COVID in KIDS. Amy Luz T. Corpuz , M.D. MPH,DPPS.
Disclosure. The presenter has no financial interest in any of the products mentioned in this presentation. No corporate payments or gifts have been received regarding this presentation….
- Jeremiah 33:6. “ Nevertheless, I will bring health and healing to it; I will heal my people and will let them enjoy abundant peace and security. ”.
[Audio] TRANSMISSION: COVID- 19 is primarily transmitted through inhalation of infected respiratory droplets, or by contact of the mucosal surfaces of the eyes, nose and mouth after touching contaminated objects and surfaces. Airborne transmission may occur when viral particles are aerosolized through aerosol-generating procedures typically performed in health facilities. imited evidence at present on whether viral RNA shed in stools is infectious and whether fecal viral shedding plays a role in the dissemination of infection. like breathing, speaking and singing have also been demonstrated to generate aerosols. Other possible modes of transmission have been reported in literature..
[Audio] TRANSMISSION: COVID- 19 is primarily transmitted through inhalation of infected respiratory droplets, or by contact of the mucosal surfaces of the eyes, nose and mouth after touching contaminated objects and surfaces. Airborne transmission may occur when viral particles are aerosolized through aerosol-generating procedures typically performed in health facilities. limited evidence at present on whether viral RNA shed in stools is infectious and whether fecal viral shedding plays a role in the dissemination of infection. like breathing, speaking and singing have also been demonstrated to generate aerosols. Other possible modes of transmission have been reported in literature..
[Audio] PATHOGENESIS OF COVID- 19 The first step in infection is the virus attaching to a host cell, achieved through the spike (S) protein of the virus binding to its target receptor, the angiotensin-converting enzyme 2 ( ACE2) receptor. The ACE2 receptor is expressed in airway epithelial cells, alveolar epithelial cells, vascular endothelial cells, and macrophages in the lung. SARS-CoV-2 reduces expression of ACE2 in lung cells, and loss of pulmonary ACE2 function is associated with acute lung injury. ACE2 also regulates the renin-angiotensin system ( RAS), hence reduced ACE2 function influences blood pressure, fluid and electrolyte balance, and enhances inflammation and vascular permeability in the airways. The binding of the virus to the ACE2 receptor triggers endocytosis of the virion, after which viral replication ensues, leading to viral assembly, maturation, and virus release. SARS-CoV-2 infection triggers a local immune response, recruiting macrophages and monocytes that respond to infection, release cytokines, and prime adaptive T and B cell immune responses. This immune response is capable of resolving the infection in most cases. However, in some cases, a dysfunctional immune response occurs, which can cause severe lung and even systemic pathology. SARS-CoV- 2 is capable of inducing death and injury of virus-infected cells and tissues in a phenomenon called pyroptosis, a highly 7.
Baby Infant With Barking Croup cough (Child Toddler Croup) Shortness of Breath.mp4.
[Audio] Moderate disease Pneumonia Child with clinical signs of non-severe pneumonia ( cough or difficulty breathing + fast breathing and/or chest indrawing) and no signs of severe pneumonia, including SpO2 ≥ 95% on room air Tachypnea (in breaths/min): 3months old to 12months old: ≥ 50 breaths per minute 1year old to 5years old: ≥ 40 breaths per minute 5-12years: ≥ 30 breaths per minute ≥12years: ≥ 20 breaths per minute While the diagnosis can be made on clinical grounds, chest imaging ( radiograph, CT scan, ultrasound) may assist in diagnosis and identify or exclude pulmonary complications..
[Audio] Moderate: 1: 16- 27 Moderate disease Pneumonia Child with clinical signs of non-severe pneumonia ( cough or difficulty breathing + fast breathing and/or chest indrawing) and no signs of severe pneumonia, including SpO2 ≥ 95% on room air Tachypnea (in breaths/min): 3months old to 12months old: ≥ 50 breaths per minute 1year old to 5years old: ≥ 40 breaths per minute 5- 12years: ≥ 30 breaths per minute ≥12years: ≥ 20 breaths per minute While the diagnosis can be made on clinical grounds, chest imaging ( radiograph, CT scan, ultrasound) may assist in diagnosis and identify or exclude pulmonary complications..
