Last winter, if you’d heard a child sneeze in your vicinity you probably wouldn’t have taken much notice. Kids get stuffy noses and mild colds all the time. It’s unavoidable - especially as we move into the cooler season.
But this year is a whole different ball game. A child clears her throat near the swimming pool and, rather than assume she might have swallowed a bit of water, we’re all on high alert for potential COVID. A runny nose? Isolate, right away. And don’t even think about leaving the house if there’s anything remotely resembling a fever.
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The extra vigilance is both understandable and necessary. But, as kids return to school and venture into public spaces more, it’s almost inevitable that they’re going to get a cough, runny nose or fever at some point. So how should parents react? If your child displays a symptom do you need to get them tested for COVID-19? If so, how often? And how long do they need to stay home for?
Gulf News asked UAE paediatricians if it’s possible to know whether your child’s symptoms might be COVID-19, and how to proceed if you think your child has the disease.
How can you tell if it’s a cold or COVID-19?
You probably can’t. The main symptoms of COVID-19 in children are so similar to the symptoms of other childhood illnesses like colds or flus that it’s almost impossible to tell.
“We cannot say with certitude whether a child has flu, Cold or COVID-19 unless we conduct a test to prove it,” says Dr Umamaheshwararao Ginjupalli, Consultant in General Pediatrics at Burjeel Royal Hospital, Al Ain.
Dr Umamaheshwararao Ginjupalli, Consultant, General Pediatrics, Burjeel Royal Hospital, Al Ain
“This is because these diseases manifest similar symptoms. If parents doubt whether their child has been exposed to an infected person or might have contracted the virus by any other means, they must ensure that the child undergoes a COVID-19 test immediately.”
The usual symptoms of COVID-19 are a cough or a fever, or both, according to the US Centers for Disease Control and Prevention (CDC).
“The most common symptoms of COVID-19 in children are similar to those in adults, but tend to be milder,” says Dr Binoy Nellissery, specialist in paediatrics and neonatology at Aster Hospital, Qusais.
But there may also be other minor symptoms, adds Dr Binoy, such as: “Muscle pain, running nose, headache, vomiting, stomach ache, loose stools, and a loss of smell or taste.”
“Abdominal symptoms like vomiting, loose stools and abdominal pain are more commonly seen in kids compared to adults,” adds Dr Binoy. “Some cases in kids have presented with having only abdominal symptoms. Babies with COVID-19 might have trouble feeding.”
The overlap between COVID-19 symptoms with other common illnesses means that many people with symptoms of COVID-19 may actually be ill with something else, according to the CDC. This is even more likely in young children, who typically have multiple viral illnesses each year; the CDC says it is common for young children to have up to eight respiratory illnesses or “colds” every year.
In children, fever has been the most frequently reported symptom. However, fever is common in many other illnesses, and temperatures can be taken wrongly and falsely interpreted as fever.
Additionally, many infected children won’t have any symptoms at all. The CDC estimates that around 45% of cases of COVID-19 in children will be asymptomatic, although it is hard to know for sure since not all children are tested unless they are displaying symptoms.
To further complicate matters, being asymptomatic doesn’t mean kids can’t spread the disease; researchers at the Children's National Hospital in Washington found that infected children can spread the SARS-CoV-2 virus for weeks even though they themselves show no COVID-19 symptoms.
Ultimately, parents know their children the best, so if you know that your little one always suffers a runny nose from Hay fever at this time of year, then it’s likely this is the culprit. But in every instance, if your child is displaying a symptom or you just feel worried, it’s always best to check with your child’s paediatrician.
What about the Multisystem Inflammatory Syndrome?
While it can be hard to identify COVID-19 symptoms from the cold or flu, the much more serious complication of COVID-19, known as the multisystem inflammatory syndrome, has more distinguishing characteristics.
These include, a “high fever that lasts for days, sore throat, abdominal pain, vomiting, diarrhea, neck pain, rash, red and puffy eyes, swollen hands and feet, red and cracked lips and feeling extra tired,” says Dr Polixenia Yadegari, specialist paediatrician at Medcare Paediatric Speciality Centre.
Dr Polixenia Yadegari, Specialist Paediatrician, Medcare Paediatric Speciality Centre
While this syndrome is generally much more dangerous for children than COVID-19, it is very rare.
As this syndrome has been linked with organ damage, if your child is displaying any of the aforementioned symptoms it’s best to take them to the emergency room right away.
At what point should I keep my child home from school?
If your child has a fever of any kind, you should keep them home from school. Although this has always been the advice, time-poor working parents may have been tempted in the past to dose their child up with paracetamol for a mild temperature and hope for the best.
This is not that time.
Even if your child feels well, if they are suffering from a fever, the Dubai Knowledge and Human Development Authority (KHDA) guidance for schools is that they should be tested for COVID-19.
The KHDA’s guidance is that if, after testing for COVID, your child’s test is positive, or if it is negative but there is a clinical assessment of probable COVID-19, then they will need to be quarantined for 14 days.
