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Thursday, April 22, 2021

Children and coronavirus: Interview with paediatrician Dr Mahesh Balsekar

Is a sterile environment a potential risk? Can a mother infected with Covid-19 breastfeed her baby? Dr Mahesh Balsekar, paediatrician and author of ‘0-2 Baby & You’ has answers, in this video interview.

By: Parenting Desk |
Updated: April 15, 2020 4:26:20 pm


In an interview with Express Parenting, Dr Mahesh Balsekar, paediatrician and author of the book “0-2: Baby & You”, addresses parents’ concerns on coronavirus. Here are excerpts from the talk, which you could also watch in the video above.

How susceptible are babies, infants and toddlers to coronavirus? Children are said to possess more immunity; is that true?

Initial studies seem to show that children are less likely to be infected. But that’s because most cases in children were asymptomatic and they were not tested. Initially, barely 3 per cent of the Covid population was believed to be paediatric, but with wider testing, it was found that almost 10 per cent of children are actually infected. In India, too, the Maharashtra data also shows that under 18 years of age, about 10 per cent of those affected are actually children. The good news, however, is that children fortunately have mild attacks of coronavirus. And overall, if you see, in adults, the rate of admissions is 20-25 per cent in moderate illness, while in paediatric, the ratio is barely 6 to 20 per cent. And it is only about 0.5 to 3 per cent that become critical. 

Is the testing for Covid-19 the same for adults and children? Could the testing results be less accurate for babies?

The testing is the same. You take a nasopharyngeal swab and the report comes in about 24 to 48 hours. Overall, the testing, however, is only about 70 per cent accurate in such diseases.

So you could have a baby, who is symptomatic, and there could be 30 per cent chances of an inaccurate result?

If you strongly suspect a Covid infection in an adult or a child and it’s a high-risk case, one would repeat the test after 24 to 48 hours to rule out inaccuracy.

If one suspects coronavirus, should one expose a child or family to the person coming home to conduct the test or even take the baby to the hospital?

We go by the clinical approach. If a child has been in contact with a Covid patient or someone who is high-risk, then we suggest a test. Cough and cold in children is very common, so if there’s no risk factor or contact, and it looks like a mild infection, one need not worry. However, if the child has a cough, it’s advisable to isolate them so the infection doesn’t spread to others in the family.

In this setting, I can fully understand a parent’s concern that they don’t want to go to a hospital, but if the child is unwell, they have to be checked. What we do usually is, we manage over the phone, but if things are not going well, we call them in. 

When should a parent hit the panic button or isolate a child? Is a cough, a sneeze reason to worry?

About 90 per cent of infection has been only through contact with a Covid-19 patient. That’s the easy part. So if you have a severe respiratory infection requiring hospitalisation, there has been contact or things are not going well, then one would definitely take further steps.

Are the symptoms at all different between babies and adults?

No, the symptoms are very similar. About 50-60 per cent will have fever or cough, but almost 75 per cent will have some symptoms, such as shortness of breath, fever or cough. But in children, about 27 per cent have no symptoms. So if one gets the infection, they can still spread it; that is why it is so difficult to control, because actually about 25 per cent of the population are without symptoms and they are the ones who are at risk of spreading the infection.

If a mother is diagnosed with coronavirus or has a mild case of it, can she still breastfeed? Normally, it is considered healthy to breastfeed when a mother has a cold because of the presence of antibodies, is it the same situation with coronavirus?

So, it’s slightly different here. If you have a mother who has had a covid infection, in these conditions, we advise the mother to be isolated from the baby. But the mother can express breast milk and this can be given to the baby because fortunately, the virus does not go into the breast milk. If it’s a mild case of infection in the mother, then the treatment is individualised. It’s perfectly fair to feed while wearing a mask and using a sanitiser. But many mothers would be very anxious. The WHO recommendation is that if it’s a mild disease, you can breastfeed. Breastfeeding is very important, but if there’s any doubt and you can give express milk, the advantage continues.

Coming to childhood vaccines, doctors are not encouraging kids to go in for routine checkups. How much can one delay vaccines and which ones can be pushed?

We’re trying to fast-track vaccines in under babies under nine months and those who are not vaccinated. So, if you have a six-week or 10-week old baby, we would like to hurry it up as much as possible. But if it’s a vaccine that is due at one year or 15 months or 20 months, it can be safely postponed by several months; it’s perfectly acceptable. 

When the vaccine for coronavirus does arrive, will it apply for babies too?

If you take the analogy of the influenza vaccine, it’s approved for babies above six months of age. It is expected that the vaccine should be available in about 20 months.

News reports that babies have contracted coronavirus in hospitals. If a newborn contracts the virus, how do you treat it?

