How to manage Covid-19 in kids: new guidelines

The Health Ministry has released revised guidelines for management of Covid-19 in children and adolescents below 18 years. Here's what has changed

A children's Covid centre is set up in Navi Mumbai on January 13. (Express Photo: Narendra Vaskar)

Last week, the Health Ministry released revised guidelines for management of Covid-19 in children and adolescents below 18 years, superseding the previous version of June 2021. Among the key updates, the revised guidelines advise against the use of antivirals or monoclonal antibodies in children and adolescents, irrespective of the severity of infection, and against the use of masks in children below the age of 5.

‘The Comprehensive Guidelines for Management of COVID-19 in Children and Adolescents Below 18 Years’ were reviewed by a group of experts in view of the current surge of cases, attributed mainly to the Omicron variant of the coronavirus.

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What to give, not give

The guidelines note that Covid-19 is a viral infection and say antimicrobials have no role in the management of uncomplicated Covid-19 infection.

“As of now in the absence of efficacy and safety data, the use of antivirals such as Remdesivir, Molnupiravir, Favipiravir, Fluvoxamine and monoclonal antibodies such as Sotrovimab, Casirivimab +Imdevimab are not recommended for children less than 18 years of age irrespective of severity of illness,” the guidelines say.

Overall, the management of children remains the same. The mainstay of treatment for fever is to give paracetamol. For cough, the guidelines advise throat soothing agents and warm saline gargles in older children and adolescents. They recommend ensuring oral fluids to maintain hydration and a nutritious diet.

“No other Covid-19 specific medication is needed for mild cases,” said Dr Aarti Kinikar, member of the Maharashtra paediatric Covid task force.

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Leading paediatrician Dr Umesh Vaidya said that in children, the main symptoms are cough, cold and fever; sore throat symptoms are more prominent than wheezing. Most paediatricians check for circumstantial evidence whether anyone in the family is symptomatic. For mild cases, RT-PCR tests are not being advised. Several paediatricians said that they have instructed families to stay in isolation for a week. However, Covid tests are required for those who need to be hospitalised.

Masks

The reason masks are not recommended for children aged 5 and under, experts said, is that youg children do not wear the mask properly and may have issues with breathing if there is underlying asthma or when they are playing. Some parents can be obsessed and force the child to wear a mask, but it is not mandatory for the child below 5 to wear one, experts said.

Children aged 6-11 may wear a mask depending on the ability of the child to use a mask safely and appropriately under direct supervision of parents/guardians. Children aged 12 years and over should wear a mask under the same conditions as adults. It is important to ensure hands are kept clean with soap and water, or an alcohol-based hand rub, while handling masks.

MIS-C

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Multi System Inflammatory Syndrome in Children (MIS-C) is a new syndrome in children characterised by unremitting fever and epidemiological linkage with SARS-CoV-2. For diagnosing MIS-C, the guidelines say caution should be exercised while interpreting an isolated increase in COVID antibodies.

Post-Covid Care

Children with asymptomatic infection or mild disease should receive routine childcare, appropriate vaccination, nutrition counselling, and psychological support on follow up, the guidelines say. For children with moderate to severe Covid, the guidelines say that on discharge from hospital, parents/caregivers should be counselled regarding monitoring for persistence/worsening respiratory difficulty and the indications for bringing the child back to the facility.

Anticoagulants & steroids

The recommendations for use of anticoagulants have been revised. If steroids are used, they should be tapered over 10-14 days, subject to clinical improvement.

Steroids are indicated only in hospitalised severe and critically ill cases under strict supervision. Corticosteroids may be used in rapidly progressive moderate and all severe cases; the guidelines recommend 5-7 days and tapering up to 10-14 days depending on clinical assessment. Steroids are to be avoided the first 3-5 days since onset of symptoms as it prolongs viral shedding, the guidelines say.

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Anuradha Mascarenhas

Anuradha Mascarenhas is a Senior Editor at The Indian Express, based in Pune. With a career spanning three decades, she is one of the most respected voices in Indian journalism regarding healthcare, science and environment and research developments. She also takes a keen interest in covering women's issues . Anuradha has won several awards including the Press Council of India's national award for excellence in journalism under the gender based reporting category in 2019 and the Laadli Media award (gender sensitivity -2024). A recipient of the Lokmat journalism award (gender category-2022), she was also shortlisted for the RedInk awards for excellence in journalism-2021. Her debut book At The Wheel Of Research, an exclusive biography of Dr Soumya Swaminathan the inaugural chief scientist of World Health Organisation was also nominated in the Popular Choice Category of JK Paper AUTHER awards. She has also secured competitive fellowships including the Laadli Media Fellowship (2022), the Survivors Against TB – New Research in TB Media Fellowship (2023) and is part of the prestigious 2025 India Cohort of the WomenLift Health Leadership Journey.” Professional Background Education: A gold medalist in Communication and Journalism from Savitribai Phule Pune University and a Master’s degree in Literature. Author: She authored the biography At The Wheel Of Research, which chronicles the life and work of Dr. Soumya Swaminathan, the former Chief Scientist at the WHO. Key Focus: She combines scientific accuracy with storytelling, translating complex medical research into compelling public and human-interest narratives. Recent Notable Articles (Late 2025) 1. Cancer & Specialized Medical Care "Tata Memorial finds way to kill drug-resistant cancer cells" (Nov 26, 2025): Reporting on a breakthrough for triple-negative breast cancer, one of the most aggressive forms of the disease. ``Discipline, diet and purpose; How a 97-year-old professor defies ageing'' (Nov 15, 2025) Report about Prof Gururaj Mutalik, the first Head of Department at Pune's B J Government Medical College who at 97 credits his longevity to healthy habits and a strong sense of purpose. 2. Environmental Health (The "Breathless Pune" Series) "Long-term exposure even to 'moderate' air leads to chronic heart, lung, kidney issues" (Nov 26, 2025): Part of an investigative series highlighting that even "safe" pollution levels are damaging to vital organs. "For every 10 µg/m3 increase in PM2.5 level, there was 6-8% jump in medicine sales" (Nov 23, 2025): Using commercial data to prove the direct link between air quality and respiratory illnesses in Pune. 3. Lifestyle & Wellness News "They didn't let cancer, diabetes and heart disease stop them from travelling" (Dec 22, 2025): A collaborative piece featuring survivors who share practical tips for traveling with chronic conditions. ``At 17, his BP shot up to 200/120 mmHG; Lancet study flags why child and teen hypertension doubled between 2000 and 2020'' (Nov 12,2025)--A report that focusses on 17-year-old-boy's hypertensive crisis and reflects the rising global trend of high blood pressure among children and adolescents. 4. Scientific Recognition & Infrastructure "For promoting sci-comm, gender diversity: IUCAA woman prof highlighted in Nature" (Nov 25, 2025): Covering the global recognition of Indian women scientists in gender studies and physics. ``Pune researchers find a spiral galaxy like the Milky Way from early universe'' (December 3, 2025)- A report on how Indian researchers discovered a massive galaxy that existed when the universe was just 1.5 billion years old , one of the earliest to have been observed so far. Signature Beat: Health, Science & Women in Leadership Anuradha is known for her COVID-19 reportage, where she was one of the first journalists to provide detailed insights into the Covishield and Covaxin trials. She has a dedicated interest in gender diversity in health and science, often profiling women researchers who are breaking the "leaky pipeline" in STEM fields. Her writing style is scrupulous, often featuring interviews with top-tier scientists and health experts from various institutions X (Twitter): @runaanu ... Read More