[Audio] Severe: 1: 27 Child with clinical signs of pneumonia ( cough or difficulty in breathing) + at least one of the following: Central cyanosis or SpO2 < 95%; severe respiratory distress (e.g. fast breathing, grunting, very severe chest indrawing); general danger sign: inability to breastfeed or drink, lethargy or unconsciousness, or convulsions Tachypnea (in breaths/min): 3months old to 12months old: ≥ 50 breaths per minute 1year old to 5years old: ≥ 40 breaths per minute 5-12years: ≥ 30 breaths per minute ≥12years: ≥ 20 breaths per minute.
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PREVENTION. GLOVES. MASK. HANDWASHING. DISTANCE. STAY HOME.
[Audio] Home interventions for children with mild COVID- 19 Children with non-severe disease – and in some cases with stable underlying comorbidities – do not require hospital interventions unless there is concern for rapid deterioration or an inability to promptly return to hospital. Laboratory confirmation of COVID-19 is not necessary for patients with mild symptoms because it will not change the management. Home management is recommended and should focus on appropriate supportive treatment, prevention of transmission of the virus to others, as well as monitoring for clinical deterioration, which will eventually prompt inpatient management Isolation to contain or prevent virus transmission within the household and community should be prioritized. Where feasible, a communication link with health care providers should be made for the duration of the home care until the child's symptoms have completely resolved..
[Audio] Home Therapies ● Specific medications against COVID- 19 are still under investigation. Studies are still currently being evaluated, consolidated, and reviewed to ensure that recommendations are evidence-based. ● Antipyretics such as paracetamol may be given to make the febrile child more comfortable. ● Home nebulization should be avoided unless the child's physician decides that it is indicated, because the risk of infection transmission via droplet nuclei or aerosols may increase during nebulizer treatments. Use a metered-dose inhaler if necessary. ● While getting essential vitamins and minerals such as Vitamin D3 and Zinc from supplements may help bolster the immune system, emphasis must be made on providing a balanced diet and proper nutrition, as well as adequate hydration. There is currently no evidence showing supplements provide direct benefits for children with COVID-19. ● Steam inhalation, or the practice of inhalation of water vapor by leaning over a bowl of boiling water, has been shown to be ineffective in treating and preventing COVID-19. In addition, it has been found to be associated with scald burns. Emotional and Mental Support ● If the child can comprehend, parents are encouraged to talk to the child about their condition in a way they can understand, giving reassurance that they are being observed closely at home with the supervision of their doctor. ● ● Continue with the child's regular routine while under quarantine at home and allow time for learning activities and simple play if the child feels well enough for it. Observe limits in screen time as recommended for the child's age..
[Audio] Isolation ● Children should stay at home and be separated from other people in the household. NOTE: Should the home not be suitable for isolation or if the local authorities decide to admit the child and his/her family in a quarantine facility, the same isolation precautions should still be followed. ● Place the child in a well-ventilated single room (e.g. open windows, use electric fans for ventilation, may use air conditioner if available) ideally with its own bathroom, where feasible. ● Ventilation at home may be improved by the following: a) bringing in as much fresh air into the home as possible by opening doors and windows if it's safe to do so; b) using fans to improve air flow; c) filter the air in the home when a heating, ventilation and air conditioning system ( HVAC) is in use; consider using a portable high-efficiency particulate air ( HEPA) cleaner if an HVAC system is not available or extra filtration is intended. ● Confine activities of the child in his/her room. If not possible, limit shared space and movement of the child in the house. ● Assign one person who is in good health as primary caretaker of the child (see section on Caregiver). ● Other household members not caring for the child should stay in a different room, or if not feasible, must always maintain a distance of at least 1 meter from the child. ● Do not allow visitors until the child has completely recovered and has no signs or symptoms of respiratory tract infection. ● The child should use dedicated dishes, drinking glasses, cups, eating utensils, towels, and beddings. ● Children 2 years of age and older should be properly instructed on how to wear a mask. The child's mask should securely cover the nose and mouth. Masks should not be worn when eating or drinking, and should not be touched when worn. All household members should also wear a surgical face mask when in the same room as the child or when interacting inside the home. ● Children younger than 2 years old should NOT wear masks due to risk of suffocation. A mask is also not