This steering is meant to inform pediatric healthcare suppliers of up-to-date details about youngsters with suspected or confirmed COVID-19 and about caring for youngsters through the pandemic. Kids are outlined as age 1 month to 18 years for the aim of this doc.
For healthcare suppliers caring for neonates (≤28 days outdated) with suspected or confirmed COVID-19, together with these born to a mom with suspected or confirmed COVID-19, please confer with CDC steering for evaluating and managing neonates in danger for COVID-19.
Incidence of COVID-19 in Kids
In the USA and globally, fewer instances of COVID-19 have been reported in youngsters (age 0-17 years) in contrast with adults.1,2 Whereas youngsters comprise 22% of the US inhabitants,3 current knowledge present that 7.3% of all instances of COVID-19 in the USA reported to CDC have been amongst youngsters (as of August third, 2020).4 The quantity and price of instances in youngsters in the USA have been steadily rising from March to July 2020. The true incidence of SARS-CoV-2 an infection in youngsters just isn’t identified as a consequence of lack of widespread testing and the prioritization of testing for adults and people with extreme sickness. Hospitalization charges in youngsters are considerably decrease than hospitalization charges in adults with COVID-19, suggesting that youngsters could have much less extreme sickness from COVID-19 in comparison with adults.5, 6 Go to CDC’s Instances, Information, and Surveillance web page for present CDC knowledge.
Infections and Transmission Amongst Kids
It’s unclear whether or not youngsters are as vulnerable to an infection by SARS-CoV-2 in contrast with adults and whether or not they can transmit the virus as successfully as adults. Latest proof means that youngsters probably have the identical or greater viral hundreds of their nasopharynx in contrast with adults7 and that youngsters can unfold the virus successfully in households and camp settings.8,9
On account of group mitigation measures and college closures, transmission of SARS-CoV-2 to and amongst youngsters could have been diminished in the USA through the pandemic within the spring and early summer time of 2020. This may increasingly clarify the low incidence in youngsters in contrast with adults. Evaluating tendencies in pediatric infections earlier than and after the return to in-person faculty and different actions could present further understanding about infections in youngsters.
The incubation interval of SARS-CoV-2 seems to be about the identical for youngsters as in adults, at 2-14 days with a median of 6 days.10
Indicators or signs of COVID-19 in youngsters embrace:
- Nasal congestion or rhinorrhea
- New lack of style or odor
- Sore throat
- Shortness of breath or problem respiratory
- Belly ache
- Nausea or vomiting
- Poor urge for food or poor feeding
Kids contaminated with SARS-CoV-2 could have many of those non-specific signs, could solely have a couple of (corresponding to solely higher respiratory signs or solely gastrointestinal signs), or could also be asymptomatic. The commonest signs in youngsters are cough and/or fever.11-15 A current systematic evaluate estimated that 16% of kids with SARS-CoV-2 an infection are asymptomatic,16 however proof means that as many as 45% of pediatric infections are asymptomatic.17 The indicators and signs of COVID-19 in youngsters are much like different infections and noninfectious processes, together with influenza, streptococcal pharyngitis, and allergic rhinitis. The dearth of specificity of indicators or signs and the numerous proportion of asymptomatic infections make symptom-based screening for identification of SARS-CoV-2 in youngsters significantly difficult.17
Severity of Sickness in Kids
Whereas youngsters contaminated with SARS-CoV-2 are much less prone to develop extreme sickness in contrast with adults, youngsters are nonetheless liable to growing extreme sickness and issues from COVID-19. Latest COVID-19 hospitalization surveillance knowledge reveals that the speed of hospitalization amongst youngsters is low (8.0 per 100,000 inhabitants) in contrast with that in adults (164.5 per 100,000 inhabitants), however hospitalization charges in youngsters are rising. 5 Whereas youngsters have decrease charges of mechanical air flow and loss of life than adults, 1 in 3 youngsters hospitalized with COVID-19 in the USA have been admitted to the intensive care unit, which is similar in adults.5
Present proof means that youngsters with sure underlying medical situations and infants (age <1 yr) is perhaps at elevated threat for extreme sickness from SARS-CoV-2 an infection.10,11,14 Of the youngsters who’ve developed extreme sickness from COVID-19, most have had underlying medical situations. 5
- There may be restricted proof about which underlying medical situations in youngsters may enhance the chance for extreme sickness. Present proof means that youngsters with medical complexity, with genetic, neurologic, metabolic situations, or with congenital coronary heart illness is perhaps at elevated threat for extreme sickness from COVID-19. Just like adults, youngsters with weight problems, diabetes, bronchial asthma and continual lung illness, sickle cell illness, or immunosuppression may additionally be at elevated threat for extreme sickness from COVID-19.
