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Coronavirus Diagnosed

Is this your child's symptom?

  • Child has symptoms of COVID-19 (fever, cough or trouble breathing) AND:
  • diagnosis was confirmed by a positive lab test OR
  • suspected diagnosis was made by a health care provider OR
  • parent or patient suspects COVID-19 based on symptoms consistent with COVID-19 AND the infection is widespread in their community. In areas with major community spread, lab tests are mainly reserved for patients who are very sick and need admission to a hospital.
  • Care Guide version: 4/9/2020
  • Author: Bart Schmitt MD, FAAP

If NOT, try one of these:

 

COVID-19 Disease: Frequently Asked Questions

  1. Trusted Sources for Accurate Information: CDC and AAP
    • Nurse call centers and doctors' offices are overloaded with calls. They need to keep their lines open for sick patients.
    • To meet the extreme demand for COVID-19 information, when possible, find your answers online. Here are the most reliable websites:
    • Nurse advice lines and medical call centers are needed for sick patient calls.
  2. COVID-19 Outbreak:
    • An outbreak of this infection began in Wuhan, China in early December 2019.
    • The first COVID-19 patient in the United States was reported on January 21, 2020. During March 2020, cases were reported in all states.
    • The first COVID-19 patient in Canada was reported January 31, 2020.
    • The World Health Organization (WHO) declared COVID-19 a global pandemic.
  3. COVID-19 Symptoms:
    • This COVID-19 coronavirus causes a respiratory illness. The most common symptoms are fever, cough and shortness of breath.
    • Less common symptoms are body aches, chills, diarrhea, headache, runny nose and sore throat.
  4. COVID-19 - CDC Definition of Exposure (Close Contact):
    • You are at risk of getting COVID-19 if the following has occurred:
    • Close contact with a person who tested positive for COVID-19 AND contact occurred while they were ill.
    • Living in or traveling from a city, country or other geographic area where there is documented community spread of COVID-19. This carries a lower risk compared to close contact if one observes social distancing.
    • Community spread is occurring in most of the US, especially in cities.
    • The CDC has the most up-to-date list of where outbreaks are occurring: Coronavirus.
  5. COVID-19 - How it is Spread:
    • COVID-19 is spread from person to person.
    • The virus spreads when respiratory droplets are produced when a person coughs or sneezes. The infected droplets can then be inhaled by a nearby person or land on the surface of their eyes.
    • Most infected people also have respiratory secretions on their hands. These secretions get transferred to healthy people on doorknobs, faucet handles, etc. The virus then gets transferred to healthy people when they touch their face or rub their eyes.
    • These are how most respiratory viruses spread.
    • Reports from China suggest that the initial coronavirus (COVID-19) cases were spread from animals (probably bats) to humans.
  6. COVID-19 - Travel:
    • Avoid all non-essential travel.
    • If you must travel, go to the CDC website for updates on travel advisories: Travelers.
  7. Other COVID-19 Facts:
    • Incubation period: average 5 days (range 2 to 14 days) after coming in contact with, or the secretions of, a person who has COVID-19.
    • Expected course of infection: 80% have a mild illness, much like normal flu or a bad cold. The symptoms usually last 2 weeks.
    • No symptom patients: an unknown percentage of infected patients have no symptoms.
    • Complications: 20% have a more severe illness with trouble breathing from viral pneumonia. Many of these need to be admitted to the hospital. People with complications generally recover in 3 to 6 weeks.
    • Death rate: currently estimated at 0.5 to 2% (CDC) of all infected patients. Children generally have a mild illness. There have been no deaths under age 10 and only 1 in teens. Older adults, especially those with chronic lung disease or weak immune systems, have the highest death rates.
    • Vaccine: there is currently no vaccine to prevent COVID-19. Many labs are working on developing a vaccine, but that will take at least a year.
    • Treatment: currently, there is no effective anti-viral medicine for coronavirus. Treatment is supportive. Oxygen and IV fluids are used for hospitalized patients.
  8. Concerns About Positive Lab Test for the Common Coronavirus that Causes Colds:
    • There are many strains of coronaviruses. Most of them cause the common cold.
    • Older viral respiratory panels only tested for the "common" coronavirus.
    • Common coronavirus strains usually don't cause serious illness in healthy children.

