Ask The Expert:

India is slowly wriggling out of COVID-19 second wave, all thanks to lockdowns, strict adherence to Covid appropriate behaviour and vaccinating the public at a faster pace. However, experts are predicting a third wave of this deadly contagious virus in the next few months and are warning that it may affect children.

Let us hope that there won’t be a repeat of these painful times and pledge to do our best in preventing COVID-19. With monsoon setting in, children are currently at a high risk of various infections and in our Ask The Expert column, we spoke to Dr Yogesh Gupta, Consultant Paediatrician and Neonatologist at Fortis Hospital, Bengaluru, on how to safeguard kids from coronavirus and other possible long-term side effects.
Children with COVID-19 are playing with blocks

Here are the answers to allay the fears of all parents and everyone.

What are the most prevalent symptoms of COVID-19 in children? Are they any different from the signs that are being seen in adult patients?

Most of the children (~80%) are actually asymptomatic meaning they don’t display any symptoms. Around 10-15 % of the children may be mildly symptomatic and their common symptoms are cold, cough, fever, throat pain, loss of smell (children > 8 years can appreciate better) and loss of appetite. However, during this second wave, we have seen a new subset of symptoms in the form of pain in the abdomen, vomiting and diarrhoea. Symptomatology can vary as the virus mutates.

Are children at a lower risk of coronavirus than adults?

During the second wave, we have seen an increase in the number of children with COVID-19 positivity which can be explained with a proportionately high number of young adults being tested positive and also can be estimated on the basis of mutation in the virus which has increased its affinity to bind to ACE2 receptors. However, children have certain defence mechanisms which make them contract a less severe disease. First of all, their number of ACE2 receptors are less, secondly, they have high Melatonin level (a sleep hormone) which has shown to confer some protection against covid, thirdly children keep getting regular vaccine shots during first five years which keeps their immune system alert and better prepared to tackle infection and lastly children tend to have fewer comorbidities hence less severe disease.

What should the parents do if their child tests positive for coronavirus?

First, there is no need to panic, as most of the cases are asymptomatic.

Mild symptomatic cases can be managed in home isolation only of course under the supervision of a paediatrician. No specific medicines are needed except simple paracetamol to manage fever. Ensure a good diet and hydration. Monitor their temperature and saturation there to four times a day and maintain a chart. Keep in touch with your child’s paediatrician and seek medical help in case you notice any danger signs. Children with comorbidities like chronic kidney disease, congenital heart and lung diseases, type 1 Diabetes, on steroids for any reason and children with malignancies on chemotherapy should be observed in a hospital setting whenever possible.

Children with moderate to severe symptoms will need hospitalisation with an ICU facility.

What are the severe symptoms to watch out for and would require emergency medical care?

It is very important to be in touch with the child’s Paediatrician. If your child is having breathing trouble, like rapid breathing, persistent fever, lethargy, refusal of feeds or inability to take orally, decreased alertness, decreased urine output or wet diaper count and saturations less than 94%, you should go to the hospital and seek medical help immediately.

Can flu vaccine protect children from this contagious infection?

As mentioned, a regular vaccination process keeps your child’s immune system alert and in a better capacity to fight infection. Already research is on to find out the relationship between MMR / BCG vaccine in children and protection against COVID-19 infection. There have been some speculations about the influenza vaccine too. Influenza outbreaks are very common with seasonal variation and H1N1(seasonal influenza) can co-exist with COVID -19 increasing morbidity and mortality hence it is important to protect the child against H1N1 till we get the Covid vaccine in children. So, I would recommend administering a flu shot to your child.

What are the post-corona effects that are being reported in the children?

COVID-19 as such may not cause severe disease in children but we have seen post covid phenomenon in children which are a cause of concern. We are seeing a significant number of children with Kawasaki Like syndrome (MIS-C, Multisystem Inflammatory Syndrome in children) following Covid-19 infection, which is characterised by inflammation in their heart, kidney, skin and liver. Though they are treatable if diagnosed early. This is thought to be an equivalent of the Hyperinflammatory response seen in adults. We have observed a surge in cases of Insulin-Dependent Type 1 Diabetes in children following Covid -19 infection. Studies are still on to find out the temporal relation of these entities to Covid.

Other less severe entities seen with or following covid are Covid tongue and Covid Toe in children. These are named after minor changes in oral mucosa and skin but of no significance and do not require any treatment.

How often are you seeing babies being born with coronavirus from already positive mothers? Are just born babies at high risk?

There are very few reported cases of vertical transmission of Covid-19 to babies. When affected, some of the babies can have severe disease which can be associated with other co morbidities like prematurity, immature lungs and low birth weight, but most of them are asymptomatic or mildly symptomatic.

If the mother is tested positive and stable, she should continue nursing the child following Covid Appropriate behaviours.

There is already a lot of panic about an impending third wave of coronavirus and how it might target children more. Please advise strong preventive measures.

The way the virus is behaving and looking at the data from other countries there is a high possibility that we would see the third wave. But still, there is no concrete evidence that only kids will be affected during the third wave.  However, it’s better to be prepared, be ready for the worst and hope for the best.

We have to ramp up our Paediatric ICU /hospital beds. As ‘children are Not mini adults’, their needs and requirements are different so we should be prepared to tackle those issues. We should train more nurses and doctors in taking care of small children.

Some precautionary measures for the safety of kids

  • Following Covid Appropriate Behaviour SMS (Social Distancing-Mask-Sanitizer). Do not ever let the guard down.
  • Maintaining a good healthy balanced diet is one of the keys to keeping your immune system active.
  • Children with comorbidities must take extra care and precaution. 
  • Screen time should be limited to less than 2 hours a day and parents should ensure to have an open channel of communication with their children to allay their fears and anxieties.
  •  Ensure that your child gets to do some sort of daily physical activity for at least one hours a day. 
  • We should not skip their routine vaccines as we have already highlighted the importance of vaccination in children.

 Vaccine trials for children against COVID-19 have started in India. When do you think we can expect jabs for the kids as well?

Yes. Vaccine trials for children have started and it should become a reality in the coming months. Till then, do not forget to stay home, stay safe, maintain social distancing, sanitizing, frequent handwashing. Remember, only covid appropriate behaviour helps in preventing this contagious virus.
Dr Yogesh Gupta, Consultant Paediatrician and Neonatologist

Dr Yogesh Gupta, MBBS, MD, DNB is a Consultant Paediatrician and Neonatologist, Fortis Hospital, Bannerghatta, Bengaluru