COVID-19 in Children
Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: U07.1 *Notifiable condition. Also see: - National Department of Health – Guide to antigen testing for SARSCoV-2 in South Africa, revision. January 2023. 4 DESCRIPTION SARS-CoV-2 infections range from asymptomatic to severe. Case definition of COVID-19 (NICD/NDOH): A suspected COVID-19 ca
Description
Diagnostic criteria
General and supportive measures
Medicine treatment
Referral
ICD-10 code: U07.1
*Notifiable condition.
Also see:
- National Department of Health – Guide to antigen testing for SARSCoV-2 in South Africa, revision. January 2023.4
DESCRIPTION
SARS-CoV-2 infections range from asymptomatic to severe.
Case definition of COVID-19 (NICD/NDOH):
- A suspected COVID-19 case includes any person presenting with an acute (≤ 14 days) respiratory tract infection (cough, sore throat, shortness of breath, anosmia or dysgeusia) or other clinical illness compatible with COVID-19 including fever, weakness, myalgia or diarrhoea, or an asymptomatic person who is a close contact of a confirmed case.
Many children with COVID-19 will have no respiratory symptoms or fever, therefore, clinicians should consider COVID-19 in all acutely ill patients, especially those requiring admission.
DIAGNOSTIC CRITERIA
Testing
- Rapid antigen tests or PCR-based tests are both acceptable options to use for diagnosis. Rapid antigen tests may be performed on all patients for whom the PCR test is indicated in situations where no PCR tests are available, or when the PCR turnaround time limits the clinical or public health response utility.
- Upper respiratory tract (nasopharyngeal or oropharyngeal) samples should be sent on all patients. Sputum can be sent when available.
- A single positive rapid or PCR test is sufficient proof of COVID-19 infection.
- A negative rapid test should be followed up by a PCR test if the patient has symptoms compatible with COVID-19 or if the patient has had a recent exposure to a confirmed case.
- Due to poor sensitivity within the first 1–2 weeks after symptom onset, serology (antibody test) is not recommended for the diagnosis of acute COVID-19 infection.
- All healthcare workers should wear appropriate personal protective equipment (PPE) for both contact and respiratory precautions when obtaining specimens.
- Record and report and notify all confirmed COVID-19 cases.
Consider testing individuals suspected of having COVID-19 AND:
- Admitted to hospital with symptoms suggestive of COVID-19 disease.
- At high risk of severe disease (e.g. those with co-morbidities or immunecompromised).
- Suspected multisystem inflammatory syndrome in children (MIS-C).
- As the pandemic matures and evolves, testing recommendations may change – please consult NICD and NDoH sources for current recommendations.
Assessment
Use the following criteria to assess and classify the severity of the child’s condition:
| MILD | MODERATE | SEVERE | |
| Mental status | Normal | Restless | Irritable/ lethargic |
| Feeding | Finishes feed | Does not finish feed | Unable to feed |
| Talking | Full sentences | Interrupted sentences | Unable to talk |
| Respiratory rate (breaths/ minute) |
< 40 < 1 year;
|
40–60 < 2 months;
|
> 60 < 2 months;
|
| Respiratory signs | No distress | Lower- wall indrawing |
Lower- wall indrawing Grunting |
| SpO2 | ≥ 95% in room-air | < 92% in room-air |
< 92% in room-air Central cyanosis |
GENERAL AND SUPPORTIVE MEASURES
Isolation
Isolation is recommended for laboratory-confirmed COVID-19 disease for 7 days from onset of symptoms or, if asymptomatic, from the date of testing.
MEDICINE TREATMENT
Ensure holistic care and review the immunization, nutritional, HIV and TB risk status of the child.
Exclude other differential diagnoses.
- Mild disease:
- Provide symptomatic treatment at home.
- Provide caregiver with a patient information pamphlet.
- Implement suitable infection prevention and control practices.
- Special investigations and imaging are not routinely indicated.
- Routine micronutrient and vitamin supplementation are not recommended.
- Do not prescribe steroids unless indicated for a concomitant non-COVID-19 condition, e.g. asthma exacerbation, croup.
- Moderate/Severe disease:
- Admit for supportive in-patient care and consult/refer.
- For pneumonia – see: Pneumonia.
- In addition, children with hypoxic pneumonia can be considered for corticosteroid therapy (discuss with specialist).
- For acute diarrhoea – see: Diarrhoea, Acute.
REFERRAL
Consult with a specialist for advice prior to referral when a child requires supportive care that cannot be safely and effectively provided at the current facility, including:
- Prior to prescribing corticosteroids.
- When the child requires ≥ 40% oxygen to maintain SpO2 above 92%.
- If the child’s clinical condition worsens.
- If the child meets criteria for Multisystem Inflammatory Syndrome in Children, (MIS-C) associated with COVID-19 (see below).
Discharge/De-isolation
Children can be discharged from hospital once they no longer require supplementary oxygen, are feeding well and can be safely cared for at home. They can be de-isolated when they are no longer likely to be shedding virus:
| Mild disease | 7 days from onset of symptoms. |
| Moderate/Severe disease | 7 days after they are clinically stable, i.e. cessation of oxygen or return to baseline if receiving oxygen prior to SARS-CoV-2 infection. |
Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024
Chapter 8: Infective/Infectious Diseases, 8.32 Covid-19 In Children
Click here for 8.32.1 Multisystem Inflammatory Syndrome in Children
Click here for 8.32.2 Neonatal Issues Related to COVID-19