When to Call for Coronavirus (COVID-19) Diagnosed or Suspected

When to Call for Coronavirus (COVID-19) Diagnosed or Suspected

Call 911 Now

  • Severe trouble breathing (struggling for each breath, can barely speak)
  • Lips or face are bluish now
  • You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

  • Trouble breathing, but not severe (includes tight breathing and hard breathing)
  • Ribs are pulling in with each breath (called retractions)
  • Breathing is much faster than normal
  • Lips or face have turned bluish during coughing
  • Wheezing (tight, purring sound with breathing out)
  • Stridor (harsh sound with breathing in)
  • Chest pain and can't take a deep breath
  • Dehydration suspected. No urine in over 8 hours, dark urine, very dry mouth and no tears.
  • Weak immune system, such as HIV, cancer, organ transplant, taking oral steroids.
  • High-Risk child. This includes lung disease, heart disease, weak immune system, and other serious chronic disease.
  • Age under 12 weeks old with fever
  • Fever over 104° F (40° C)
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Nonstop coughing spells
  • Age under 3 months old with any cough
  • Earache or ear discharge
  • Sinus pain (not just congestion)
  • Fever lasts more than 3 days
  • Fever returns after gone for more than 24 hours
  • You think your child needs to be seen, but the problem is not urgent

Call 911 Now

  • Severe trouble breathing (struggling for each breath, can barely speak)
  • Lips or face are bluish now
  • You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

  • Trouble breathing, but not severe (includes tight breathing and hard breathing)
  • Ribs are pulling in with each breath (called retractions)
  • Breathing is much faster than normal
  • Lips or face have turned bluish during coughing
  • Wheezing (tight, purring sound with breathing out)
  • Stridor (harsh sound with breathing in)
  • Chest pain and can't take a deep breath
  • Dehydration suspected. No urine in over 8 hours, dark urine, very dry mouth and no tears.
  • Weak immune system, such as HIV, cancer, organ transplant, taking oral steroids.
  • High-Risk child. This includes lung disease, heart disease, weak immune system, and other serious chronic disease.
  • Age under 12 weeks old with fever
  • Fever over 104° F (40° C)
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Nonstop coughing spells
  • Age under 3 months old with any cough
  • Earache or ear discharge
  • Sinus pain (not just congestion)
  • Fever lasts more than 3 days
  • Fever returns after gone for more than 24 hours
  • You think your child needs to be seen, but the problem is not urgent

 

