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 kids throughout the pandemic. Youngsters 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For healthcare suppliers caring for neonates (≤28 days outdated) with suspected or confirmed COVID-19, together with these born to a mom with suspected or confirmed COVID-19, please consult with CDC steering for evaluating and managing neonates in danger for COVID-19.
Incidence of COVID-19 in Youngsters
In america 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 latest knowledge present that 7.3% of all instances of COVID-19 in america reported to CDC have been amongst youngsters (as of August third, 2020).4 The quantity and fee of instances in youngsters in america have been steadily rising from March to July 2020. The true incidence of SARS-CoV-2 an infection in youngsters shouldn’t be identified attributable to 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 Circumstances, Knowledge, and Surveillance web page for present CDC knowledge.
Infections and Transmission Amongst Youngsters
It’s unclear whether or not youngsters are as prone 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 youngsters doubtless have the identical or larger viral masses of their nasopharynx in contrast with adults7 and that youngsters can unfold the virus successfully in households and camp settings.8,9
Resulting from neighborhood mitigation measures and college closures, transmission of SARS-CoV-2 to and amongst youngsters could have been lowered in america throughout 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 developments 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 kids as in adults, at 2-14 days with a median of 6 days.10
Indicators or signs of COVID-19 in youngsters embody:
- Nasal congestion or rhinorrhea
- New lack of style or scent
- Sore throat
- Shortness of breath or issue respiration
- Stomach ache
- Nausea or vomiting
- Poor urge for food or poor feeding
Youngsters contaminated with SARS-CoV-2 could have many of those non-specific signs, could solely have a couple of (equivalent 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 latest systematic overview estimated that 16% of youngsters 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 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 youngsters significantly difficult.17
Severity of Sickness in Youngsters
Whereas youngsters contaminated with SARS-CoV-2 are much less prone to develop extreme sickness in contrast with adults, youngsters are nonetheless susceptible to growing extreme sickness and problems from COVID-19. Current COVID-19 hospitalization surveillance knowledge reveals that the speed of hospitalization amongst youngsters is low (8.Zero 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 dying than adults, 1 in Three youngsters hospitalized with COVID-19 in america have been admitted to the intensive care unit, which is identical 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 kids who’ve developed extreme sickness from COVID-19, most have had underlying medical situations. 5
- There’s 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. Much like adults, youngsters with weight problems, diabetes, bronchial asthma and power 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 intently, it seems that most infants18 and kids with sure underlying situations equivalent to most cancers19 who’re contaminated with SARS-CoV-2 don’t often develop extreme sickness.
- Hospitalization charges in america are larger 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
Much 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 Youngsters 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 america, go to MIS-C Data for Healthcare Suppliers.
Viral exams (nucleic acid or antigen) are advisable to diagnose acute an infection with SARS-CoV-2. Testing methods, together with scientific standards for contemplating testing and advisable specimen sort, are the identical for kids and adults. CDC’s steering for the analysis and administration of neonates in danger for COVID-19 particulars particular testing issues 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 dwelling isolation for folks not in healthcare settings.
Testing, Isolation, and Quarantine for College-Aged Youngsters
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 protected to return to high school or be with folks outdoors the family. Assessment CDC’s info for varsity directors on symptom screening and testing for kids at school in addition to CDC’s Neighborhood Mitigation framework.
College-aged youngsters 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 15 minutes 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 neighborhood with substantial transmission as outlined by the native public well being division and described in CDC’s Neighborhood Mitigation framework)
- No signs however have had shut contact (inside 6 ft of somebody for a complete of 15 minutes or extra) with an individual with laboratory confirmed or possible SARS-CoV-2 an infection.
Youngsters with signs of an infectious illness mustn’t attend faculty, however the size of time the kid ought to keep dwelling is dependent upon the most probably etiology of sickness (COVID-19 or not). Return to high school insurance policies for kids with COVID-19 needs to be based mostly on CDC’s advice 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 10 days of isolation with enchancment of signs.
- If the kid has signs of COVID-19, however the youngster has not had shut contact (inside 6 ft of somebody for a complete of 15 minutes 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 neighborhood with substantial transmission), she or he needs to be evaluated for different illness processes. If the kid is decided to doubtless not have COVID-19 by a healthcare supplier, he/she needs to be allowed to return to high school in keeping with current faculty insurance policies for non-COVID diseases. Examples of non-COVID return to high school insurance policies embody decision of fever with out antipyretics for 24 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 neighborhood with substantial transmission), she or he needs to be examined for SARS-CoV-2 an infection, if attainable. 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 keeping 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 May Be Sick.