- Whereas healthcare suppliers ought to preserve a excessive index of suspicion for SARS-CoV-2 an infection in these populations and monitor the development of sickness carefully, it seems that most infants18 and kids with sure underlying situations corresponding to most cancers19 who’re contaminated with SARS-CoV-2 don’t normally develop extreme sickness.
- Hospitalization charges in the USA are greater amongst Hispanic/Latino youngsters and black, non-Hispanic youngsters and non-Hispanic black youngsters in contrast with white youngsters, which can be associated to the upper charges of weight problems and different underlying situations amongst these populations.5
Just like adults, youngsters with extreme COVID-19 could develop respiratory failure, myocarditis, shock, acute renal failure, coagulopathy, and multi-organ system failure. Some youngsters with COVID-19 have developed different critical issues like intussusception or diabetic ketoacidosis.10,14, 20,21 Kids contaminated with SARS-CoV-2 are additionally in danger for growing multisystem inflammatory syndrome in youngsters (MIS-C).22 For the case definition, advisable analysis, and present knowledge on MIS-C instances in the USA, go to MIS-C Info for Healthcare Suppliers.
Viral checks (nucleic acid or antigen) are advisable to diagnose acute an infection with SARS-CoV-2. Testing methods, together with medical standards for contemplating testing and advisable specimen kind, are the identical for youngsters and adults. CDC’s steering for the analysis and administration of neonates in danger for COVID-19 particulars particular testing concerns for newborns.
For extra info on CDC’s suggestions for isolation, which apply to youngsters and adults, go to: discontinuing precautions and disposition of sufferers with COVID-19 in healthcare settings and discontinuation of residence isolation for folks not in healthcare settings.
Testing, Isolation, and Quarantine for Faculty-Aged Kids
As youngsters return to high school and different in-person actions, pediatric healthcare suppliers needs to be ready to reply questions from households about testing and when it’s secure to return to high school or be with folks outdoors the family. Evaluate CDC’s info for college directors on symptom screening and testing for youngsters in class in addition to CDC’s Group Mitigation framework.
Faculty-aged youngsters needs to be prioritized for viral testing if they’ve:
- Indicators or signs of COVID-19 and
- shut contact (inside 6 toes of somebody for a complete of quarter-hour or extra) with an individual with laboratory confirmed or possible SARS-CoV-2 an infection or
- elevated probability for publicity (which incorporates dwelling in or touring to a group with substantial transmission as outlined by the native public well being division and described in CDC’s Group Mitigation framework)
- No signs however have had shut contact (inside 6 toes of somebody for a complete of quarter-hour or extra) with an individual with laboratory confirmed or possible SARS-CoV-2 an infection.
Kids with signs of an infectious illness shouldn’t attend faculty, however the size of time the kid ought to keep residence will depend on the most certainly etiology of sickness (COVID-19 or not). Return to high school insurance policies for youngsters with COVID-19 needs to be based mostly on CDC’s advice for discontinuation of residence isolation. A destructive check or physician’s word ought to not be required for return to high school upon completion of the ten days of isolation with enchancment of signs.
- If the kid has signs of COVID-19, however the baby has not had shut contact (inside 6 toes of somebody for a complete of quarter-hour or extra) with an individual with laboratory confirmed or possible SARS-CoV-2 an infection and the kid doesn’t have an elevated probability for publicity to SARS-CoV-2 (which incorporates dwelling in or touring to a group with substantial transmission), she or he needs to be evaluated for different illness processes. If the kid is decided to probably not have COVID-19 by a healthcare supplier, he/she needs to be allowed to return to high school based on present faculty insurance policies for non-COVID diseases. Examples of non-COVID return to high school insurance policies embrace decision of fever with out antipyretics for twenty-four hours for non-COVID viral diseases or after initiation of antibiotics for bacterial diseases.
