Aga Khan University faculty are working alongside Pakistan’s health ministry, UNICEF, WHO, the Pakistan Paediatric Association and a range of public and private hospitals to prepare clinical guidelines to ensure children with the coronavirus receive treatment suited to their age and needs.
While signs, symptoms and treatment protocols for adults are established, the relatively fewer cases of COVID-19 among children mean that physicians lack evidence on how the disease presents itself in the young and how best to treat it.
The characteristic triad of fever, cough and shortness of breath seen in adults is absent in children. In a recent case seen by doctors of an 18-month-old boy, who had previously been hospitalised, the child was readmitted to a private hospital while experiencing fits and a high fever. The child later tested positive for coronavirus even though he did not display symptoms common in adults such as a cough and shortness of breath.
To overcome this information gap, AKU’s faculty consulted guidelines from the rest of the world and combined global evidence with their on-the-ground insights into a detailed set of clinical guidelines. This is now being peer-reviewed by partners in the medical community who will update the guidelines as knowledge about the virus evolves.
“COVID-19 is a new disease that is presenting new challenges to the medical community,” said Dr Sonia Qureshi, assistant professor in paediatrics and child health and one of the key contributors to the guidelines. “Specialists need to be open to learning each day and we hope the guidelines will improve the screening and treatment of children in these difficult times.”
The treatment guidelines distinguish between mild, moderate and severe forms of the illness and recommend different types of medicines, laboratory and radiology tests in line with the patient’s condition.
The guidelines also highlight aspects of newborn care for instances where an expectant mother tests positive for the coronavirus. While there is currently no evidence of intrauterine (or in the womb) transmission, precautions are recommended for post-delivery care including washing hands before touching and feeding the infant, and wearing a mask while breastfeeding. The guidelines also call for close monitoring of a newborn’s vital signs, respiratory and gastrointestinal disturbances.
“Many children are coming to hospital with illnesses that are regularly noticed in summer such as typhoid fever and other respiratory ailments,” said Dr Fyezah Jehan, an assistant professor in AKU’s paediatrics and child health department. “But they may also have the coronavirus and may be showing different symptoms. We need to inquire into whether other epidemiological criteria such as contact with a COVID-19 patient, living with a family member who has attended a mass gathering, or whether a cluster of respiratory illnesses has previously occurred. That will help decide whether to conduct a test and how we treat the child.”
Dr Farah Qamar, another major contributor to the guidelines and an associate professor at AKU, said that the document will continue to be updated as information on screening and symptoms continues to unfold.
The Children’s Hospital Lahore is also involved in the initiative. Drs Ali Faisal Saleem, Asad Ali and Fatima Mir from the Aga Khan University also contributed to the guidelines.
This story was updated on May 12, 2020. The guidelines have been now published by the Pakistan Paediatric Association, a national body of specialists in children’s medicine, and have been submitted to Pakistan’s health ministry for further action.