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Guidelines on Medical Care for Pediatric Patients with COVID-19 (Omicron)
[General Principles]
It is important for physicians to make decisions based on specific conditions of patients rather than uniformly applying these guidelines.
Symptoms including continued fever, spasms, dehydration, shortness of breath, intercostal pain, consciousness disorder, and continued lethargy are signs that point to the possible aggravation of severity and thus require close attention.
* Pay closer attention to acute shortness of breath in patients aged 0-3 and intercostal pain and dehydration in all children and adolescents.
If infants aged no more than 3 months show a sudden fever without any respiratory symptoms, make sure to check for blood poisoning, urinary tract infection, etc.
Antibiotics are not effective for cough and mucus. It is not recommended to uniformly prescribe antibiotics to pediatric patients with a fever.
[1] Clinical Traits
Non-specific symptoms include fever, fatigue, appetite loss, and headache, and respiratory symptoms include sore throat, nasal discharge, nasal congestion, cough, and phlegm.
As COVID-19 is a respiratory disease, the most common symptom detected in all age groups is a lower respiratory tract infection such as pneumonia (bronchiolitis in patients aged less than 1). Severe cases may develop shortness of breath.
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Other symptoms displayed by different age groups
① (Infants under 5) Fever, respiratory symptoms, lethargy, and decreased food intake
- Hoarseness, “barking” cough, and symptoms of laryngitis and croup caused by difficulty breathing
- Febrile convulsions in the initial stage due to a high fever
② (Children aged 5-11) General respiratory symptoms and fever
③ (Adolescents aged 12-18) Non-specific symptoms similar to adults (headache, muscle pain, etc.), respiratory symptoms (cough, nasal discharge, sore throat, etc.), and digestive symptoms (vomiting, diarrhea, etc.)
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[2] Guidelines on Symptom Control and Conservative Care
① Fever and chills
A fever continues for about 2-3 days after the onset of symptoms.
If the fever continues for more than 72 hours without showing signs of improvement or the recurrence of a high fever of 38°C or higher is identified, a thoracic spine X-ray is recommended.
It is essential to feed children plenty of fluids*, dress them in light-weight and loose clothes, and ensure enough rest.
* Patients with a high fever require 1.2 times more fluids.
Antipyretic analgesics are administered in the following cases.
- Fever reaching 38°C or higher
- Children showing signs of suffering from a fever
- Patients with chronic cardiopulmonary diseases, metabolic diseases, and neurological disorders that may cause febrile convulsions
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* Acetaminophen dosages
1) Infants: 10-15mg/kg or a dosage deemed necessary every 4-6 hours (no more than 75mg/kg per day)
* A dosage of 3-4.5cc of an acetaminophen syrup (32mg/mL) can be administered for children weighing 10kg.
2) Children weighing 40kg or more: A dosage of 500mg can be administered (same as adults).
3) Children aged 12 or higher: 325-1,000mg or a dosage deemed necessary every 4-6 hours (no more than 4,000mg per day)
* Ibuprofen dosages
1) Children aged 6 months-11 years: 5-10mg/kg every 6-8 hours (no more than 40mg/kg per day)
* A dosage of 2.5-5cc of an ibuprofen syrup (20mg/mL) can be administered for children weighing 10kg.
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② Dehydration
Dehydration can occur with decreased food and fluid intake due to difficulty swallowing incurred by edema and pain in pharynx and larynx.
As for infants, seek face-to-face consultations with physicians if diapers are changed less than 4 times a day (or the number of diapers changed is reduced by more than half) for more than 24 hours.
It is essential to feed a suffient amount of food and fluids.
It is recommended to prescribe an oral rehydration solution or feed slightly salted rice gruel based on the child’s age.
③ Breathing Problems
Abnormal breath sounds due to simple nasal congestion can be checked at home.
Increased breathing rates*, cyanoderma, intercostal retractions are signs of breathing problems** and require contact-free or face-to-face consultation with the physician.
* (Criteria for increased breathing rates by age)
① < 2 months: 60 times/min or more,
② 3-11 months: 50 times/min or more,
③ 12-60 months: 40 times/min or more,
④ > 60 months: 30 times/min or more
** Shortness of breath due to edema in pharynx and larynx entail symptoms similar to or more severe than those associated with laryngitis. They often improve during daytime and aggravate at night.
Note: Viral infections in the lower parts of both lungs frequently identified through the chest X-ray in the case of:
① Onset of a severe sore throat following a fever for 3-4 days after testing positive;
② Development of a dry cough after the onset of phlegm and wet cough; or
③ Chest pain
Oral steroids may be administered based on the physician’s diagnosis for shortness of breath caused by acute obstructive laryngitis.
④ Spasms
If the duration of spasms is short and the condition afterwards remains stable, the patient can be cared for from home.
Febrile convulsions may occur in children under 6 without any history of spasms and epilepsy. Administer fever reducers to ease febrile convulsions.
Make sure that the patient is laid with his/her head tilted to either side so that the airway is kept open.
Keep monitoring the patient to prevent any secondary injuries and seek emergency care through 119 if spasms continue for more than 5 minutes.
⑤ Others
(Cough, nasal discharge, nasal congestion, and phlegm) Adjust the indoor temperature and humidity, ensure the intake of sufficient fluids, and consider the use of general medications* to ease the symptoms.
* Cough suppressant, cough remedy, expectorant, antihistaminic, and decongestant
** Monitor if any stridor is heard when the child is whining, being fed, and lying in a comfortable position. Keep an optimal environment by adjusting the indoor temperature and humidity.
(Diarrhea and loose feces) This symptom subsides after a certain period of time in most cases, but close monitoring is required for the possible dehydration.
* Administer HIDRSEC or dioctalhedral smectite in appropriate dosages if necessary.
(Sore throat, headache, and muscle pain) Administer acetaminophen and NSAID in appropriate dosages.
(Nausea and vomiting) Consider IV injections if the child is unable to swallow oral medications and food due to vomiting.
(Skin disorders) Some children display edema and petechial hemorrhage in combination with diverse skin disorders. Apply symptomatic treatment as needed.
[3] Situations Requiring Immediate Face-to-Face Consultations
When a high fever of 38°C or higher continues for more than 72 hours without signs of improvement (lengthening intervals between attacks of fever, decreasing peak levels, etc.)
When seizure symptoms such as uncontrollable jerking movements of the arms and legs, dilated pupils, etc., are detected
When the child experiences trouble breathing and intercostal retractions, with the sunken appearance of the upper part of the collarbones and the lower part of the ribs
When the notable decrease in the amounts of food intake and urine continues for more than 24 hours
When chest pain and non-specific stomachache continue or aggravate
When the child appears unresponsive and seems to be experiencing clouding of consciousness
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