recommended: (1) if the child has difficulty breathing when a mask is worn; (2) if the child has a cognitive or respiratory impairment which makes tolerating a mask difficult; ( 3) if the mask is a possible choking or strangulation hazard; and ( 4) if wearing a mask causes the child to touch his face more frequently. ● Try to find the right size of mask for the child's face and be sure to adjust for a secure fit. The regular adult-sized face mask may be too large for a small child. N95 masks are not recommended for children and should be reserved for healthcare workers at increased risk of exposure to COVID-19. ● Children older than 2 years old may use a face shield together with a face mask. Ensure that the use of a face shield does not pose a risk of suffocation for the child. Neonates and children less than 2 years old should NOT use a face shield. Face shields must be thoroughly disinfected using alcohol or detergent solution then air-dried after every use. ● The child and all household members should practice hand hygiene ( handwashing or use of hand disinfection) following contact with the child suspected or confirmed to have COVID- 19. ● Teach the child to cover his/her mouth and nose during coughing or sneezing using tissue, inner part of the elbow or sleeves, followed by hand hygiene. Caregiver ● Ideally, assign one person of good health, non-elderly, and with no underlying comorbidities and immunocompromising conditions, to avoid undue risk to the caregiver. ● Caregivers should wear a surgical mask that covers their nose and mouth when in the same room as the patient. DO NOT touch or handle masks during use. Once wet or dirty with secretions, remove the mask WITHOUT touching the front and replace immediately with a dry mask. DO NOT reuse masks. Cloth masks do not provide adequate protection in this setting and should NOT be used. ● Caregiver should use disposable gloves when handling oral or respiratory secretions, stool or urine. Wash and disinfect hands after removing gloves. Hygiene and Sanitation ● Proper hand washing with soap and water for at least 20 seconds should be performed in these situations: ○ Before and after contact with the child, especially after handling the child's secretions ○ Before and after preparing the child's food / feeding the child ○ After assisting the child in using the toilet or diaper-changing, and after bathing the child ○ If hands are visibly dirty ● Use disposable paper towels or clean cloth towels (with frequent replacements) to dry hands. ● Avoid direct contact with the child's secretions and stool. ● The toilet should be flushed with the lid down to prevent droplet splatter and aerosol clouds. ● Clean and disinfect surfaces frequently touched in the room as well as toilet surfaces using regular household soap or detergent. Ensure cleaning agents are properly labeled and stored beyond the child's reach, to prevent accidental ingestion/ poisoning. Laundry and Disposal of Soiled Linen and Diapers ● Waste generated during home care (including diapers, tissue/ wipes, etc.) should be placed into a waste bin with a lid in the child's room. The trash bag must be tightly sealed before disposal. ● Do not shake dirty laundry; this minimizes the possibility of dispersing the virus through the air. ● Clothes/beddings/ pillows/stuffed toys used by the child must be washed separately. ● Machine washing with warm water and laundry detergent is recommended. If machine washing is not possible, soiled linen can be soaked in hot water and soap in a large drum using a stick to stir and being careful to avoid splashing. The drum should then be emptied, and the linens soaked in 0.05% chlorine for approximately 30 minutes. The laundry should then be rinsed with clean water. If still dirty, soiled linen may be washed thoroughly using regular laundry soap/ household detergent and warm water, then allowed to dry under the sun. ● If stools are on surfaces of linen or towels, the stool should be carefully removed with paper towels and immediately safely disposed of in a toilet or latrine. Then the soiled linen or towels should be treated as soiled linens. ● Wear disposable gloves and face masks when handling soiled items. Place all used disposable gloves, face masks, and other contaminated items in a lined container before disposing of them with other household waste. ● Wash hands with soap and water (or use an alcohol-based hand sanitizer) immediately after handling these items. Soap and water should be used preferentially if hands are visibly dirty. Monitoring ● The caregiver should be instructed to record the child's symptoms using the symptom monitoring form ( Appendix B), and should notify the healthcare provider if the child's symptoms worsen or if one of the child's contacts develops symptoms. It may be necessary to bring the child to the nearest health care facility for proper assessment if symptoms worsen or if no improvement is seen in 2-3 days at home..
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[Audio] Mild disease : No pneumonia Symptomatic patients meeting the case definition for COVID- 19 without evidence of viral pneumonia or hypoxia..
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THANK you! Keep safe. Dr. Amy Corpuz Pediatrics Clinic.