Answers by Dr Reeta Bora, Professor of Paediatrics and Neonatology, Lakhimpur Medical College, Assam. She is a member of IAP, NNF and the only DM Neonatologist in the entire NE region.
- What do we know about the present COVID-19 strains and its impact on young people and children?
In the first wave of COVID-19 pandemic in India in 2020, it was observed that children were less affected than adults. However, in the second wave of COVID-19 in India in 2021, an increased number of children have been affected. The Indian variant of SARS-CoV-2 could be accelerating the devastating second wave. The Ministry of Health & Family welfare, Govt of India, reported that between March 1 and April 10, 2021, there were 79,688 paediatric cases in the five highest hit states. The new variant has mutations that make the virus more infective and increase its transmissibility. This, along with people lowering the guard, huge social mixing and gatherings could have triggered large scale cases. Since large numbers of adults are getting infected, the proportion of children and young people are also increasingly seen infected.
- Do we need special precautions for the delivery of the babies born of Covid positive mothers? Can Covid positive mothers breastfeed their babies?
There are no special precautions for the babies born of Covid positive mothers. If there is no provision of separate delivery room for the Covid positive mother, her bed should be separated and kept away from rest of the delivery beds. All life-saving birth practices like skin-to-skin care, delayed cord clamping, early breast feeding, and Kangaroo Mother Care should be continued with proper hygienic practices. COVID-19 affected mothers can directly breastfeed their newborn and infants provided they maintain the hygienic practices namely periodic hand hygiene, wearing of mask while feeding, keeping the infant at a distance of six feet distance while someone who is unaffected takes care of the baby, preferably vaccinated and without any high-risk factor for infection.
- Is the vaccine going to be administered for pregnant women, like being done in other countries?
Global scientific evidences in vaccination do not show any safety concerns in pregnant women and breastfeeding mothers. The vaccines currently in use have proved to be safe for pregnant and lactating mothers. The Federation of Obstetrics and Gynaecological Societies of India (FOGSI) has recently advocated for vaccination in pregnant women and lactating mothers. We are awaiting the revised guidelines from the MoHFW. As on today, GoI does not encourage vaccination in pregnant and lactating mothers.
- Does testing COVID-19 positive affect routine vaccination for children?
Routine vaccination should be continued in normal, uninfected children as per the schedule. However, a child who has tested positive should be isolated till the infection subsides and symptoms disappear. COVID-19 positive children without uneventful infection period can take routine vaccination after 4-6 weeks. Children who were treated with either steroids, transfuse Plasma or received IVIG during the course of Covid infection, should delay the routine vaccination by 90 days after administration of such medication. We need to look at the risk Vs benefit of routine immunisation during COVID-19 pandemic. Risk of dying of vaccine preventable diseases may become higher without routine vaccination compared to risk of contracting COVID-19. Routine vaccinations should be continued similar to non-COVID-19 times, maintaining masking and social distancing and hand hygiene in the vaccination clinics.
- What vitamins/diet can be given to kids to boost their immunity?
Although there are no evidences to say that certain vitamins and minerals can lower the risk of COVID-19 infection, we know that Vitamin C, Zinc, protein etc are important for our body for maintenance of immunity in general. Hence a balanced diet providing all elements of essential nutrients in recommended doses should be advised to be taken daily to maintain health. Maintaining nutrition for children of marginalised communities, who depend on programs like midday meal in school for part of their nutrition, becomes all the more important. Parents should be made aware about needs of the child in such communities so that they try to meet the child’s need with affordable and easily available food at home.
- Is there any particular age group among children that is more prone to the virus? Can there be complications in children affected with COVID-19? What are the signs to look out for?
Usually, children have milder disease as compared to adults. The symptoms can range from respiratory symptoms like cough, sore throat with fever to gastrointestinal symptoms like abdominal cramps, diarrhoea and vomiting. Breathing difficulty, chest-indrawing and grunting are indicative of moderate to severe disease. In a small proportion of children, there can be Multisystem Inflammatory Syndrome i.e. MIS – present usually 1-4 weeks after the acute phase with multisystem involvement. The symptoms may include conjunctivitis, skin rash, cardiac failure, shock, bleeding diathesis, renal failure, respiratory problems etc.
- To ensure mental health of children, parents also need to have sound mental health. How can this be achieved?
Parents need to maintain their mental health. Acceptance of the fact that COVID-19 pandemic is there, but that it is also going to go away as time arrives is important for all of us. Parents need to concentrate in their families. Doing household chores together as a family, regular physical exercise and meditation, nutritious food, quality family time and proper sleep helps in maintaining sound mental health.
- What care should be taken for a COVID-19 positive child at home – for their physical and mental health?
A COVID-19 positive child should be kept isolated in a well-ventilated room, away from other uninfected children and family members. Small children, who are unable to take care of themselves, should be accompanied by one of the parents, preferably mother. She should wear double mask while caring for the child. Others precautions like respiratory hygiene, hand and surface hygiene should also be practised. Follow medical advice for managing symptoms in the child. Regular monitoring should be done as per the advice of the physician including monitoring of respiratory rate and oxygen saturation. Nutritious food with adequate fluid intake should be ensured for the COVID-19 positive child. Parents also need to take care of their child’s mental health during the duration of isolation. Remaining in isolation for long period can make them feel lonely. So, parents need to provide them with adequate quality time by reading books, storytelling etc. A child’s anxiety and queries around Coronavirus should be addressed. Access to fake and negative news should be restricted. Health workers should encourage parents to find innovative ways for their children to spend time in an enriching environment.
- How can children best shield themselves against COVID-19? What should parents tell their children to ensure protection?
For children who can understand, parents can teach them the protective measures like hand hygiene, masking and social distancing. Most of the time, they are able to understand the significance and can take care.
- Should Assam be preparing specialised treatment protocol for children?
The treatment and management protocol for Children developed by the National Advisory Board has been adopted and is in practice in the State.