This steerage is meant to inform pediatric healthcare suppliers of up-to-date details about kids with suspected or confirmed COVID-19 and about caring for kids 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For healthcare suppliers caring for neonates (≤28 days outdated) with suspected or confirmed COVID-19, together with these born to a mom with suspected or confirmed COVID-19, please check with CDC steerage for evaluating and managing neonates in danger for COVID-19.
Incidence of COVID-19 in Kids
In the US and globally, fewer instances of COVID-19 have been reported in kids (age 0-17 years) in contrast with adults.1,2 Whereas kids comprise 22% of the US inhabitants,3 latest knowledge present that 7.3% of all instances of COVID-19 in the US reported to CDC have been amongst kids (as of August third, 2020).4 The quantity and price of instances in kids in the US have been steadily rising from March to July 2020. The true incidence of SARS-CoV-2 an infection in kids isn’t recognized resulting from lack of widespread testing and the prioritization of testing for adults and people with extreme sickness. Hospitalization charges in kids are considerably decrease than hospitalization charges in adults with COVID-19, suggesting that kids could have much less extreme sickness from COVID-19 in comparison with adults.5, 6 Go to CDC’s Instances, Knowledge, and Surveillance web page for present CDC knowledge.
Infections and Transmission Amongst Kids
It’s unclear whether or not kids are as inclined to an infection by SARS-CoV-2 in contrast with adults and whether or not they can transmit the virus as successfully as adults. Current proof means that kids seemingly have the identical or greater viral hundreds of their nasopharynx in contrast with adults7 and that kids can unfold the virus successfully in households and camp settings.8,9
As a result of group mitigation measures and college closures, transmission of SARS-CoV-2 to and amongst kids could have been decreased in the US through the pandemic within the spring and early summer season of 2020. This may occasionally clarify the low incidence in kids in contrast with adults. Evaluating tendencies in pediatric infections earlier than and after the return to in-person college and different actions could present further understanding about infections in kids.
The incubation interval of SARS-CoV-2 seems to be about the identical for kids as in adults, at 2-14 days with a mean of 6 days.10
Indicators or signs of COVID-19 in kids embrace:
- Nasal congestion or rhinorrhea
- New lack of style or odor
- Sore throat
- Shortness of breath or issue respiratory
- Stomach 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 number of (equivalent to solely higher respiratory signs or solely gastrointestinal signs), or could also be asymptomatic. The most typical signs in kids are cough and/or fever.11-15 A latest systematic evaluation 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 kids are just 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 kids notably difficult.17
Severity of Sickness in Kids
Whereas kids contaminated with SARS-CoV-2 are much less more likely to develop extreme sickness in contrast with adults, kids are nonetheless susceptible to growing extreme sickness and problems from COVID-19. Current COVID-19 hospitalization surveillance knowledge exhibits that the speed of hospitalization amongst kids is low (8.0 per 100,000 inhabitants) in contrast with that in adults (164.5 per 100,000 inhabitants), however hospitalization charges in kids are rising. 5 Whereas kids have decrease charges of mechanical air flow and loss of life than adults, 1 in 3 kids hospitalized with COVID-19 in the US have been admitted to the intensive care unit, which is identical in adults.5
Present proof means that kids with sure underlying medical circumstances and infants (age <1 yr) is perhaps at elevated threat for extreme sickness from SARS-CoV-2 an infection.10,11,14 Of the kids who’ve developed extreme sickness from COVID-19, most have had underlying medical circumstances. 5
- There’s restricted proof about which underlying medical circumstances in kids may improve the danger for extreme sickness. Present proof means that kids with medical complexity, with genetic, neurologic, metabolic circumstances, or with congenital coronary heart illness is perhaps at elevated threat for extreme sickness from COVID-19. Just like adults, kids 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 keep a excessive index of suspicion for SARS-CoV-2 an infection in these populations and monitor the development of sickness intently, it seems that most infants18 and kids with sure underlying circumstances equivalent to most cancers19 who’re contaminated with SARS-CoV-2 don’t normally develop extreme sickness.
- Hospitalization charges in the US are greater amongst Hispanic/Latino kids and black, non-Hispanic kids and non-Hispanic black kids in contrast with white kids, which can be associated to the upper charges of weight problems and different underlying circumstances amongst these populations.5
Just like adults, kids with extreme COVID-19 could develop respiratory failure, myocarditis, shock, acute renal failure, coagulopathy, and multi-organ system failure. Some kids with COVID-19 have developed different severe 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 kids (MIS-C).22 For the case definition, really useful analysis, and present knowledge on MIS-C instances in the US, go to MIS-C Data for Healthcare Suppliers.
Viral exams (nucleic acid or antigen) are really useful to diagnose acute an infection with SARS-CoV-2. Testing methods, together with medical standards for contemplating testing and really useful specimen sort, are the identical for kids and adults. CDC’s steerage for the analysis and administration of neonates in danger for COVID-19 particulars particular testing concerns for newborns.
For extra data on CDC’s suggestions for isolation, which apply to kids and adults, go to: discontinuing precautions and disposition of sufferers with COVID-19 in healthcare settings and discontinuation of dwelling isolation for individuals not in healthcare settings.
Testing, Isolation, and Quarantine for Faculty-Aged Kids
As kids 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 individuals exterior the family. Assessment CDC’s data for varsity directors on symptom screening and testing for kids in class in addition to CDC’s Group Mitigation framework.