If your child’s test is negative and there is no clinic suspicion of COVID-19 then he or she can resume in-person school as soon as they are symptom-free.
When it comes to the common cold-like symptoms such as a runny nose or cough without a fever, as well as abdominal symptoms without a fever, it is also better to err on the side of caution.
Coughs frequently linger for weeks, and in past years many parents would send their child to school still with a mild cough or stuffy nose, rather than have them miss three weeks or more of school when they feel well in themselves.
Dr Binoy Nellissery, Pediatrics And Neonatology, Specialist, Aster Hospital, Qusais
However - hard as it may be for working parents - this year the general advice is to keep your child home from school even if they are displaying mild cold-like symptoms.
Since all UAE schools are required to have a distance-learning provision this term, they should still be able to keep up with the school work if they are feeling well in themselves, and it helps to keep everyone in the community safer.
“Running noses and other extremely mild infections are common among school-going children,” says Dr Umamaheshwararao. “If a child manifests similar symptoms, it doesn’t mean that they have been infected by COVID-19, unless the child may have come into contact with an already infected person outside or inside the family. In case the parents are in doubt, they must immediately get the child tested for COVID-19. In such cases, they shouldn’t be sent to school or allowed outside.”
My child is coughing – is it COVID-19?
As explained above, a cough or runny nose could be any viral respiratory infection as they symptoms heavily overlap. However, Dr Binoy Nellissery, a specialist in paediatrics and neonatology at Aster Hospital shares some pointers on the likelihood of it being a COVID-19 infection and says it depends on the following:
- Whether the child has had close contact with COVID-19 patients
- If the doctor feels strongly it could be Covid 19 infection after checking the child and after evaluating the tests (blood tests, X-rays etc)
- Associated symptoms like rash, abdominal pain, vomiting, loose stools
- Symptoms persisting beyond the expected time of resolution
Should you get your asymptomatic child tested for COVID-19?
Only if they may have been exposed to the virus, or if it is required by their school or other institution. “It is not necessary that parents must test their child routinely and frequently for COVID-19,” says Dr Umamaheshwararao Ginjupalli, Consultant in General Pediatrics at Burjeel Royal Hospital, Al Ain.
“A child should undergo a COVID-19 test, if parents suspect him/her to be infected. Regular or routine checkups or test for COVID-19 are advisable for healthcare workers. A child does not need that unless he/she comes in contact with an infected person or manifests any symptoms such as body pain, breathing difficult or fever.
“Parents must take appropriate precautions and must educate their children on ways of contracting the virus and teaching them how to stay safe.”
What should you do if you think your child is displaying symptoms of COVID-19?
If your child has a fever, cough, or other symptoms of COVID-19, call your doctor first of all, says Dr Binoy. “They can tell you what to do and whether your child needs to be seen in person.”
“First and foremost ensure that your child does not have direct contact with family or friends, especially those at high risk,” adds Dr Polixenia Yadegari.
“Next, call your pediatrician, clinic or hospital ahead of your visit to inform them that you are suspecting this diagnosis. When visiting the healthcare facility make sure the child has a face mask (if they are over 2 years old) and that they keep the safe distance between others. Once you reach the healthcare facility, notify them and then the protocol for testing is in place to be implemented.”
But it’s important to keep things in perspective, adds Dr Polixenia: “It is natural for parents to feel anxiety and fear over the impact of the new Coronavirus. But if your child coughs or sneezes it is very unlikely to be Coronavirus. The clinical data indicates that the children are less likely to be affected than adults. There are plenty of other common viruses that affect children.”
Nevertheless, Dr Binoy says, “Get the child to the emergency department right away if your child has the following: Breathing difficulty; Pain or pressure in their chest; Blue lips or face; Severe belly pain; Acts confused or not like themselves; Cannot wake up or stay awake; If it is a baby - trouble feeding.”
How to reduce your child’s risk of catching COVID-19
If your child is old enough, Dr Binoy says you can teach them to:
- Practice "social distancing." This means keeping people, even those who are healthy, away from each other. It is also sometimes called "physical distancing."
- Wear a cloth mask in public. Experts in many countries recommend this for everyone, including children 2 years and older. This is mostly so that if your child is sick, even if they don't have any symptoms, they are less likely to spread the infection to other people.
- Wash their hands with soap and water often. This is especially important after being out in public. Make sure to rub the hands with soap for at least 20 seconds, cleaning the wrists, fingernails, and in between the fingers. Then rinse the hands and dry them with a paper towel that can be thrown away.
- Washing with soap and water is best. But if your child is not near a sink, they can use a hand sanitizing gel to clean their hands. The gels with at least 60 percent alcohol work the best. It's important to keep sanitizer out of young children's reach, since the alcohol can be harmful if swallowed. If your child is younger than 6 years old, help them when they use sanitizer.
- Avoid touching their face with their hands, especially their mouth, nose, or eyes.