Typical laboratory findings in youngsters with COVID-19 embody delicate 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 embody 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 scientific indications. For extra info, see suggestions from the American School of Radiologyexterior icon.
Pediatric healthcare suppliers ought to take into account the kid’s scientific presentation, requirement for supportive care, underlying medical situations, and the power for caregivers to take care of the kid at dwelling when deciding whether or not the kid may have inpatient take care of COVID-19. For extra info, go to Steering for dwelling care of individuals not requiring hospitalization for Coronavirus Illness 2019 (COVID-19). Present mother and father sources on emergency warning indicators for COVID-19 and caring for somebody at dwelling.
Presently, there are not any particular medicine authorised by the U.S. Meals and Drug Administration (FDA) for therapy of COVID-19. Remedy of COVID-19 stays largely supportive and contains prevention and administration of problems. Remdesivirexterior icon, which has proven advantages in scientific trials in adults, is at present obtainable by way of 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 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, overview issues for kidsexterior icon in NIH’s COVID-19 Remedy Pointers.25
For info on analysis and administration of MIS-C, go to MIS-C Data for Healthcare Suppliers.
You will need to keep in mind that youngsters contaminated with SARS-CoV-2 can current with different critical situations equivalent to diabetic ketoacidosis or intussusception, and a broad differential should be maintained in evaluating in poor health youngsters throughout the COVID-19 pandemic.10,14,20,21,26-29 Customary 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 additionally to proceed to think about and take a look at for different diagnoses, equivalent to neighborhood acquired pneumoniaexterior icon and influenza (see CDC’s Flu Data 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 printed tips associated to the therapy and administration of grownup and pediatric sufferers with COVID-19:
Neighborhood mitigation measures equivalent to shelter-in-place orders resulted in declines in outpatient pediatric visits and fewer vaccine doses administered throughout the early COVID-19 pandemic,30 leaving youngsters in danger for vaccine-preventable ailments. 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 providers and vaccination suggestions throughout the pandemic, go to Vaccination Steering.
Healthcare suppliers ought to determine youngsters who’ve missed well-child visits and/or advisable vaccinations and call 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 providers and additional analysis if issues 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 accomplished in-person, even throughout the COVID-19 pandemic, to guage 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 amenities 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 stage of neighborhood transmission, overview 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 training 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 info on stress and coping throughout 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 completely different occasions of the day
- Decreasing crowding in ready rooms, by asking sufferers to stay outdoors (e.g., keep of their automobiles, if relevant) till they’re known as into the power 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 info, go to Utilizing Telehealth Companies
- 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 Vital Classes From the Coronavirus Illness 2019 (COVID-19) Outbreak in China: Abstract of a Report of 72314 Circumstances From the Chinese language Heart for Illness Management and Prevention. JAMA
- U.S. Census Bureau. https://www.census.gov/quickfacts/reality/desk/US/AGE295219#AGE295219exterior icon
- CDC. Demographic Tendencies 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 Youngsters 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 Youngsters — 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 Ailments.
- 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 Youngsters Cared for at Texas Youngsters’s Hospital: Preliminary Medical Traits and Outcomes, Journal of the Pediatric Infectious Ailments Society
- Xu H, Liu E, Xie J, et al. A observe up examine of youngsters contaminated with SARS-CoV-2 from Western China. Annals of Translational Drugs.
- Shekerdemian LS, Mahmood NR, Wolfe KK, et al. Traits and Outcomes of Youngsters 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 Circumstances – 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 printed research. BJA: British Journal of Anaesthesia.
- Poline et al. Systematic SARS-CoV-2 screening at hospital admission in youngsters: A French potential multicenter examine. Medical Infectious Illness.
- Solar, D., Chen, X., Li, H. et al. SARS-CoV-2 an infection in infants below 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 Youngsters 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 middle’s observational examine. World Journal of Pediatrics.
- Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem Inflammatory Syndrome in US Youngsters and Adolescents. NEJM.
- Zimmerman P, Curtis N. COVID-19 in Youngsters, 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 Pointers: Particular Concerns in Youngsters. 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 Three US Youngsters’s Hospitals. JAMA Surg
- Cai X, Ma Y, Li S, Chen Y, Rong Z, Li W. Medical Traits of 5 COVID-19 Circumstances With Non-respiratory Signs because the First Manifestation in Youngsters. 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