Special precautions in children during COVID 19 pandemic

Overview

During second wave, there were increasing number of children affected. Threat of third wave is constantly lurking over our head. COVID 19 can be threatening in children less than 1 yr old and those with underlying medical conditions.
However, most infections in children are mild or asymptomatic, which require home care.

Home care

• Isolate the child from other family members especially elderly people, with one dedicated caregiver.
• Caregiver must wear mask, wash hands frequently and monitor herself for development of symptoms.
• Clean frequently touched areas, like door knobs, tables daily. Laundry of infected child should be handled with wearing gloves. It can be machine washed with hottest temperature with other laundry.
• Whole family staying with the child must be home quarantined, except those who are fully vaccinated and or had COVID 19 in past 3 months.
  If any of the following is observed, child needs to be admitted in the hospital.
  Troubled breathing
  Persistent pain / pressure in the chest
  New confusion
  Cannot wake up / stay awake when not tired
  Pale / grey / blue coloured skin

Prevention in children

Hand wash

• Frequent hand washing with soap and water for 20 secs or with alcohol based solution (60%and above), is a most important step in prevention.
• Hand washing needs to be supervised for those below 6years.
• Healthy habits need to be inculcated by being a role model, explaining the importance of hand washing and making it a family activity.
• While coughing, mouth and nose should be covered with either a tissue or inside of elbow. Covering with hands is not advised as same hands can spread infections.

When to wash hands?

After blowing your nose, coughing or sneezing
After being in public space
Before and after caring for someone who is sick
Before, during and after preparing food
Before eating
After toilet visit
After touching animal, animal feed or animal waste
After touching garbage

Method of hand washing
Wet hands with water
Take ample of soap in the hands
Rub palms together
Rub back of the palms with special attention to the gaps between fingers
Rub back of the fingers
Rub tip of the fingers on the palm
Clean thumbs with opposite hand
Rubbing of wrist
Wash off the soap completely with running water

Avoid close contact

What is close contact?

• In contact with a sick person, within 6ft and for more than 15mins.
  Whenever there is more interaction, there is increased risk of getting infected.
• However, due to social restrictions, the risk of children getting socially deprived has increased. CDC has defined risk levels for the play dates in children.
• Low risk is virtual play date with no physical contact.
• Medium risk is infrequent play dates with same family, who observe preventive measures strictly. It needs to be outdoor and social distancing should be maintained throughout.
  Highest risk is frequent play dates with different play mates, indoor and no social distancing is observed.
  In my opinion, medium risk play dates are always advisable to cut down chances of getting infected as well as for social development of children.

Masks

• In addition to social distancing and frequent hand washing, masks needs to worn every where by everyone except children below 2 years
  Those who have troubled breathing
  Those who have developmental and behavioural problems

Which type of masks recommended?

Cloth (cotton) double layer masks
Those mask made up with tightly woven fabric, which does not let light pass through when held against light
Surgical tri-ply mask, only when visiting hospitals
Masks with exhalation valve, Double masks, N95 masks and mask simulators such as dupatta, gamcha are not recommended for use by common people.

Situations where mask is not possible to wear-

Dinning : wear mask most of the time except when eating and drinking.

Water activities : mask cannot be worn as it is difficult to breath through wet mask.

High intensity exercises : Wearing mask during high intensity exercises add to increase work of breathing, so masks are not recommended. In children, such activities need to be supervised.

Children below 2 years : Masks are not recommended as they are of improper fit, children suck on to it and they have low lung reserve. In these children, social distancing and face shield can be used.

Cleaning and disinfection
Daily cleaning with household cleaners are advisable with special attention to high touch ares such as door knobs, remotes, switches, table, counter tops.

Travelling
Any travelling is not safe for children, it is better to defer traveling till pandemic mellows down.

Vaccination
All essential vaccination must be administered as per vaccines schedule, with special attention to Influenza vaccine.

Keeping children healthy
Inculcate balance and healthy dietary habits in children along with daily exercises/activities.
Children below 5 years of age are recommended to be active throughout the day.
For children between 6 yrs to 17 yrs, 60 mins of moderate to vigorous intensity physical activity daily with mix of aerobic, muscle and bone strengthening activities are recommended.

Prevention is better than cure. Vulnerable groups need to be protected till the pandemic mellows down.