Springdale Mason Pediatrics

Coronavirus (COVID-19) - Diagnosed or Suspected

Definition

You or your child have symptoms of COVID-19 (fever, cough or shortness of breath) AND:

  • Diagnosis was confirmed by positive lab test OR
  • Suspected diagnosis was made by a doctor OR
  • You suspect COVID-19 based on symptoms consistent with COVID-19 AND widespread prevalence in your community. In areas with major community spread, lab test confirmation will mainly be indicated on patients who need hospitalization.
  • Updated: July 6, 2020

Call or Return If

  • Trouble breathing occurs
  • You think you or your child needs to be seen
  • Symptoms become worse

About This Topic

COVID-19 Basics

  • COVID-19 Symptoms: The most common symptoms are cough, fever and shortness of breath. Other common symptoms are chills, shivering (shaking), sore throat, muscle pains or body aches, headache, loss of smell and taste. The CDC also includes the following less common symptoms: runny nose, fatigue (tiredness), nausea, vomiting and diarrhea.
  • Incubation Period: average 5 days (range 2 to 14 days) after coming in contact with the secretions of a person who has COVID-19.
  • No Symptoms but Infected: Over 20% of infected patients have no symptoms.
  • Mild Infections: 80% of those with symptoms have a mild illness, much like normal flu or a bad cold. The symptoms usually last 2 weeks.
  • Severe Infections: 20% of those with symptoms develop 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.
  • Deaths: Children generally have a mild illness and recover quickly. Pediatric deaths are very rare. Older adults, especially those with chronic lung disease, heart disease, diabetes or weak immune systems, have the highest death rates. The overall death rate is around 1%.
  • Vaccine: There currently is no vaccine to prevent COVID-19. Research is on the fast track in many labs. New vaccines usually take at least a year to develop.
  • Treatment: New treatments for severe COVID-19 are becoming available. They are only used on hospitalized patients and are given in a vein (IV).

Trusted Sources for Accurate COVID-19 Information - CDC and AAP

  • To meet the high demand for COVID-19 information, when possible, find your answers online. Here are the most reliable websites:
  • CDC website: https://www.cdc.gov/coronavirus
  • American Academy of Pediatrics parent website: www.healthychildren.org
  • Nurse advice lines and medical call centers are needed for sick patient calls.

COVID-19 - How it is Spread

  • COVID-19 is spread from person to person.
  • The virus spreads from respiratory droplets 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 methods are how most respiratory viruses spread.

Multisystem Inflammatory Syndrome (MIS-C)

  • MIS-C is a a very, very rare complication of COVID-19. In general, COVID-19 continues to be a mild disease in children.
  • The most common symptoms are fever, a red rash, abdominal pain and diarrhea or vomiting. Half of the patients develop trouble breathing. Some children become confused or overly sleepy.
  • Onset of symptoms: Usually about 4 weeks after a COVID-19 infection and apparent recovery.
  • Peak age: 8 years. Age range: 6 months to 21 years.
  • Treatment: MIS-C is treatable with medications, including IV immune serum globulin.
  • If a child gets this rare complication, a parent will know that their child needs to see a doctor. Patients with MIS-C need to be admitted to the hospital.
  • At this time, it cannot be prevented nor predicted.

