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Session 4-Management of Paediatric COVID19

1) The document provides guidance on managing pediatric COVID-19 cases at the community level, including home care and primary health center care. It outlines classifications of disease severity and levels of management. 2) Principles of community-based care by ASHA and MPW include daily home visits, ensuring home delivery of drugs, monitoring for danger signs, and checking adherence to COVID-19 behaviors. 3) The document emphasizes the importance of recognizing danger signs like rapid breathing and referring severe or MIS-C cases to the district hospital level immediately. It provides case definitions and diagnostic criteria for MIS-C.

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10 views24 pages

Session 4-Management of Paediatric COVID19

1) The document provides guidance on managing pediatric COVID-19 cases at the community level, including home care and primary health center care. It outlines classifications of disease severity and levels of management. 2) Principles of community-based care by ASHA and MPW include daily home visits, ensuring home delivery of drugs, monitoring for danger signs, and checking adherence to COVID-19 behaviors. 3) The document emphasizes the importance of recognizing danger signs like rapid breathing and referring severe or MIS-C cases to the district hospital level immediately. It provides case definitions and diagnostic criteria for MIS-C.

Uploaded by

Uncertain Neuron
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Management of Pediatric COVID19

at Community level -
Home care and HWC level
Dr. Sumita Ghosh
Additional Commissioner & Incharge
(CH, AH, RBSK, CAC and ADs), MoHFW
CORONAVIRUS DISEASE 2019 (COVID-19)

The COVID-19 (SARS-CoV-2) is a major public health crisis,


that has affected people of all ages, gender and race.

Among confirmed cases <12 % individuals belonged to <20


years of age .

There is now focus on enhancing preparedness for the next


wave; including paediatric care facilities .
Classification of disease
• Infection is diagnosed while screening family members; child
Asymptomatic is otherwise asymptomatic.

• Fever and/or upper respiratory symptoms without any


Mild evidence of fast breathing and normal oxygen saturation on
room air (Spo2 => 94%)

• Fast breathing and/or oxygen saturation (SpO2) between 90-


Moderate 93% on room air.

Severe disease • Any signs of severe respiratory distress and/or SpO2 less than
90% on room air.
Children with SEVERE DISEASE are at high risk for respiratory and multi-organ failure and need critical care support.
LEVEL OF Patient at
community
MANAGEMENT

TRIAGING AT PHC/

After recovery – follow up


CENTRE LEVEL

MILD DISEASE SEVERE DISEASE


MODERATE DISEASE
home isolation possible

home isolation NOT possible

Home Covid
Care DCH
Centre DCHC
(CCC)

Worsening of Symptoms
Common symptoms of COVID-19 in children

- Fever
- Cough /Difficulty in breathing
- Loose motion
- Sore throat Common
symptoms
- Rhinorrhea/nasal block of
COVID’19
• Body ache/ Malaise
• Headache
• Loss of sense of smell/taste
• Anorexia, Nausea/vomiting
COVID-19: Prevention

Masking
Social
Distancing

Respiratory
hygiene

Hand
Hygiene

Essential Nutrition Practices For Good


Immunity
Principles of community based care by ASHA/MPW
• Daily home visits by ASHAs and MPWs Instructions to caregivers
• Update the CHO on the status. Do not panic. Most cases can be managed
at home with simple monitoring
• Ensure that
Children will need a care giver to be with
• Home delivery of required drugs
them
• Look for danger signs
Recognize danger signs and immediately
• Fill up checklists inform ASHA/ MPW
• Checklists for surveillance and All family members and close contacts to be
monitored and tested as per protocol
monitoring by ANM/ASHA
Ensure strict adherence to COVID
• Physical Triage Checklist- Home appropriate behavior. 
Isolation Daily checklist Food and Nutrition of the child need
special attention
Ensure Cleanliness and regular
disinfection . Child to be kept in a well
ventilated room.
Symptomatic Management of
Symptomatic Management
Children with Mild COVID at the
of Home isolated children CCC

