We must try and manage children in an evidence-based way, despite having very little evidence at our disposal. A national guideline for the management of children with COVID-19 is hosted and maintained by the Royal College of Paediatrics and Child Health.
Severe COVID-19 in children is rare. To date, the largest review of children with COVID-19 included 2143 children in China. Only 112 (5·6%) of 2143 children had severe disease (defined as hypoxia) and 13 (0·6%) children developed respiratory or multiorgan failure or acute respiratory distress syndrome (ARDS). At the time of writing, there have been two reported deaths in children testing positive for COVID-19 in China, and no deaths in Italy.
One concern is that even though most infected children will have mild symptoms, some might become severely unwell. It is hard to determine common clinical characteristics in children with severe disease, and it is unclear whether there is a common biomarker, due to the small number of cases.
For children with an underlying chest condition (eg, cystic fibrosis or severe asthma), parental concern is heightened. Children with chronic chest conditions, and their families, have invested years of hard work to maintain good respiratory health; to hear constantly that people with underlying conditions are at increased risk can therefore be alarming.
The National Child Mortality Database are working to analyse possible emerging patterns of child deaths that might be linked to COVID-19.
COVID-19 infection in children. The Lancet Respiratory Medicine. Published online: 27 March 2020
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