COVID-19 in children: Some important questions answered


While last year it was not the case, this year, more and more children have started getting affected by the coronavirus infection, as part of the second wave. As such, parents may be worried about them, having several questions unanswered.

To address their doubts and assuage them, Dr Sreenath S Manikanti, senior pediatrician and neonatologist at Fortis La-Femme Hospital in Bengaluru shared with answers to some FAQs about COVID-19 in children. Read on.

“The majority of children with COVID-19 are asymptomatic. Most will have mild illness, and 60-70 per cent are either asymptomatic or have mild disease. Very few children, who are symptomatic (1-2 per cent) require ICU care in tertiary centres,” the doctor said.


1. Is there an increase in infection in the second wave in children?
Yes, probably because of multiple reasons:
* Mutants, which are more infectious.
* Laxity on part of the family — COVID-appropriate behaviour was reduced.
* Now, PCR testing is easier to do for kids, so more kids are diagnosed with Covid.

2. Are the symptoms different in the second wave?
Symptoms are similar. Fever, however, lasts longer and is slightly more. Adolescents appear to have longer fever of 5-6 days. Gastrointestinal symptoms such as diarrhea, vomiting and abdominal pain are seen more in the second wave, along with fever, body aches and cough.

3. How do children get infected?
Mostly from other family members and siblings, going out to play. Mode of transmission is mostly direct contact and airborne. Spread through fomites has very less chance.

4. If one family is positive, should everyone including asymptomatic children be screened?
Yes, there are two reasons to do a test: < 0.1 per cent will develop severe disease. But admission may be difficult in this situation without test reports; and to reduce transmission, for asymptomatic children, get tests done 4-5 days after the adult is positive.

5. What tests are done if the child is suspected to have Covid?
Ideally an RT-PCR. One can do a Rapid Ag test in cases of difficulty of getting a report, but it’s less sensitive. Sometimes, sampling may be inadequate, causing negative tests. Hence, even if the test is negative but the child appears to be COVID-positive, we need to treat it as positive if there is contact history. New variants are likely to picked up with RT-PCR.

6. How to manage a child or a family member who is Covid positive?
Home isolation, treating fever with Paracetamol above 100F, good hydration, normal diet, and symptomatic treatment if mild symptoms.

7. What to monitor (if telephonic monitoring by pediatrician)?
Increased respiration, breathlessness, increased irritability, high grade fever persisting for more than 4 days.

8. How to take care of a child if parents have tested positive?
Isolation is difficult in nuclear families; better if the younger child is left with the mother. Parents need to wear masks and take precautions. If it’s an older child, the parent who has tested negative can take care of the child. Sending them to grandparents’ can be risky, if asymptomatic. Test the child before doing that.

9. Can children be super spreaders?
Yes, they can give infection to others, including other family members and other kids.

10. Mother is RT PCR +ve, can she breastfeed the newborn?
Yes, benefits of breastfeeding outweigh the risks. Mother can breastfeed taking adequate precautions like using a mask and sanitiser.

11. Can children be isolated with a parent if the child is positive and parents are negative?
There may be a lot of anxiety if the child is left isolated. Keep them with the parent — use appropriate PPE. Attendants should not come in contact with other people and get tested if they develop symptoms.

12. Reinfection risk in children?
Not clear, but very small risk as with adults.

13. Vaccination below 18 years?
As of now, there is no data on efficacy and safety of COVID vaccine in children. Trials are on in younger children, even as young as 6 months old.

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