For Fever: Paracetamol 10-15


mg/kg/ dose and can be repeated
every 4- 6 hours

For cough: In older children – saline


gargles
: Cough syrup can be given
Fluids and feeds: Ensure oral fluids
to maintain hydration
Antibiotics: not indicated
Red flags / danger signs for referral
*Age based Respiratory rate cut-offs for rapid
Rapid breathing Grunt, nasal Severe Chest breathing
(age based)* flaring indrawing <2 months more than or equal to 60/
minute
2 to 12 months more than or equal to 50/
Poor oral intake minute
SpO2< 94% Cold extremities (esp. infants and 12 months to 5 more than or equal to
young children) years 40/minute
More than 5 year more than or equal to 30/
minute
Lethargic (esp.
Fever persisting Seizures/
infant and young
>3 days encephalopathy
children)
Post COVID19 care in children
A pulse oximeter should be given to the patient at discharge

Advice about warning signs

• Development of fever
• Persistent drop in oxygen saturation
• Increased cough
• Breathlessness
• Chest pain
• Headache
• Jaw pain/ tooth pain
• Nasal blockage.

Emergency contact number of ASHA, MPW, CHO - in case of warning signs


When to suspect MIS-C?
When to MIS-C?
MIS-C is a severe post-COVID-19 inflammatory disorder in
children
• Associated with complications such as cardiac dysfunction, coronary
aneurysms, thrombosis, and multi-organ dysfunction etc
• MIS-C cases tend to peak 2-6 weeks following the peak of COVID-19 cases
in the community
• MIS-C should be suspected in children with
• Persistent fever beyond 3 days with (Rash, bilateral non-purulent
conjunctivitis, diarrhoea, vomiting, or abdominal pain, bleeding,
respiratory distress, shock),
• Especially if child had contact with COVID-19 patient in past 1-2 months
or had acute COVID infection.
Case definition of MIS-C
New syndrome-Multisystem
inflammatory syndrome (MIS-C)
seen in children

Characterized by:
Unremitting fever > 38 C
Epidemiological linkage with
SARS CoV – 2
Clinical features suggestive of
MIS
Emergency warning signs of MIS-C

Pale, gray or blue-


colored skin, lips or
Severe stomach pain Difficulty breathing
nail beds — depending
on skin tone

Pain or pressure in the


Inability to wake up or
New confusion chest that does not go
stay awake
away
Diagnostic criteria of MIS-C (WHO criteria)
Constellation of clinical and laboratory parameters has been suggested for
diagnosis
Children and adolescents 0–19 years
of age with fever ≥ 3 days

Clinical (Signs & symptoms any 2 of


Laboratory
these)
• Rash or bilateral non-purulent conjunctivitis or
• Elevated markers of inflammation such as
muco-cutaneous inflammation signs (oral, hands
or feet). ESR, C-reactive protein, or procalcitonin.
• Hypotension or shock • No other obvious microbial cause of
• Features of myocardial dysfunction, pericarditis, inflammation, including bacterial sepsis,
valvulitis, or coronary abnormalities (including staphylococcal or streptococcal shock
ECHO findings or elevated Troponin/NTproBNP) syndromes.
• Evidence of coagulopathy (by PT, PTT, elevated d- • Evidence of COVID-19 (RT-PCR, antigen test
Dimers) or serology positive), or likely contact with
• Acute gastrointestinal problems (diarrhoea, patients with COVID-19.
vomiting, or abdominal pain).
Formats for Home
Monitoring, HWC & PHC
Level Care
What to do if you suspect MIS- C?

REFER IMMEDIATELY TO THE


DCH – LEVEL ONLY
THREE IMPORTANT CHECKLISTS

1) Checklists for surveillance and monitoring by ANM/ASHA

2) Physical Triage Checklist- Home Isolation Daily checklist

3) Facility level checklist for Surveillance in Children

(To be used by Community Health Officer/Staff Nurse/Medical

Officer)
Checklists for surveillance and monitoring by ANM/ASHA
Physical Triage Checklist- Home Isolation Daily checklist (To be filled for 14 days)
Facility level checklist for Surveillance in Children
(To be used by Community Health Officer/Staff Nurse/Medical Officer)
 

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