Care Advice

Probable COVID-19 with Mild Symptoms

  1. COVID-19 Infection: What You Should Know about It
    • Your child has been diagnosed as probably having COVID-19 OR
    • You or your doctor suspect COVID-19 because it is widespread in your community and your child has developed symptoms that match (cough and/or fever).
    • Your child probably did not receive a lab test for COVID-19. It doesn't matter.
      • The most common symptoms are fever and cough.
      • Other less common symptoms are body aches, chills, diarrhea, headache, runny nose and sore throat.
      • Most infections are mild, especially in children.
  2. Treatment of Symptoms
    • The treatment is the same whether your child has COVID-19, influenza or some other respiratory virus.
    • The only difference for COVID-19 is the need to stay on home isolation until your child recovers. Reason: you want to protect other people from getting it. The elderly and people with serious health problems can die from COVID-19.
    • Treat the symptoms that are bothering your child the most. See other Care Guides (such as Sore Throat or Cough) for details of treatment, if needed.
    • There is no anti-viral medicine for treating COVID-19.
    • Antibiotics are not helpful for viral infections.
    • You don't need to call or see your doctor unless your child develops trouble breathing or becomes worse in any other way.
  3. Home Isolation is Needed Until Test Results are Back
    • Isolation means separating sick people with a contagious disease from people who are not sick (CDC). That means Stay at home. Also called Stay in place.
    • Isolate the sick patient. Reason: they are contagious and can spread their infection to others.
    • Other family members should also stay at home on quarantine. Living with a suspected COVID-19 patient implies close contact has occurred.
    • Do Not allow any visitors (such as friends).
    • Do Not go to school or work.
    • Do Not go to stores, restaurants, places of worship or other public places.
    • Avoid public transportation or ride sharing.
    • The patient needs to stay at home but does not need to be confined to a single room. Preventing spread of respiratory infections within a home is nearly impossible. The sick person should try to avoid very close contact with other family members. That includes hugging, kissing, sitting next to or sleeping in the same bed.
    • None of this is realistic for young children.
  4. Fever Treatment
    • For fever above 102° F (39° C) you may use acetaminophen or ibuprofen if the patient is uncomfortable. There are no proven reasons to avoid ibuprofen.
    • For fevers between 100° to 102° F (37.8° to 39 ° C), fever medicines are not needed. Reason: fevers turn on your body's immune system. Fever helps fight the infection.
    • Exception: if the patient also has pain, treat it.
    • Fluids: offer cool fluids in unlimited amounts. Reason: to prevent dehydration. Staying well-hydrated helps the body sweat and give off heat.
  5. Homemade Cough Medicine
    • Age 3 Months to 1 Year:
      • Give warm clear fluids (e.g., apple juice or lemonade) to thin the mucus and relax the airway. Dosage: 1-3 teaspoons (5-15 ml) four times per day.
      • If nothing else helps: give a small amount of corn syrup. Dosage: ¼ teaspoon (1 ml). Can give up to 4 times a day when coughing. Caution: avoid honey until 1 year old. Reason: risk for botulism.
    • Age 1 year and older: Use honey, ½ to 1 teaspoon (2 to 5 ml) as needed as a homemade cough medicine. It can thin the secretions and loosen the cough. If honey is not available, can use corn syrup. OTC cough syrups containing honey are also available. They are not more effective than plain honey and cost much more per dose.
    • Age 6 years and older: Use cough drops (throat drops) to decrease the tickle in the throat. If not available, can use hard candy. Avoid cough drops before 6 years. Reason: risk of choking.
    • Over the Counter (OTC) cough medicines are not recommended. Reason: no proven benefit for children. Honey has been shown to work better.
    • Never use OTC cough medicines under 6 years of age. Reason: cough is a protective reflex and should not be suppressed.
  6. Fluids - Stay well Hydrated
    • Drink lots of fluids. Water is best.
    • Goal: keep the patient well hydrated.
    • It loosens up any phlegm in the lungs. Then it's easier to cough up.
    • It helps the body sweat and give off heat.
  7. How to Protect Others - When You or Your Child Are Sick:
    • Stay home from school or work if you are sick. Your doctor or local health department will tell you when it is safe to return.
    • Cough and sneeze into your shirt sleeve or inner elbow. Don't cough into your hand or the air.
    • If available, sneeze into a tissue and throw it into a trash can.
    • Wash hands often with soap and water. After coughing or sneezing are important times.
    • Don't share glasses, plates or eating utensils.
    • Wear a face mask when around others.
    • Always wear a face mask (if available) if you have to leave your home (such as going to a medical facility). Always call first to get approval and careful directions.
  8. Call Your Doctor If:
    • Shortness of breath occurs
    • Breathing difficulty occurs
    • Your child becomes worse