After Care Advice

COVID-19 Infection with Mild Symptoms - Overview:
  • You or your child have been diagnosed as probably having COVID-19 OR
  • You or your doctor suspect COVID-19 because it is widespread in your community and you have developed symptoms that match (cough and/or fever).
  • You may or may not have received a lab test for COVID-19. It doesn't matter. Most infections are mild, especially in children.
  • Here's some care advice to help the sick person feel better.
Treatment of Symptoms:
  • The treatment is the same whether you have COVID-19, influenza or some other respiratory virus.
  • The only difference for COVID-19 is you need to stay on home isolation until you recover. Reason: You want to protect other people from getting it.
  • Treat the symptoms that are bothering you the most.
  • There is no anti-viral medication for treating COVID-19 at home.
  • Antibiotics are not helpful for viral infections.
  • You don't need to call or see your doctor unless you develop trouble breathing or become worse in any other way.
Fever Treatment:
  • For fever above 102 F (39 C), you may use acetaminophen or ibuprofen if the patient is uncomfortable. (See Dosage table).
  • For fevers 100-102 F (37.8 to 39 C), fever medicines are not needed. Reason: Fever turns 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: prevent dehydration. Staying well hydrated helps the body sweat and give off heat.
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: 1/4 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 1/2 to 1 tsp (2 to 5 ml) as needed as a homemade cough medicine. It can thin the secretions and loosen the cough. (If 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.
  • OTC cough medicines are not recommended. (Reason: no proven benefit for children.) Honey has been shown to work better.
  • Don't use OTC cough medicines under 6 years of age. Reason: Cough is a protective reflex.
Sore Throat Pain Relief:
  • COVID-19 often causes a sore throat. Here are some tips on treating it:
  • Age over 1 year: Can sip warm fluids such as chicken broth or apple juice. Some children prefer cold foods such as popsicles or ice cream.
  • Age over 6 years: Can also suck on hard candy or lollipops. Butterscotch seems to help.
  • Age over 8 years: Can also gargle. Use warm water with a little table salt added. A liquid antacid can be added instead of salt. Use Mylanta or the store brand. No prescription is needed.
  • Pain medicine: Use if pain interferes with swallowing. Not needed for mild pain.
Muscle Pains - Treatment:
  • COVID-19 can normally cause muscle pains and body aches.
  • Massage: Gently massage any sore muscles.
  • Stretching: Gently stretch any sore muscles.
  • Apply Heat: Use a heat pack, heating pad or warm wet washcloth. Do this for 10 minutes 3 times per day.
  • Warm bath: For widespread muscle pains, consider a warm bath for 20 minutes 2 times a day. Gently exercise the sore muscles under water.
  • Pain medicine: For widespread body aches, give acetaminophen every 4 hours OR ibuprofen every 6 hours as needed. (See Dosage table.) Not needed for mild aches.
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.
Home Isolation Is Needed:
  • Isolation means separating sick people with a contagious disease from people who are not sick. (CDC) That means stay at home.
  • 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.
  • Other family members should also stay at home on quarantine. Living with a suspected COVID-19 patient implies close contact has occurred. Exceptions: Essential workers who have COVID-19 exposure but do not have any symptoms. Talk to your employer.
  • 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.
  • Isolation Questions for Your PCP: Home isolation can be complicated. A parent may need to return to work. Someone in the household may be elderly or have a serious medical problem. If you have additional questions, call your doctor during office hours. Your doctor is the best resource for up-to-date information on COVID-19.
COVID-19 Testing - Talk with your Health Care Provider:
  • For questions about testing, call your doctor during office hours.
  • The decision is a complicated one.
  • The availability of testing and where to get it can be different for every community.
  • National and state recommendations also continue to change.
  • Your doctor is the best resource for up-to-date information on testing.
  • Here are some facts that may answer some of your questions:
  • Diagnostic Tests: These are performed on nasal secretions and tell us if you have a COVID-19 infection now.
  • Antibody Tests: These are performed on blood and tell us if you have antibodies from a previous infection. They are not done until at least 3 weeks have passed from the start of your infection.
  • Tests for COVID-19 are mainly done on people who are sick (have symptoms of COVID-19). Tests are usually not done on people who have no symptoms.
  • Testing is routinely performed on patients who have serious symptoms or are admitted to the hospital. It is usually not done on patients with mild symptoms who don't need to be seen.
  • Testing is also needed on adults who have essential jobs and need to know if they can return to the work force.
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 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 you have to leave your home (such as going to a medical facility). Always call first to get approval and careful directions.

Author: Barton Schmitt MD, FAAP
Copyright 2000-2020 Schmitt Pediatric Guidelines LLC
Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it.
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