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COVID-19 Infection in Children: Diagnosis and Management
Frank Zhu1, Jocelyn Y Ang2,3,4
1Division of Pediatric Infectious Diseases, Department of Pediatrics, Medical College of Wisconsin, Suite 450C, 999 North 92nd Street, Wauwatosa, Milwaukee, WI 53226 USA.
Insights
This review summarizes pediatric COVID-19 diagnosis and management, noting increased Omicron variant cases in children. Vaccination is key, with specific treatments available for high-risk or severe pediatric COVID-19 cases.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Public Health
Background:
- The proportion of pediatric COVID-19 cases has risen significantly, particularly with the Omicron variant.
- While generally milder, severe COVID-19 and complications like MIS-C and long COVID can occur in children.
- There is a notable gap in pediatric-specific COVID-19 management data, with many guidelines based on adult recommendations.
Purpose of the Study:
- To provide a concise and updated review of pediatric COVID-19 diagnosis and management strategies.
- To address the evolving landscape of the pandemic in relation to child health.
- To consolidate current knowledge for healthcare providers managing pediatric COVID-19.
Main Methods:
- Review of current literature and clinical guidelines on pediatric COVID-19.
- Analysis of diagnostic approaches, including nucleic acid amplification tests (PCR).
- Evaluation of management strategies, encompassing supportive care, vaccination, and therapeutic interventions.
Main Results:
- Common symptoms include fever and cough; atypical presentations also occur.
- Nucleic acid amplification tests (respiratory PCR) are the primary diagnostic tool.
- Vaccination is strongly recommended for prevention; treatments like monoclonal antibodies, Paxlovid, and remdesivir are options for at-risk individuals.
- Severe cases may require remdesivir, dexamethasone, and immunomodulatory agents; anticoagulation is advised for thrombosis risk.
Conclusions:
- Pediatric COVID-19 requires ongoing vigilance due to potential for severe disease and long-term complications.
- Vaccination remains the most critical preventive measure.
- Tailored management strategies, including antiviral and immunomodulatory therapies, are essential for at-risk and severely ill children.
- Further research into pediatric-specific COVID-19 data is crucial.
Purpose Of Review:
Due to the rapidly changing landscape of COVID-19, the purpose of this review is to provide a concise and updated summary of pediatric COVID-19 diagnosis and management.
Recent Findings:
The relative proportion of pediatric cases have significantly increased following the emergence of the Omicron variant (from < 2% in the early pandemic to 25% from 1/27 to 2/3/22). While children present with milder symptoms than adults, severe disease can still occur, particularly in children with comorbidities. There is a relative paucity of pediatric data in the management of COVID-19 and the majority of recommendations remain based on adult data.
Summary:
Fever and cough remain the most common clinical presentations, although atypical presentations such as "COVID toes," anosmia, and croup may be present. Children are at risk for post-infectious complications such as MIS-C and long COVID. Nucleic acid amplification tests through respiratory PCR remain the mainstay of diagnosis. The mainstay of management remains supportive care and prevention through vaccination is highly recommended. In patients at increased risk of progression, interventions such as monoclonal antibody therapy, PO Paxlovid, or IV remdesivir × 3 days should be considered. In patients with severe disease, the use of remdesivir, dexamethasone, and immunomodulatory agents (tocilizumab, baricitinib) is recommended. Children can be at risk for thrombosis from COVID-19 and anticoagulation is recommended in children with markedly elevated D-dimer levels or superimposed clinical risk factors for hospital associated venous thromboembolism.
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