COVID-19 and children
Your questions answered by experts
The second wave of COVID-19 in India has left parents looking for information on protecting their children and the steps to take if their child, or a family member, has symptoms of COVID-19, or tests positive.
Experts from UNICEF, together with the The World Health Organization (WHO), All India Institute of Medical Sciences (AIIMS), New Delhi, Ministry of Health and Family Welfare (MoHFW), the Indian Academy of Pediatrics (IAP), and the National Neonatology Forum (NNF), answer your most pressing questions about COVID-19 and children.
Can children get COVID-19?
Yes. It’s possible for anyone, of any age, to contract COVID-19 — including children.
Why are more children in India testing positive for COVID-19 during the second wave?
As the number of people across India testing positive for the COVID-19 has increased, the number of children contracting the virus has also increased. However, we have not seen a sudden spike in the overall percentage of children affected by COVID-19 in India.
One feature of the new wave is that now entire households are becoming infected with the virus, more so than in the first wave.
We still need to be cautious and continue to follow COVID-19 appropriate behaviors strictly. It’s also important to be aware how children are feeling each day.
I am worried. How can I prevent my child from getting a COVID-19 infection?
There are no medicines or pills proven to prevent coronavirus infection in any person.
Only recently, a few vaccines are available, which mainly protect against disease. At present, the vaccines are approved for use in adults only.
The best way to protect children is to continue to follow COVID-19 appropriate behaviors:
- Always maintain a physical distance and stay home as much as possible, unless going for medical treatment or urgent supplies.
- Wear masks when you are outside, and make sure the face mask is covering your nose. Children above two years of age can also wear a mask.
- Continually wash hands with soap, or use a 70 per cent sanitizer, making sure the whole surface of the hands is covered.
- Get vaccinated – everyone above 18 years of age is eligible.
- Avoid attending public functions, avoid social gatherings, and avoid group play
- Discuss, demonstrate, and reiterate the importance of COVID-19 Appropriate Behavior (CAB) with your children.
How do I protect my children if a family member tests positive for COVID-19?
To start with, do not panic. Your family member with COVID-19 needs to isolate immediately, in a separate room from the rest of the family (if possible),and seek medical advice.
No-one should enter the room where your family member is isolating (adults or children).
While your family member is isolating, interact with them from outside the room via a doorway, and always wear a mask.
More information on what to do if someone around you tests positive for COVID-19 can be found here.
How do we manage different COVID-19 situations in the family at home?
If anyone in the family has COVID-19, the doctor will advise you all to isolate at home.
Here’s how to manage different situations in the home, depending on who in the family has COVID-19:
If a mother and her child/children are COVID-19 positive
Let children stay with their mother, unless their mother is too sick to care for them or is hospitalized.
For infant children, mothers should continue breastfeeding as much as is possible and feasible.
If a mother is COVID-19 positive, but her child/children are negative
If no other childcare options are available, and the mother is not too sick or hospitalized, she can take care of her children.
However, while doing so she must continue to:
If a child tests positive for COVID-19 and their parents are negative
Parents can continue to take care of the child.
However, while caring for their child, parents should:
Avoid leaving children with confirmed, or suspected, COVID-19 with their grandparents.
Elderly people are at very high risk of serious disease from COVID-19. So, unless a child’s status is corona negative, they should not be left with, or be in contact with, their grandparents.
My child has a fever. How can I tell if it is COVID-19 or something else?
You cannot tell.
For an ordinary person and even for a doctor, it is difficult to know the difference between a common cold/fever and COVID-19 without a test.
This means that every case of fever or cough in your child could be COVID-19 — especially if a family member is suffering from COVID-19 or has recently recovered from the virus.
If all members of the family are hospitalized, how can we help our children who don’t need hospitalization?
Please call 1098. The children will be taken care of by CHILDLINE.
How does COVID-19 affect children?
COVID-19 affects different people in different ways. People of any age can be infected and transmit the virus. However, older people and those with pre-existing medical conditions are more likely to develop severe illness from it.
COVID-19 is still a new virus and we’re still learning about how it affects women and children.
But as parents, we don’t need to worry unnecessarily. We have witnessed very few severe cases of COVID-19 among children in India that required hospitalization. Data from across the world, and India, shows that infection is generally very mild in children.
Over 60-70 per cent of children who get COVID-19 are asymptomatic — meaning they don’t show any symptoms of the virus at all.
