Links To And Excerpts From “Information for Pediatric Healthcare Providers” On COVID-19 From The CDC

In this post I link to and excerpt from the CDC‘s Information for Pediatric Healthcare Providers updated Aug 19, 2020.

Here are excerpts from the above:

On This Page

• Infections Among Children
• Symptoms and Severity
• Testing and Isolation
• Laboratory and Radiographic Findings
• Management
• Immunizations and Well-Child Care
• Additional Information
• References

Clinical Presentation

The incubation period of SARS-CoV-2 appears to be about the same for children as in adults, at 2-14 days with an average of 6 days.¹⁰

Signs or symptoms of COVID-19 in children include:

• Fever
• Fatigue
• Headache
• Myalgia
• Cough
• Nasal congestion or rhinorrhea
• New loss of taste or smell
• Sore throat
• Shortness of breath or difficulty breathing
• Abdominal pain
• Diarrhea
• Nausea or vomiting
• Poor appetite or poor feeding

Children infected with SARS-CoV-2 may have many of these non-specific symptoms, may only have a few (such as only upper respiratory symptoms or only gastrointestinal symptoms), or may be asymptomatic. The most common symptoms in children are cough and/or fever.^11-15 A recent systematic review estimated that 16% of children with SARS-CoV-2 infection are asymptomatic,¹⁶ but evidence suggests that as many as 45% of pediatric infections are asymptomatic.¹⁷ The signs and symptoms of COVID-19 in children are similar to other infections and noninfectious processes, including influenza, streptococcal pharyngitis, and allergic rhinitis. The lack of specificity of signs or symptoms and the significant proportion of asymptomatic infections make symptom-based screening for identification of SARS-CoV-2 in children particularly challenging.¹⁷

Severity of Illness in Children

While children infected with SARS-CoV-2 are less likely to develop severe illness compared with adults, children are still at risk of developing severe illness and complications from COVID-19.

Similar to adults, children with severe COVID-19 may develop respiratory failure, myocarditis, shock, acute renal failure, coagulopathy, and multi-organ system failure. Some children with COVID-19 have developed other serious problems like intussusception or diabetic ketoacidosis.^{10,14, 20,21} Children infected with SARS-CoV-2 are also at risk for developing multisystem inflammatory syndrome in children (MIS-C).²² For the case definition, recommended evaluation, and current data on MIS-C cases in the United States, visit MIS-C Information for Healthcare Providers.

Management of COVID-19 in Children

Pediatric healthcare providers should consider the child’s clinical presentation, requirement for supportive care, underlying medical conditions, and the ability for caregivers to care for the child at home when deciding whether the child may need inpatient care for COVID-19. For more information, visit Guidance for home care of people not requiring hospitalization for Coronavirus Disease 2019 (COVID-19). Provide parents resources on emergency warning signs for COVID-19 and caring for someone at home.

Currently, there are no specific drugs approved by the U.S. Food and Drug Administration (FDA) for treatment of COVID-19. Treatment of COVID-19 remains largely supportive and includes prevention and management of complications.

For more information, review considerations for children in NIH’s COVID-19 Treatment Guidelines.²⁵

For information on evaluation and management of MIS-C, visit MIS-C Information for Healthcare Providers.

It is important to remember that children infected with SARS-CoV-2 can present with other serious conditions such as  diabetic ketoacidosis or intussusception, and a broad differential must be maintained in evaluating ill children during the COVID-19 pandemic.^{10,14,20,21,26-29} Standard evaluation and management of co-occurring conditions should be maintained for a child infected with SARS-CoV-2, with additional infection control measures. Pediatric providers should have an appropriate suspicion for COVID-19, but also to continue to consider and test for other diagnoses, such as community acquired pneumonia and influenza (see CDC’s Flu Information for Healthcare Professionals for more information).

CDC has specific guidance for inpatient obstetric healthcare settings and the evaluation and management of neonates at risk for COVID-19. Additionally, several other organizations have published guidelines related to the treatment and management of adult and pediatric patients with COVID-19:

• National Institutes of Health (NIH) Coronavirus Disease 2019 (COVID-19) Treatment Guidelines
• World Health Organization (WHO) Interim Guidance on Clinical Management of Severe Acute Respiratory Infection when Novel Coronavirus (nCoV) Infection is Suspected
• Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children
• Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19

Additional Information

• MIS-C Information for Healthcare Providers
• Interim Clinical Guidance for Management of Patients with Confirmed COVID-19
• Considerations for Inpatient Obstetric Healthcare Settings
• Evaluation and Management Considerations for Neonates At Risk for COVID-19
• Guidance on Care for Breastfeeding Women
• Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed COVID-19 in Healthcare Settings
• Health Alert Network (HAN): Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19)
• Steps Healthcare Facilities Can Take to Prepare for COVID-19
• What Healthcare Personnel Should Know about Caring for Patients with Confirmed or Possible COVID-19 Infection
• National Institutes of Health: Coronavirus Disease 2019 (COVID-19) Treatment Guidelines