Table 1 COVID-19 management and treatment in children, according to disease severity

Asymptomatic infection

None

None

Mild case:

fever and/or asthenia with upper respiratory signs, not requiring supplemental oxygen

• Paracetamol (10–15 mg/kg every 4–6 h) in case of fever > 38 °C

• Airway suction in case of obstruction

• Consider monoclonal antibodies only in the presence of risk factors^a

Moderate case:

respiratory signs/symptoms (such as cough, mild distress with polypnea) requiring supplemental oxygen with nasal cannulas or Venturi system +/−fever, difficulty in feeding, signs of dehydration

• Paracetamol in case of fever > 38 °C

• Airway suction in case of obstruction

• Oxygen therapy using nasal cannulas or facial mask with Venturi system (target oxygen saturation > 95%), refer to WHO Interim guidance

• Intravenous access, adequate fluid and caloric intake based on hydration status

• Monitor vital signs (Bedside-PEWS) [3] every 8 h (or before in case of changes in the clinical picture)

• Dexamethasone (0.1–0.2 mg/kg) or methylprednisolone (1–2 mg/kg day)

• Remdesivir (5 mg/kg/1st day than 2.5 mg/kg for 5 days)

• Dexamethasone/methylprednisolone plus Remdesivir

Severe illness:

respiratory signs/symptoms (tachypnea, labored breathing) requiring supplemental oxygen with high flow nasal cannulas or non-invasive ventilation +/− fever, systemic signs of worsening (lethargy, inability to feed/drink)

• Paracetamol in case of fever > 38 °C

• Airway suction in case of obstruction

• Oxygen therapy using high-flow nasal cannulas or non-invasive ventilation (target oxygen saturation > 95%), refer to WHO Interim guidance

• Intravenous access, adequate fluid and caloric intake based on hydration status. Monitor urinary output.

• Venous thromboembolism prevention: low molecular-weight heparin

• Avoid empiric antibiotic treatment if no evidence of bacterial infection (consult an infectious disease specialist or refer to hospital guidelines)

• Monitor vital signs (Bedside-PEWS) [3] every 8 h (or before in case of changes in the clinical picture)

• Dexamethasone/methylprednisolone

• Dexamethasone/methylprednisolone plus Remdesivir (available for this group of patients only within clinical trials)

Critical illness:

ARDS

Respiratory involvement requiring mechanical ventilation or extracorporeal membrane oxygenation

• Paracetamol in case of fever > 38 °C

• Airway suction in case of obstruction

• Oxygen therapy using mechanical ventilation (target oxygen saturation > 95%) or extracorporeal membrane oxygenation, refer to WHO Interim guidance

• Intravenous access, adequate fluid and caloric intake based on hydration status. Monitor urinary output.

• Venous thromboembolism prevention: low molecular-weight heparin

• Avoid empiric antibiotic treatment if no evidence of bacterial infection (consult an infectious disease specialist or refer to hospital guidelines)

• Monitor vital signs (Bedside-PEWS) [4] every 8 h (or before in case of changes in the clinical picture)

• Dexamethasone/methylprednisolone