Of the children that are symptomatic, only around 1-2 per cent need intensive care unit treatment. This number is less than the percentage of adults requiring intensive care.
A small proportion of children may develop severe disease, though this is much less common than in adults and the elderly.
The most common symptoms of infection in children are:
- Mild cough
- Body pain
We have also noted that COVID-19 symptoms such as pain in the abdomen, loose motions, and vomiting are also present in children.
Clinical features or symptoms affecting children and adolescents, possibly associated with COVID-19, can include (but are not limited to):
- Body pain
- Poor feeding
- Loss of taste or smell (in children over eight years old)
- Red or pink eyes
- Swollen and/or red lips, tongue, hands or feet
- Gastrointestinal problems (diarrhoea, vomiting)
Which children are at risk of getting severe illness from COVID-19?
Children with a pre-existing major disease might be at higher risk of getting severe illness from COVID-19. For example, a heart, kidney or liver disease, or malignancies.
Children with obesity, diabetes, asthma or chronic lung disease, sickle cell disease, or immunosuppression might also be at increased risk for severe illness from COVID-19.
While parents need to monitor the progression of illness closely, it appears that most infants and children with these underlying conditions also do not usually develop severe COVID-19 illness.
Do all children who develop severe COVID-19 need to go to the ICU?
All children with severe disease will need hospital care but not necessarily ICU care. Severe cases that develop acute respiratory distress and certain other complications, will require management in the ICUs.
Are children super-spreaders of the virus?
No. Children being super-spreaders is a myth. The latest studies have revealed that children are not super-spreaders of the virus. In fact, the capacity of children to spread the infection is much less as compared to adults.
What should I do if my child has symptoms of COVID-19?
Seek medical attention.
If advised by the doctor, then:
- Get your child tested for COVID-19.
- Isolate/stay at home.
When should I get my child tested for COVID-19?
Get your child tested for COVID-19 if:
- Family members, that your child has been in contact with, test positive for COVID-19.
- Your child has symptoms of COVID-19.
- Your child has a fever that has continued beyond three days.
Do all children need to be tested for COVID-19?
If your child has been in contact with a COVID-19 positive person, but does not have any symptoms, you should remain watchful for symptoms until 14 days after the initial contact.
If at any point within the 14 days after contact, the child develops symptoms like a fever, cough, runny nose, vomiting, loose stools, etc. then you should get them tested for COVID-19.
You should also get your child tested if they have any symptoms, even if you aren’t sure if they have been in close contact with someone who has tested positive for COVID-19 or has symptoms.
Medical advice from the child’s designate pediatrician / family doctor / health facility should be sought for children who have any symptoms.
Early diagnosis and treatment are critical. Initial reports suggest that in most cases, children with COVID-19 respond well to symptomatic treatment at home.
What should I do if my child tests positive for COVID-19?
Your child will be advised to stay at home and isolate.
During this time:
- Record temperature and oxygen saturation with a pulse oximeter if available at home, every six hours. Measure their temperature frequently. If it is more than 100-degree F, then you can do tepid sponging with tap water and give them syrup or tablet paracetamol. If fever is >100°F, give paracetamol 10–15 mg/kg/dose.
- Continue to follow good hand and respiratory hygiene practices like regular handwashing with soap so that your child is protected against other viruses and bacteria causing diseases.
- Continue to follow personal protective measures for yourself and your child. Your child should wear a surgical mask anytime they are around people. Change the mask after eight hours of continuous wear. Caregivers interacting with the child should wear gloves and a mask.
- Feed your child home-cooked food and keep them well hydrated. Give plenty of liquids and give a soft and light diet.
- One may give vitamin C, zinc to boost overall health and immunity. Other nutritional supplements like syrup multivitamin, vitamin D, calcium can be given as per their doctor’s advice.
- Be watchful for danger signs (explained below). If any of these signs are present, seek urgent medical advice at your nearest hospital.
What are the danger signs and symptoms to monitor in children with COVID-19 at home?
If your child is isolating at home with COVID-19, it’s important to know, and look out for the following five symptoms:
1. High Fever lasting beyond three days
2. Decreased oral intake by the child
3. Child becoming lethargic
4. Increasing respiratory rate
5. Oxygen saturation dropping below 95 per cent at home (ensure proper recording with good displayed waves).
In such a situation, you should consult your pediatrician / family doctor / health facility and take your child to a facility with COVID-19 care.