- If the kid has signs of COVID-19 and has elevated probability for publicity (which incorporates dwelling in or touring to a group with substantial transmission), she or he needs to be examined for SARS-CoV-2 an infection, if attainable. If the check result’s destructive, the kid needs to be allowed to return to high school as soon as their signs of sickness have improved in keeping with non-COVID return to high school insurance policies. If testing can’t be obtained, the kid needs to be thought-about a presumed case of COVID-19 and may isolate based on CDC’s suggestions for discontinuation of residence isolation.
- If the kid has had shut contact to somebody with SARS-CoV-2, she or he needs to be examined for SARS-CoV-2 however should stay in quarantine for the 14-day incubation interval even when outcomes are destructive, in accordance with CDC’s Quarantine If You May Be Sick. The easiest way to guard your self and others is to keep residence for 14 days in the event you suppose you’ve been uncovered to somebody who has COVID-19. Verify your native well being division’s web site for details about choices in your space to presumably shorten this quarantine interval.
Typical laboratory findings in youngsters with COVID-19 embrace gentle abnormalities in white blood cell rely (both elevated or decreased lymphocyte counts), mildly elevated inflammatory markers (together with procalcitonin), and mildly elevated liver enzymes.23 Radiologic findings in youngsters with COVID-19 embrace unilateral or bilateral infiltrates on chest radiograph or CT, ground-glass opacities on CT, and consolidation with surrounding Halo signal on CT.23,24 CT needs to be used sparingly and just for hospitalized, symptomatic sufferers with particular medical indications. For extra info, see suggestions from the American School of Radiologyexterior icon.
Pediatric healthcare suppliers ought to take into account the kid’s medical presentation, requirement for supportive care, underlying medical situations, and the power for caregivers to take care of the kid at residence when deciding whether or not the kid might have inpatient take care of COVID-19. For extra info, go to Steering for residence care of individuals not requiring hospitalization for Coronavirus Illness 2019 (COVID-19). Present dad and mom assets on emergency warning indicators for COVID-19 and caring for somebody at residence.
At the moment, there are not any particular medicine authorized by the U.S. Meals and Drug Administration (FDA) for remedy of COVID-19. Therapy of COVID-19 stays largely supportive and consists of prevention and administration of issues. Remdesivirexterior icon, which has proven advantages in medical trials in adults, is at present obtainable by way of Emergency Use Authorization or compassionate use applications for youngsters. The security and effectiveness of remdesivir for remedy of COVID-19 has not but been evaluated in youngsters. Moreover, the Nationwide Institutes of Well being (NIH) means that dexamethasoneexterior icon could also be useful in pediatric sufferers with COVID-19 respiratory illness who’re on mechanical air flow. For extra info, evaluate concerns for youngstersexterior icon in NIH’s COVID-19 Therapy Pointers.25
For info on analysis and administration of MIS-C, go to MIS-C Info for Healthcare Suppliers.
You will need to keep in mind that youngsters contaminated with SARS-CoV-2 can current with different critical situations corresponding to diabetic ketoacidosis or intussusception, and a broad differential have to be maintained in evaluating unwell youngsters through the COVID-19 pandemic.10,14,20,21,26-29 Commonplace analysis and administration of co-occurring situations needs to be maintained for a kid contaminated with SARS-CoV-2, with further an infection management measures. Pediatric suppliers ought to have an applicable suspicion for COVID-19, but in addition to proceed to think about and check for different diagnoses, corresponding to group acquired pneumoniaexterior icon and influenza (see CDC’s Flu Info for Healthcare Professionals for extra info).
