How does a family cope when their youngest member is admitted to a paediatric ICU and they can only see her via video calls? In the ongoing surge of Covid-19 infections ravaging India, more and more parents find themselves confronted with these and myriad other challenges as the number of children testing positive rises across the country. While cumulative numbers nationwide were not available, more than 1.3 lakh minors were infected in Maharashtra alone since February 15, according to state data. Doctors attest to this rise. “We are seeing around 50-60 children with Covid every day.
Last year, this number was 5 to 8 per day,” says Dr Rakshay Shetty, head, paediatric critical care at Rainbow Children’s Hospital in Bengaluru. Last week, in an acknowledgement of this escalation in numbers, Union Ministry of Health and Family Welfare released separate guidelines for the treatment of children. It’s not just the growing number of cases. While most cases are mild, the number of children showing symptoms this year is higher. “In the second wave, we are seeing a significant increase in kids showing symptoms such as fever, sore throat, cough, cold, and vomiting,” says Dr Dhanya Dharmapalan, consultant, paediatric infectious diseases, Apollo Hospitals, Navi Mumbai. “The number of children needing medical attention is a little more this time. We are also seeing a few more children having pneumonia,” says Dr Shetty.
When the pandemic began last year, children were relatively less affected by the virus than adults; the bigger worry used to be that they might be asymptomatic carriers who could infect older family members, while remaining fine themselves. Parents are only coming to terms with the change. Content marketing executive Mangala R says people were astonished when she and her two sons, aged 1.5 years and 8 years, tested positive. “Everyone was shocked because we all thought kids don’t get Covid, right?” She herself was not prepared for the ordeal of all three of them falling sick simultaneously. When she had to be hospitalised one night, her elder son stepped up. Says Vedant, 8: “I was most scared that night when mom’s oxygen levels were really low.
I had to carry my brother the whole day.” Mangala says, “Kids grow up during these times. He didn’t cry once.” Just as it happened with Mangala, it is common in the current wave for entire families, including kids, to fall ill at the same time. “If both parents are Covid-positive, we take it for granted that everyone in the house is infected,” says Indore-based paediatrician Dr Hemant Jain, who has seen patients as young as 10 days old in the current Covid surge. The difference is that now parents, who are stepping out for work and socialising, seem to be passing on the infection to children, rather than vice-versa. In some cases, everyone getting simultaneously infected means they can also isolate together at home. Bengaluru-based Aashish Washikar’s doctor advised his family to stay together after he, his wife and their two daughters, aged 2 and 7, tested positive in March.
But it was rough. “When their test results had yet to arrive and I was in isolation, my wife’s health deteriorated. The younger one was in shock,” says Washikar. There have also been instances of the entire family having to be hospitalised, say doctors. “Sometimes the mother and the father might be admitted in different hospitals and the child admitted here. We have to do video consultations with parents or grandparents to keep them updated,” says Dr Srikanta JT, consultant, paediatric pulmonology, Aster CMI Hospital, Bengaluru. HOSPITAL, ALONE Compared with adults, the challenge in treating children with Covid is two-fold — social and medical. “You have these children who are 2, 5 or 7 years old getting admitted and having to stay alone for the first time in the ICU.
That’s really difficult for kids,” says Dr Srikanta. Nor is isolating at home easier for children. When consultant Pallavee Panthry had to be admitted to a hospital in Ghaziabad with Covid, her 12-year-old daughter, Naisha, who was also positive, had to isolate for a couple of days. “Naisha had to stay alone at home for two days. My husband would drop off her meals and sit outside till she went to sleep,” says Panthry, who was discharged on May 3. Then there is the challenge of making young children understand what is happening. Natasha Singh (name changed on request) had to tell her three-year-old daughter she would not be able to hug her beloved Nana for a few days since they were both positive. But it was hard to make her understand. “She was not able to absorb the fact that we all had Covid. She wanted to go to my dad because she’s very fond of him — she would cry about not being allowed to do that,” says Singh, from her parents’ home in Bengaluru.
The three-year-old finally got the chance to hug him briefly on Monday, her birthday, wearing a mask. When children are too young to talk, parents need to keep a close watch on symptoms. With older children, counsellors advise having age-appropriate conversations about Covid. “Educate the child on what’s happening in the world but don’t show them terrifying visuals,” says Mangaluru-based child psychologist Joy Santhosh. “Use non-stigmatising language, like saying they’ve ‘contracted’ Covid instead of saying someone ‘brought Covid’ into the house,” says Gauri Divan, a Goa-based public health researcher in early child development.
But it is tough to make a child understand, says Pooja Jogal, a marketing professional from Pune, whose 7-year-old tested positive. “They think Covid is something that makes people die.” The fear of stigma, too, might linger. During her son Arnav’s Zoom call with his friends, she overheard one of them yell out, ‘Hey, Arnav has Covid.’ “Kids have a fear of being alienated if their peers find out they have Covid, I think,” Jogal adds. The protocol for children is to treat the symptoms, like paracetamol for fever. For more serious cases, approved options for children under 12 are limited to steroids. In the most severe cases, “you throw in everything but the kitchen sink,” says Dr Srikanta. Doctors have also been seeing a few cases of pneumonia and in some a serious post-Covid complication called multisystem inflammatory syndrome in children (MIS-C), which manifests a couple of weeks later and requires hospitalisation.
“In MIS-C, a child can deteriorate fast and parents need to seek medical advice early,” says Dr Dharmapalan. While 95-98% of children are fortunate enough to have mild or no symptoms that require minimal medication, there are a few rare cases of fatalities being reported among children as well. Says Dr Srikanta: “It cheers us up that most of our patients really get better. But we are disheartened when we lose an adolescent, who could have probably gone on to do a great deal in their lives.” Parents, understandably, are often frantic with worry when their children test positive. “The most difficult part is the parents’ anxiety. This leads to a lot of unnecessary treatment,” says Dr Shetty.
Washikar would agree, having been one of those parents at one point. “I felt doctors were not taking seriously the fact that a child as young as two years had Covid and not prescribing stronger medicine. Later, I realised they know best and we should just trust them,” says Washikar. But he had his reasons. “All rational thinking fades away when it comes to your kids in situations like these.” Arora, who requested to be identified only by her surname, recalls how her heart sank when her five-month-old’s Covid test, which was carried out while she distracted him with nursery rhyme videos, came positive.
“The baby was my priority. We had done everything to take care of him but I still felt so helpless when he tested positive,” says Arora. Only when her son returned to his active self did her stress ease. What didn’t help during her family’s ordeal, Mangala recalls, was the avalanche of advice. Instead of unsolicited advice, she suggests, send unsolicited meals for children. As parents try to tide over this crisis, virologists have sounded the alarm over the impact of a possible third wave on children in India. The lack of a vaccine for this age group will render them more vulnerable, particularly if schools reopen, they say. Maharashtra has said it will be setting up a paediatric task force —more states might need to follow suit.