When should I take my child with COVID-19 to hospital?
|Signs and symptoms||Actions to take|
In children 0-2 months
> 60 breaths per minute
In children 2–12 months
> 50 breaths per minute
In children 12–59 months
> 40 breaths per minute
Oxygen saturation is below 94%
In babies of up to 1 year of age:
If your child has ANY of the following signs/symptoms, they are danger signs:
My child has a chronic disease. Do I continue his steroid treatment or other treatment?
Most of the treatment of pre-existing diseases need not be altered unless your child contracts serious disease. In such children, preventive care and some extra precautions at home to avoid infection are important. If such a child contracts an infection, it is advisable to consult your doctor for specific advice about ongoing medications.
We have heard about steroids, Favipiravir, Remdesivir, Tocilizumab, etc. When do we use them?
These drugs have limited use in childhood COVID-19 patients. Some are used only in serious patients usually in ICU. So far, they are almost never needed in children with COVID-19. Medicines should always be prescribed by a doctor.
What about medicines such as azithromycin, ivermectin, doxycycline, hydroxychloroquine (HCQ), ayurvedic, homeopathic, etc.?
There is no scientific evidence to use these drugs for the treatment of COVID-19 in children. Some of these drugs are used when adults are hospitalized with serious disease. There is no role of these drugs in-home treatment.
My child tested COVID-19 positive one week ago. He is due for his routine vaccinations in two weeks. What should I do?
Routine immunization can be continued two weeks after the child is asymptomatic (of COVID infection). If a child needs some higher medications such as high-dose steroids, which suppresses the components of patient immunity, immunization needs to be deferred for three months after the medication.
Do children need to wear a mask and what kind of mask should my child wear?
Yes. The Indian Academy of Pediatrics recommends that masks need to be worn by all children above the age of two.
WHO recommends that children who are in general good health can wear a non-medical or fabric mask, and children with underlying health conditions should, in consultation with their medical providers, wear a medical mask.
If your child is above two and willing to wear a mask, assist them in wearing their mask properly and over their nose. Create fun games around wearing masks. WHO also recommends that if children under five years wear a mask, a parent or other guardian should be within direct line of sight of the child to supervise the safe use of the mask.
How can I help my child to wash their hands properly?
To eliminate all traces of the virus on your hands, a quick scrub and a rinse won’t cut it. Below is a step-by-step process for effective handwashing.
- Step 1: Wet hands with running water.
- Step 2: Apply enough soap to cover wet hands.
- Step 3: Scrub all surfaces of the hands – including the back of hands, between fingers and under nails – for at least 20 seconds.
- Step 4: Rinse thoroughly with running water.
- Step 5: Dry hands with a clean cloth or single-use towel.
What precautions can my family take against COVID-19 while travelling?
While travelling, all parents should follow standard hygiene measures for themselves and their children:
- Wear your mask and ensure your children always do the same during the journey and when outside your accommodation (including while taking photographs).
- Washing hands properly with soap.
- Carrying sufficient hand sanitizer.
- Avoiding close contact with anyone who is coughing or sneezing.
While at your hotel or accommodation:
- Use a disinfectant wipe to clean key surfaces, doorknobs, remote controls, etc.
While in transit:
- Clean your seat, armrest, touchscreen, etc. with a disinfecting wipe once inside an aircraft or other vehicle.
What is COVID-19?
Coronavirus disease 2019 (COVID-19) – ‘CO’ stands for corona, ‘VI’ for the virus, and ‘D’ for disease – is a disease caused by a new strain of coronavirus first identified in Wuhan, China.
Can pregnant women pass coronavirus onto their unborn child/children?
At this time, there is not enough evidence to determine whether the virus is transmitted from a mother to her baby during pregnancy, or the potential impact this may have on the baby. This is currently being investigated.
Pregnant women should continue to follow appropriate precautions to protect themselves from exposure to the virus, and seek medical care early, if experiencing symptoms, such as fever, cough or difficulty breathing.
Is it safe for a mother to breastfeed if she is infected with coronavirus?
All mothers in affected and at-risk areas who have symptoms of fever, cough or difficulty breathing should seek medical care early and follow instructions from a health care provider.
Considering the benefits of breastfeeding and the insignificant role of breastmilk in the transmission of other respiratory viruses, a mother can continue breastfeeding while applying all the necessary precaution e.g. wear a medical mask while breastfeeding the baby; wash your hands with soap and water or use alcohol-based hand rub before feeding; and routine clean and disinfect surfaces around you.