CDC has particular steering for inpatient obstetric healthcare settings and the analysis and administration of neonates in danger for COVID-19. Moreover, a number of different organizations have revealed tips associated to the remedy and administration of grownup and pediatric sufferers with COVID-19:
Group mitigation measures corresponding to shelter-in-place orders resulted in declines in outpatient pediatric visits and fewer vaccine doses administered through the early COVID-19 pandemic,30 leaving youngsters in danger for vaccine-preventable illnesses. Healthcare suppliers ought to work with households to maintain youngsters updated with all advisable vaccinations, particularly with influenza vaccinations for the 2020-2021 influenza season. For extra info on influenza, go to CDC’s Influenza web page. For extra info on immunization companies and vaccination suggestions through the pandemic, go to Vaccination Steering.
Healthcare suppliers ought to determine youngsters who’ve missed well-child visits and/or advisable vaccinations and get in touch with them to schedule in-person appointments, with prioritization of infants, youngsters age < 24 months and school-aged youngsters. Developmental surveillance and early childhood screenings, together with developmental and autism screening, ought to proceed together with referrals for early intervention companies and additional analysis if considerations are recognized.
All newborns needs to be seen by a pediatric healthcare supplier shortly after hospital discharge (three to 5 days of age). Ideally, new child visits needs to be achieved in-person, even through the COVID-19 pandemic, to guage feeding and weight achieve, verify for dehydration and jaundice, guarantee all parts of new child screening have been accomplished with applicable confirmatory testing and follow-up, and consider maternal well-being. All healthcare services ought to guarantee an infection prevention and management insurance policies are in place to reduce probability of publicity to SARS-CoV-2 amongst suppliers, sufferers, and households. For particular suggestions by healthcare facility kind and degree of group transmission, evaluate An infection Management Steering for Healthcare Professionals. CDC has further trainings and details about potential exposures within the office for healthcare suppliers.
Pediatric healthcare suppliers ought to incorporate schooling on on a regular basis an infection prevention measures, such because the significance of correct hand hygiene, social distancing, and sporting masks when in public, in addition to info on stress and coping through the pandemic of their common anticipatory steering with youngsters and their households. Pediatric healthcare suppliers ought to educate sufferers and households about an infection prevention insurance policies that exist in clinics, emergency departments, hospitals, and clinics. Remind folks to hunt emergency care instantly, if indicated, as delaying care could trigger hurt.
Major care practices ought to proceed to make use of an infection prevention methods together with:
- Scheduling sick visits and well-child visits throughout totally different instances of the day
- Lowering crowding in ready rooms, by asking sufferers to stay outdoors (e.g., keep of their automobiles, if relevant) till they’re referred to as into the ability for his or her appointment, or establishing triage cubicles to display screen sufferers safely
- Contemplating telemedicine for visits that don’t contain vaccination or don’t require an in-person bodily examination. For extra info, go to Utilizing Telehealth Providers
- Stokes EK, Zambrano LD, Anderson KN, et al. Coronavirus Illness 2019 Case Surveillance — United States, January 22–Might 30, 2020. MMWR
- Wu Z, McGoogan JM. Traits of and Essential Classes From the Coronavirus Illness 2019 (COVID-19) Outbreak in China: Abstract of a Report of 72314 Instances From the Chinese language Middle for Illness Management and Prevention. JAMA
- U.S. Census Bureau. https://www.census.gov/quickfacts/truth/desk/US/AGE295219#AGE295219exterior icon
- CDC. Demographic Traits of COVID-19. https://www.cdc.gov/covid-data-tracker/index.html#demographics. Information retrieved July 27, 2020.
- Kim L, Whitaker M, O’Halloran A, et al. Hospitalization Charges and Traits of Kids Aged <18 Years Hospitalized with Laboratory-Confirmed COVID-19 – COVID-NET, 14 States, March 1-July 25, 2020. MMWR..
- CDC COVID-19 Response Workforce. Coronavirus Illness 2019 in Kids — United States, February 12–April 2, 2020. MMWR Morbidity and Mortality Weekly Report. ePub: 6 April 2020.
- Sargent TH, Muller WJ, Zheng X, et al. Age-Associated Variations in Nasopharyngeal Extreme Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Ranges in Sufferers With Gentle to Average Coronavirus Illness 2019 (COVID-19). JAMA Pediatrics.