Faculty-aged kids needs to be prioritized for viral testing if they’ve:
- Indicators or signs of COVID-19 and
- shut contact (inside 6 ft 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 chance for publicity (which incorporates residing 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 ft 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 mustn’t attend college, however the size of time the kid ought to keep dwelling depends upon the probably etiology of sickness (COVID-19 or not). Return to high school insurance policies for kids with COVID-19 needs to be primarily based on CDC’s suggestion for discontinuation of dwelling isolation. A detrimental take a look at or physician’s notice 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 ft 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 chance for publicity to SARS-CoV-2 (which incorporates residing in or touring to a group with substantial transmission), she or he needs to be evaluated for different illness processes. If the kid is set to seemingly not have COVID-19 by a healthcare supplier, he/she needs to be allowed to return to high school in line with present college insurance policies for non-COVID sicknesses. 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 sicknesses or after initiation of antibiotics for bacterial sicknesses.
- If the kid has signs of COVID-19 and has elevated chance for publicity (which incorporates residing in or touring to a group with substantial transmission), she or he needs to be examined for SARS-CoV-2 an infection, if doable. If the take a look at result’s detrimental, the kid needs to be allowed to return to high school as soon as their signs of sickness have improved in line 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 will isolate in line with CDC’s suggestions for discontinuation of dwelling 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 detrimental, in accordance with CDC’s Quarantine If You Would possibly Be Sick. One of the best ways to guard your self and others is to keep dwelling for 14 days for those who suppose you’ve been uncovered to somebody who has COVID-19. Examine 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 kids with COVID-19 embrace delicate abnormalities in white blood cell depend (both elevated or decreased lymphocyte counts), mildly elevated inflammatory markers (together with procalcitonin), and mildly elevated liver enzymes.23 Radiologic findings in kids 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 data, see suggestions from the American School of Radiologyexterior icon.
Pediatric healthcare suppliers ought to contemplate the kid’s medical presentation, requirement for supportive care, underlying medical circumstances, and the flexibility for caregivers to look after the kid at dwelling when deciding whether or not the kid might have inpatient look after COVID-19. For extra data, go to Steerage for dwelling 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 dwelling.
At present, there aren’t any particular medication accepted by the U.S. Meals and Drug Administration (FDA) for therapy of COVID-19. Remedy of COVID-19 stays largely supportive and consists of prevention and administration of problems. Remdesivirexterior icon, which has proven advantages in medical trials in adults, is at present obtainable via Emergency Use Authorization or compassionate use applications for kids. The protection and effectiveness of remdesivir for therapy of COVID-19 has not but been evaluated in kids. Moreover, the Nationwide Institutes of Well being (NIH) means that dexamethasoneexterior icon could also be helpful in pediatric sufferers with COVID-19 respiratory illness who’re on mechanical air flow. For extra data, evaluation concerns for kidsexterior icon in NIH’s COVID-19 Remedy Tips.25
For data on analysis and administration of MIS-C, go to MIS-C Data for Healthcare Suppliers.
It is very important keep in mind that kids contaminated with SARS-CoV-2 can current with different severe circumstances equivalent to diabetic ketoacidosis or intussusception, and a broad differential should be maintained in evaluating ailing kids through the COVID-19 pandemic.10,14,20,21,26-29 Normal analysis and administration of co-occurring circumstances 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 take a look at for different diagnoses, equivalent to group acquired pneumoniaexterior icon and influenza (see CDC’s Flu Data for Healthcare Professionals for extra data).
CDC has particular steerage 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 pointers associated to the therapy and administration of grownup and pediatric sufferers with COVID-19:
Group mitigation measures equivalent 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 kids in danger for vaccine-preventable ailments. Healthcare suppliers ought to work with households to maintain kids updated with all really useful vaccinations, particularly with influenza vaccinations for the 2020-2021 influenza season. For extra data on influenza, go to CDC’s Influenza web page. For extra data on immunization companies and vaccination suggestions through the pandemic, go to Vaccination Steerage.
Healthcare suppliers ought to determine kids who’ve missed well-child visits and/or really useful vaccinations and speak to them to schedule in-person appointments, with prioritization of infants, kids age < 24 months and school-aged kids. 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 completed in-person, even through the COVID-19 pandemic, to judge feeding and weight acquire, examine for dehydration and jaundice, guarantee all elements 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 likelihood of publicity to SARS-CoV-2 amongst suppliers, sufferers, and households. For particular suggestions by healthcare facility sort and degree of group transmission, evaluation An infection Management Steerage 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 carrying masks when in public, in addition to data on stress and coping through the pandemic of their common anticipatory steerage with kids 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 individuals to hunt emergency care instantly, if indicated, as delaying care could trigger hurt.
Main care practices ought to proceed to make use of an infection prevention methods together with:
- Scheduling sick visits and well-child visits throughout completely different instances of the day
- Decreasing crowding in ready rooms, by asking sufferers to stay exterior (e.g., keep of their automobiles, if relevant) till they’re referred to as into the ability for his or her appointment, or organising 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 data, go to Utilizing Telehealth Providers
- Stokes EK, Zambrano LD, Anderson KN, et al. Coronavirus Illness 2019 Case Surveillance — United States, January 22–Could 30, 2020. MMWR
- Wu Z, McGoogan JM. Traits of and Vital 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. Knowledge 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 Staff. 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 Reasonable 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 Medication.
- 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 kids: a meta-analysis of revealed research. BJA: British Journal of Anaesthesia.
- Poline et al. Systematic SARS-CoV-2 screening at hospital admission in kids: 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 kids. 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 Assessment 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: completely different factors from adults. An infection and immunity.
- Nationwide Institutes of Well being. COVID-19 Remedy Tips: Particular Concerns in Kids. https://www.covid19treatmentguidelines.nih.gov/special-populations/kids/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