New COVID-19 guidelines for children and adolescents: What to know
The Union Health Ministry recently revised its guidelines for the management of COVID-19 in those below 18 years of age. The fresh advisory lays down norms regarding the use of drugs, different treatment methods, masking, among other aspects. A group of experts had reviewed the previous guidelines, issued in June 2021, in view of the current COVID-19 situation in India.
Should children mask up or not?
Under the new guidelines, children aged five or younger do not have to wear a mask. Those aged six to 11 years may use a mask if they are able to do so safely and appropriately under the direct supervision of their parents. Meanwhile, children aged 12 or above should wear a mask under the same conditions as adults, the ministry's guidelines state.
Use of antivirals and monoclonal antibodies
The Health Ministry said the use of antivirals and monoclonal antibodies is not recommended for children, irrespective of the severity of infection. Antivirals include drugs such as remdesivir, molnupiravir, and favipiravir. Further, antimicrobials are also not recommended in asymptomatic and mild cases. However, if there is clinical suspicion of a complicated infection, antimicrobials may be prescribed, according to the guidelines.
No steroids in asymptomatic, mild cases
Steroids have been termed harmful in asymptomatic and mild COVID-19 cases. Further, they should be avoided in the first three to five days since the onset of symptoms as they could prolong viral shedding, the guidelines state. Besides, corticosteroids may be used in rapidly progressive moderate cases and all severe cases. They can be tapered up to 10-14 days, depending on daily clinical assessment.
Diagnosis of MIS-C cases
Multi System Inflammatory Syndrome in Children (MIS-C) is a relatively new and serious condition linked to the coronavirus. In this regard, the Health Ministry has advised caution while diagnosing such cases. The C-Reactive Protein (CRP) level for the diagnosis of MIS-C has been changed to over 5 mg/dL. The previous parameter was over 2 mg/dL.
Post-COVID-19 care for children
In case of asymptomatic infection or mild disease, children should receive childcare, appropriate vaccination, nutrition counseling, and psychological support as a follow-up. On the other hand, if a child suffered from moderate to severe disease, parents should be counseled about monitoring respiratory symptoms upon discharge. Those who may develop any organ-specific dysfunction during or after hospitalization should also be given appropriate care.
Vaccination for children in India
As far as vaccination for children is concerned, India has so far cleared inoculations for those aged between 15 and 18 years. In fact, more than 50% of adolescents in that cohort have received their first dose of the coronavirus vaccine. The authorities are now mulling vaccination for the 12-14 age group in the next phase.
