Summary:

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
• convulsions

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.