The central government has issued comprehensive guidelines for the management and treatment of Covid-19 among children. The health ministry's Directorate General of Health Services (DGHS) guidelines advise against administering Remdesivir and routine use of HRCT imaging. The DGHS said that steroids are harmful in asymptomatic and mild cases of infection.
The guidelines state that "Steroids should be used at the right time, at the right dose and for the right duration. Self-medication of steroids must be avoided. " It also stated that Remdesivir (an emergency use authorization drug) should not be recommended to children. "There is a lack of sufficient safety and efficacy data with respect to Remdesivir in children below 18 years of age," the guidelines state.
CT Scan: The guidelines recommended using high-resolution CT (HRCT) to determine the extent and nature of lung involvement in Covid-19 patients. "However, any additional information gained from HRCT scan of the chest often has little impact on treatment decisions, which are based almost entirely on clinical severity and physiological impairment. Therefore, treating physicians should be highly selective in ordering HRCT imaging of the chest in COVID-19 patients," the guidelines said.
Medication: For mild infections, the guidelines recommend giving paracetamol 10-15mg/kg/dose every 4 to 5 hours for fever and throat soothing agents, as well as warm saline, gargles for cough in older children and adolescents.
For Cases That Are Moderate To Severe: In the case of a moderate infection, the guidelines recommend starting oxygen therapy right away.
"Corticosteroids are not required in all children with moderate illness; they may be given in rapidly progressive disease, and anticoagulants may be indicated," according to the guidelines.
The guidelines stated that if Acute Respiratory Distress Syndrome (ARDS) develops in children with severe Covid-19, necessary management should be initiated.
"In case shock develops, necessary management should be initiated. If there is evidence/strong suspicion of superadded bacterial infection, antimicrobials should be administered. need organ support in case of organ dysfunction, e.g. renal replacement therapy," it said.
A six-minute walk test under the supervision of parents/guardians was also recommended in the guidelines for children over the age of 12.
"It is a simple clinical test to assess cardiopulmonary exercise tolerance and is used to unmask hypoxia. Attach a pulse oximeter to his/her finger and ask the child to walk in the confines of their room for six minutes continuously," the guidelines state.