose may be given every 4-6 hours for fever and warm saline gargles, and throat soothing agents in older children or adolescents have been recommended for cough.

Guidelines for moderate and severe cases in children:

The guidelines, in case of moderate infection, suggest initiating immediate oxygen therapy.

As per the guidelines, corticosteroids are not required in all children with moderate illness. They may be administered in rapidly progressive disease and anticoagulants may also be indicated.

For the severe COVID-19 cases among the children, the guidelines by DGHS said if Acute Respiratory Distress Syndrome develops in Children, necessary management must be initiated.

Antimicrobials must be administered if there is evidence/strong suspicion of the superadded bacterial infection. In case of organ dysfunction, organ support may be needed, e.g. renal replacement therapy.

Guidelines for 6-minute walk test on children:

The guidelines by DGHS have recommended a 6-minute walk test on children above the age of 12 years under the supervision of parents or guardians.

As per the guidelines, it is a simple clinical test for assessing cardiopulmonary exercise tolerance and is used to unmask hypoxia. Attach a pulse oximeter to the child’s finger and ask them to walk in the confines of their room for six minutes continuously.

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