The good part is that under nine years of age, there have been only a couple of cases. So for newborns who have come with respiratory distress, almost all have recovered. Infection, in hospitals, fortunately doesn’t come through the placenta or through breastfeeding, but through contact with the mother or caregivers in the hospital. So, the recovery is good. 

Does it take same period of recovery, for adults and babies, for coronavirus? 

It depends on the severity of the infection. Most adults take about three weeks to recover. Most children recover from the infection within a week to 10 days.

And can the infection through pets? What is the verdict on this?

I am a pet lover; there’s no risk! Pets have to be worried about us, rather than the other way around (laughs).

Any tips for building a child’s immunity at home?

For undernourished children, it helps tremendously to give supplements. For a well-nourished child, it makes no difference. Vitamin A, C and zinc supplements can help, but are not mandatory. There’s no proof that it helps, but there’s no harm either.

What about steam inhalation, ‘haldi pani’ (turmeric and water) and other remedies that are being suggested?

Heat is supposed to inactivate, but you need heat that is quite strong and for quite long to inactivate the virus. I would say these are unproven home strategies, but there is no harm in doing them.

What about kids going outdoors, to get natural sunlight? What can they do right now?

Yes, once the lockdown is lifted, going out in open spaces is fine, with safe distancing. It’s a tough call, but they should be at home right now.

Can one relax TV viewing hours now?

I think children are very smart. If you relax it now, the same pattern will continue later!

Can the infection pass through fruits and vegetables for babies? Should we be cooking them differently or separately? With the lockdown, it can be hard to get access to potassium permanganate to wash vegetables. 

So the presence of virus on the floors, vegetables and packing of food…the infectivity of these materials is very low. However, we have to be careful. All vegetables have to be cooked and fruits have to be washed and consumed. The risk is very low, but it’s good to take care. 

Is it enough to wash vegetables in salt water? 

Yes, as long as you wash and cook it, it’s fine.

When it comes to hygiene habits, how can parents communicate to children? Will these stick in the long run?

Hand-washing, sneezing into your elbow, not touching strangers will become part of our way of living. There are lots of cartoons, etc, being circulated in the media that can be shown to children. They should be educated at a young age on how to manage coughs, colds and understand general hygiene.

A philosophical question — we’re living in extremely sterilised environments. We’re sanitising constantly, we’re not stepping out, could we actually end up reducing our immunity? Even after the lockdown, we’re going to be so cautious about how we live our lives.

You have asked a very interesting question. Now we all know that children are infected less often than others and if they do get infection, it is less severe. And one theory is that it’s because they are carrying viruses in their throat. And if we do a virus swab for general viruses, almost 40 per cent have some virus or the other. So when you have a lot of normal viruses in your throat and you’re exposed to Covid, the latter somehow doesn’t get entry into the system. So this is one of the reasons why children seem to be catching Covid less. 

Also, children are immunologically immature. So, most of the complications which take place in Covid is because of the immune hyper responses; the lungs start getting damaged, the heart starts getting depressed. So, children mount a less vigorous immune response. And for this reason, children seem to be escaping the threat. 

But the other question, which you’re saying, about  keeping a sterile environment. So there is a theory, what is called a hygiene hypothesis, which means that when you’re living in a very sterile environment, then these patients and these individuals don’t develop immunity and they actually start developing auto-immune conditions and other problems. So when your hygiene level improves and your economic condition improves, you tend towards auto-immune and other diseases. But right now, it may be a protective factor for children and maybe it will work a little bit in India. 

That’s an interesting answer, with confusing repercussions. So, in lighter vein, should we do a daily teaspoon of mud?

So, it’s interesting. There was a British asthma expert who had come to India some five-seven years ago, who said that if you don’t want your child to get asthma, tell them to play in mud; exactly what you are saying. So if you catch infection in childhood, then you go towards the immunity way. If you don’t get infections in childhood, you can get asthma and other diseases. So this is actually a theory.

At what age do you tell your kid to toughen up and get exposed? What is the tipping point?

It’s a very difficult call to make. For a newborn and young infants, the immunity is low and they can get severe infection. So, under three months of age, one would be very careful. Once they are nine months to 12 months, then one can start getting a little relaxed. And in our environment, whether you like it or not, when you start sending kids to nurseries and play-schools, at 15 months or 24 months, they all get so many infections; we all go through it. So, this is inevitable.

Don’t miss these articles on Coronavirus from the Explained section:

How coronavirus attacks, step by step

Mask or no mask? Why the guidance has been shifting

Besides a face cover, should I wear gloves when I go outdoors?

How the Agra, Bhilwara and Pathanamthitta Covid-19 containment models differ

Can coronavirus damage your brain?

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