pediatrics

As the number of Delta variant cases rises, health officials throughout the world are concerned, and are pushing health organizations to release revised COVID guidelines. The variant affects not just adults, but also children, according to reports. Because the majority of children have not yet had their COVID vaccinations, they are more likely to catch the virus, develop symptoms, and transmit it to others.

To talk about the same, we had a panel of experts on our special segment: Dr Smita Malhotra, Senior Consultant, Pediatrics and Gastroenterology, Apollo Hospital; Dr Shyam Kukreja, HOD, Pediatrics, Max Hospital; Dr Amit Gupta, Neonatologist and Pediatrician, Motherhood Hospital; Dr Rajeev Seth, Senior Pediatrician, Chairman, IPSCAN; Dr Naveen Bajaj, Senior Consultant, Neonatologist, Deep Hospital.

Below are a few excerpts from the interview:

Recent reports suggest that Covid in a child could be as worrying as in an adult. How worrying is this situation?

Dr. Rajeev Seth: We’ve witnessed two waves so far. The children were less affected in both rounds. As you can see from wave one, the majority of the youngsters were asymptomatic, and only a few cases were reported. More children were afflicted during this period because the disease’s effect was proportionately larger in the overall population, and children were also seen with a wide range of mild, moderate, and severe illnesses caused by covid. Mild infections may have gone unnoticed, while moderate infections may have caused breathing difficulties and decreased oxygen saturation, and severe infections may have resulted in multisystem inflammatory illness, requiring hospitalisation. Those extreme cases are now insignificant in comparison. In general, it is assumed that children who have a strong immune system and do not suffer from any serious illnesses have a robust immune system. Right now, it is critical that we take excellent care of our children. Except for one that we knew about from Zydus Cadila, none of the vaccinations have been authorised for children. For 12-18 it will take about another few months before it is available for children above 12 years.

In terms of diet, nutrition, and general well-being, adults must look after the child. Because the majority of the children have been confined indoors, they are at risk for behavioural and emotional problems. When the time comes, vaccination will be the most important component in achieving complete immunity. However, most studies suggest that approximately 60-67 percent of youngsters have antibodies, indicating that they had either a mild or moderate illness. Most professional organisations were keeping an eye on the disease’s varied patterns as it progressed. It’s becoming increasingly obvious that we don’t need to be so afraid. However, we must be prepared in the event of a significant third wave. Both secondary and tertiary care establishments have resources accessible for referrals. As a result, we must modernise the healthcare sector to provide secondary and tertiary treatment for children with covid.

There was a report by MHA which came out saying that our infrastructure is not enough to take care of children in case they get severe Covid infection. What is your overall assessment and how are pediatrician planning to deal with the upcoming third wave of Covid?

Dr. Shyam Kukreja: There are three questions that we have here,

1. Is third wave really imminent?
2. If it comes how children are going to be affected? Are they going to be affected in a different way as compare to what was happened in first and second wave?
3. If the third wave comes, are we prepared for it?

If you take a big group of children, for example, there are 100 cases of covid infection in adults, which means 15 of them are in trouble. They require oxygen, hospitalisation, and specialized treatment. In a group of 100 children infected with Covid, less than 1% will experience difficulties, but our denominator is so large that even 1% will be a significant amount. Therefore, I think we have to be prepared for lot of counseling of parents because 99% are going to be ordinary mild cases.

Are we prepared? What about severe cases? Are our ICU’s prepared as far as the infrastructure is concerned ?

 Dr. Shyam Kukreja : Due to the large number of people, any infrastructure might fail. But I believe that now everyone is ready. It should, in my opinion, be much better controlled.

Do you think infrastructure wise India is where it should be?

Dr. Smrita Malhotra : Yes we have children who are severly affected who need tertiary care like Pediatric ICU including the elite specialty that they are under. Obviously we lack such facilities as of now. But rising up to the challenge, one may say that there will be a coordinated effort with the tertiary care centres, nursing homes, coordinating efforts between the referring pediatricians and the tertiary care center doctors.

Maternity hospitals have refused to take in Covid patients at all. What do the people who want to continue consulting the doctor in these hospitals do?