COVID-19 Prevention

  1. COVID-19: How to Protect Yourself and Family from Catching It:
    • Avoid any contact with people known to have COVID-19 infection. Avoid talking to or sitting close to them.
    • Social Distancing: try to stay at least 6 feet (2 meters) away from anyone who is sick, especially if they are coughing. Also called physical distancing. Do avoid others, because you can’t tell who might be sick. If COVID-19 becomes widespread in your community, try to stay 6 feet (2 meters) away from everyone outside your family unit. Follow any stay at home (stay in place) orders in your community. Leave your home only for essential needs such as buying food or seeking medical care.
    • Wash hands often with soap and water (very important). Always do this before you eat.
    • Use an alcohol-based hand sanitizer if water is not available. Reason: soap and water work better.
    • Don't touch your eyes, nose or mouth unless your hands are clean. Germs on the hands can get into your body this way.
    • Do not share glasses, plates or eating utensils.
    • No longer shake hands. Greet others with a smile and a nod.
    • Avoid ERs and urgent care clinics if you don't need to go there. These are places where you are likely to be exposed to infections.
    • Masks: At first, the CDC did not recommend wearing a face mask, unless you are sick. As community spread has become high, they recommended face masks for everyone going into public buildings, such as grocery stores.
  2. Keep Your Body Strong:
    • Get your body ready to fight the COVID-19 virus.
    • Get enough sleep (very important).
    • Keep your heart strong. Walk or exercise every day. Take the stairs. Caution: avoid physical exhaustion.
    • Stay well-hydrated.
    • Eat healthy meals. Avoid overeating to deal with fears.
    • Avoid the over-use of anti-fever medicines. Fever fights infections and ramps up your immune system.
  3. Keep Your Mind Positive
    • Live in the present, not the future. The future is where your needless worries live. Stay positive.
    • Use a mantra to reduce your fears, such as "I am strong."
    • Go to a park if you live near one. Being in nature is good for your immune system.
    • As long as they are well, hug your family members frequently. Speak to them in a kind and loving voice. Love strengthens your immune system.
  4. Breastfeeding and COVID-19:
    • Breastfeeding experts recommend you continue to breastfeed even if you are sick with COVID-19.
    • Wash your hands before feeding your baby.
    • The CDC recommends to wear a mask, if available. Be careful to avoid coughing on your baby.
    • Breastmilk gives beneficial antibodies your body is making against this illness to your baby. This should provide some protection against this illness for your baby, like it does for influenza and most other viral illnesses.
    • The virus is probably not passed through breastmilk, but this is not yet known for sure.
    • Call your doctor if breastfeeding isn't going well OR your baby becomes sick.
  5. How to Protect Others - When You or Your Child Are Sick:
    • Stay home from school or work if you are sick. Your doctor or local health department will tell you when it is safe to return.
    • Cough and sneeze into your shirt sleeve or inner elbow. Don't cough into your hand or the air.
    • If available, sneeze into a tissue and throw it into a trash can.
    • Wash hands often with soap and water. After coughing or sneezing are important times.
    • Don't share glasses, plates or eating utensils.
    • Wear a face mask when around others.
    • If you have to leave your home (such as going to a medical facility), always wear a face mask (if available). Always call first to get approval and careful directions.

Questions about COVID-19 Testing

  1. COVID-19 Testing: Who Needs It
    • Tests for COVID-19 are only done on people who are sick (have a fever OR cough) AND also have a health history that puts them at risk for having COVID-19. That mainly means close contact with someone who has lab confirmed or suspected COVID-19 disease.
    • As community spread increases, who needs testing may change.
    • When cases of COVID-19 are everywhere, testing becomes pointless on mildly ill patients. Testing will mainly be helpful for patients who need admission to the hospital.
    • Testing requires a doctor's order (as with all medical tests).
    • Testing is performed on fluid collected on a throat swab and/or nasal swab.
    • Swab specimens are then sent to a lab.
    • The results become available in 24 to 72 hours.
    • Caution: once there is widespread community transmission, testing is not done on exposed people who don't have serious symptoms.
  2. Testing Sites for Specimen Collection
    • Swabs of the throat and/or nose will only be collected on people who have a doctor's order.
    • People cannot walk in and request a COVID-19 test.
    • Specimen collection sites vary from city to city. Your local health department may operate drive-through sites.
    • In general, they are not done in medical offices or clinics.
    • If you are sent to have a COVID-19 test done, go to the site recommended by your local health department, nurse advice line, or primary care provider.
    • Caution: don't go to an ER, other health facility or testing site without a doctor's order. If you do, you will not receive a test. And you may be exposed to patients who have COVID-19.

Going to an ER or Other Medical Facility: Doing It Safely

  1. Call Ahead First, if Going to an ER or Other Medical Facility
    • Most patients with COVID-19 never need to see a doctor. That will change if you develop trouble breathing or any other serious symptoms.
    • In that case, your doctor or nurse will tell you where to go and call ahead.
    • If you are going to a medical facility without a referral, you must call ahead first.
    • Tell them you are bringing a person exposed to COVID-19 who now has symptoms (fever or cough). They may transfer your call to a doctor or triage nurse to help decide if you need testing. Often you will not.
    • Reason to call first: so healthcare workers can make plans to prevent spread of COVID-19 to others. You don’t want to be a "spreader."
    • They can also tell you the safest way to enter the medical facility.
  2. Announce Possible COVID-19 Exposure When You Arrive:
    • Tell the first healthcare worker you meet that the patient may have been exposed to COVID-19.
    • Tell them the patient has been referred for COVID-19 testing because of symptoms. If you were referred to an ER, it will also be for a full medical exam.
  3. Cover Your Mouth and Nose - Wear a Mask:
    • Cover the patient’s mouth and nose with a disposable tissue (e.g., Kleenex or paper towel) or a washcloth.
    • Have the patient wear a disposable face mask if you have one.
    • Ask for a mask on arrival.

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC.

 

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