- Park YJ, Chloe YJ, Park O, et al. Contact Tracing Throughout Coronavirus Illness Outbreak, South Korea, 2020. Rising Infectious Illnesses.
- Szablewski CM, Chang Ok, Brown MM, et al. SARS-CoV-2 transmission and an infection amongst attendees of an in a single day camp – Georgia, June. 2020. MMWR
- CDC. COVID-19 Pandemic Planning Situations. https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html#table-2
- Dong Y, Mo X, Hu Y, et al. Epidemiological Traits of 2143 Pediatric Sufferers With 2019 Coronavirus Illness in China. Pediatrics
- Foster CE, Moulton EA, Munoz FM, et al. Coronavirus Illness 2019 in Kids Cared for at Texas Kids’s Hospital: Preliminary Medical Traits and Outcomes, Journal of the Pediatric Infectious Illnesses Society
- Xu H, Liu E, Xie J, et al. A observe up research of kids contaminated with SARS-CoV-2 from Western China. Annals of Translational Drugs.
- Shekerdemian LS, Mahmood NR, Wolfe KK, et al. Traits and Outcomes of Kids With Coronavirus Illness 2019 (COVID-19) An infection Admitted to US and Canadian Pediatric Intensive Care Models. JAMA Pediatrics.
- Mannheim J, Gretsch S, Layden JE, Fricchione MJ. Traits of Hospitalized Pediatric COVID-19 Instances – Chicago, Illinois, March – April 2020 [published online ahead of print, 2020 Jun 1]. J Pediatric Infect Dis Soc.
- Assaker, Rita, et al. Presenting signs of COVID-19 in youngsters: a meta-analysis of revealed research. BJA: British Journal of Anaesthesia.
- Poline et al. Systematic SARS-CoV-2 screening at hospital admission in youngsters: A French potential multicenter research. Medical Infectious Illness.
- Solar, D., Chen, X., Li, H. et al. SARS-CoV-2 an infection in infants beneath 1 yr of age in Wuhan Metropolis, China. World Journal of Pediatrics.
- Boulad F, Kamboj M, Bouvier N, Mauguen A, Kung AL. COVID-19 in Kids with Most cancers in New York Metropolis. JAMA Oncol.
- Oualha M, Bendavid M, Berteloot L, et al. Extreme and deadly types of COVID-19 in youngsters. Archives de Pediatrie.
- Solar D, Li H, Lu XX, et al. Medical options of extreme pediatric sufferers with COVD-19 in Wuhan: a single heart’s observational research. World Journal of Pediatrics.
- Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem Inflammatory Syndrome in US Kids and Adolescents. NEJM.
- Zimmerman P, Curtis N. COVID-19 in Kids, Being pregnant, and Neonates: A Evaluate of Epidemiologic and Medical Options. The Pediatric Infectious Illness Journal.
- Xia W, Shao J, Guo Y, et al. Medical and CT options in pediatric sufferers with COVID-19 an infection: totally different factors from adults. An infection and immunity.
- Nationwide Institutes of Well being. COVID-19 Therapy Pointers: Particular Issues in Kids. https://www.covid19treatmentguidelines.nih.gov/special-populations/youngsters/exterior icon
- Lin EE, Blumberg TJ, Adler AC, et al. Incidence of COVID-19 in Pediatric Surgical Sufferers Amongst 3 US Kids’s Hospitals. JAMA Surg
- Cai X, Ma Y, Li S, Chen Y, Rong Z, Li W. Medical Traits of 5 COVID-19 Instances With Non-respiratory Signs because the First Manifestation in Kids. Entrance Pediatr.
- Martínez-Castaño I, Calabuig-Barbero E, Gonzálvez-Piñera J, López-Ayala JM. COVID-19 An infection Is a Diagnostic Problem in Infants With Ileocecal Intussusception. Pediatr Emerg Care.
- Moazzam Z, Salim A, Ashraf A, Jehan F, Arshad M. Intussusception in an toddler as a manifestation of COVID-19. J Pediatr Surg Case Rep.
- Santoli JM, Lindley MC, DeSilva MB, et al. Results of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration – United States, 2020. MMWR