This document has been prepared by the South African Paediatric Association (SAPA) to assist primary health care workers, general practitioners, and paediatricians in the ambulatory / out-patient / home-based care of children with SARS-CoV-2 infection.
Important considerations Children with mild COVID-19 can be safely managed in isolation at home. Children with moderate or severe COVID-19 require hospitalisation; clinical signs include: tachypnoea, lower chest wall indrawing, <92% oxygen saturation in room air, restlessness, difficulty in completed feeds or speaking sentences. Not specific to COVID-19, the integrated management of childhood illness general danger signs for children under 5 years are:
- inability to drink or breastfeed
- vomiting without retaining any fluids
- lethargy or unconsciousness
In addition, heath care workers need to be mindful of the presence of dehydration, persistent fever and WHO signs of multisystem inflammatory syndrome in children (MIS-C)*.
There is limited evidence for the use of medication in the management of ambulatory COVID-19 in children. The following proposed medications have been suggested based on expert opinion and or extrapolated from adult studies. In general, the ambulatory/home-based management of children is largely supportive with close monitoring for signs of deterioration.
There is currently no convincing data supporting the use of vitamin A, vitamin C, vitamin D, thiamine, nicotinic acid, zinc, selenium, inhaled steroids or short acting β‐agonist, lopinavir/ritonavir, hydroxychloroquine, azithromycin, ivermectin, cough mixtures or any other medication in children with COVID‐19; their routine use for this indication is consequently discouraged.
Corticosteroids, anticoagulation, antiviral or monoclonal antibody treatment for COVID‐19 or MIS‐C may be used in hospitalised children but are not indicated as part of ambulatory care. The care of people with SARS‐CoV‐2 infection is an area of active research and these recommendations will be updated as required.
This document represents the view of the South African Paediatric Association, a professional society representing paediatricians in the public and private sector in South Africa. The document is supported by the Paediatric Management Group.