Dr. Amit Gupta: Majority of these hospitals are preparing for the next wave. Like in the second wave they were not taking covid patients initially, but have started taking them in now. Our infrastructure is getting ready for it. We are not anticipating any major thing as sir previously said most likely its not going to happen but these small hospitals are taking in mothers who are covid positive, separating them, taking all universal precautions just to keep them.

Depending on the immunity of the children, many of them already have antibody. Do you think that’s enough to fight covid third wave?

Dr. Naveen Bajaj: Talking about new born specially and said that new born are much more protected than the older children because of the factor that receptor for this virus to enter into a cell are relative the less in those kids, specially in new born and they have an immunity which is better for there particular spike protein so that particular immunity is better. Infants gain immunity from breastmilk itself which is known to transfer antibodies from mother to the baby. So it is very important that all the newborns should be breastfed exclusively and must continue till 2-3 years of age.

Talking about the immunity in children, is there anything parents can do?

Dr Shyam Kukreja: Children generally have good immunity. That’s why pediatricians have been out of work in the last two phases. Children have good innate immunity as they keep on having common colds and getting cross immunity. Because of that, children don’t smoke and they have immature lungs, so they already have so much immunity. Apart from that, breast milk is the best for babies till the age of 2 yrs.

Should we be prepared for the mutation in the virus affecting children or should we be so much dependent on the immunity of children?

Dr Smita Malhotra: It is a fact that children have good immunity, but there is one more fact which I have seen is that they come with a lot of weight gain, lack of sleep, as they are spending more time on their phones and TV screens. They are not going out to play, which is causing an epidemic of obesity along with this covid pandemic. So children don’t need some immunity building food, but normal food, which includes a wide range of different coloured foods and vegetables. Avoiding junk food is really important for good health. And as far as the preparation for mutation is concerned, it might cause problems in critical cases, like we had seen in the second wave, where we had MISC. When they had MISC, they needed more care as they have cardiac issues and they get affected, for which we needed pediatric Echoes. Unfortunately, we lack, but apart from that, we can take care of ourselves as we have an adequate amount of oxygen, medication, and ventilators.

What about emergency cases Dr. Gupta? Fortunately the numbers are low but there are cases unfortunately, which require further care.

Dr Amit Gupta: All the district hospitals and PMO recently had a meeting where they are trying to coordinate and trying to come up with solutions. We are trying to build ICU’s. If God forbid this third wave to happen, then we are most probably really for it.

Talking about jabs for healthy children, as the vaccination for children is being said to come by 2022, don’t you think it’s too late considering the third wave?

Dr Naveen Bajaj: Yes, we have to wait as it is a scientific approach to make sure that the vaccine doesn’t have any side-effects on growing children. We have other things as an alternative to this, like everyone in the family should get vaccinated and children should get other vaccinations, such as vaccinations for flue, etc, so that they don’t catch other infections which will affect their immunity and make them more prone to covid infection.

Why is it like children have good immunity but they are at risk of being carriers?

Dr Rajeev Seth: Children are prone to being carriers, as this was also seen in the first wave and second wave. For this, children need to take the proper vaccines at the proper time. They need to be in touch with their pediatricians because it is not like that all other diseases have gone because of covid. So proper care and vaccination are very important till the time we have the covid vaccine in place.

What would you say to the worried parents at this time?

Dr Shyam Kukreja: The Covid vaccine will come in due course, as we are seeing data in adults so that we will be more sure with children, but there is one thing that parents should get their kids vaccinated for other diseases as they are more deadly in children than covid.

Is like that the children below the age of 13 have even better immunity that they don’t need vaccine at all?

Dr Amit Gupta: Yes, they have very very good immunity, but parents need to create a cocoon effect around them by getting vaccinated. Especially mothers who are feeding their kids need to take extra care.

We talked about importance of vaccine, breast feeding, but what would you give for a final advice to the viewers ?

Dr Naveen Bajaj: Those who are breast feeding should continue that, skin to skin contact is very helpful for kids so don’t isolate them for a bit. Make them wear mask. That’s all.