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When small is big

Mohammed Rayaan | Updated on May 03, 2021

Minor issue: Covid-19 is self-limiting for most children, who show mild symptoms such as a cough or a fever   -  ISTOCK.COM

Babies and toddlers are among those testing positive for Covid-19 in its second wave

* Years from now, children who lived or were born in these pandemic times may possibly be remembered as the generation whose childhood was “paused”

* As the second wave of the “once-in-a-generation” pandemic continues to unfold, the focus in many quarters is on the very young

* Babies born prematurely are at a higher risk

***

Dr Sen* looked hard at the report in front of him. It was the blood test of an infant who had been admitted to the Delhi government hospital where he worked as a paediatrician. The baby was 20 days old and had just tested positive for Covid-19.

Years from now, children who lived or were born in these pandemic times may possibly be remembered as the generation whose childhood was “paused”. They have witnessed a wide range of trauma that was last seen collectively across the globe perhaps during World War II.

The novel coronavirus has been raging across India, felling lives. And in recent times, doctors say a lot of those who have tested positive are babies and toddlers, a phenomenon not seen as commonly in the first phase of the pandemic last year.

Second wave

As the second wave of the “once-in-a-generation” pandemic continues to unfold, the focus in many quarters is on the very young. Health experts have said that more and more young people are being hit by the virus.

In the last few days, over 3 lakh Covid-19 cases have been registered in India on a daily basis. The experts say that while the pandemic has affected fewer children than adults, there are several cases of the very young being infected in the second wave of the pandemic.

According to the government’s National Centre for Disease Control, so far about 3.30 per cent of the total cases are of children under 10 years (over 5.86 lakh) while minors and young adults in the 11-20 age group (over 14.4 lakh) account for 8.14 per cent.

“We are witnessing more affected children (0-18 year olds) in the second wave. The same is true as per anecdotal data coming from other centres in India. The cause of this change is uncertain,” says Dr Binu Ninan, the head of the Department of Paediatrics and Neonatology at MGM Healthcare, Chennai.

One reason for this, perhaps, is the presence of new viral mutants and an increased susceptibility of children to these. “But the currently available data is inadequate to definitively attribute the increase in Covid-19 infections in children to this phenomenon,” he explains. “Lack of an approved vaccine for children would also contribute to their higher risk of contracting the infection.”

The Institute of Child Health (ICH), Egmore, Chennai, has been witnessing about 20 cases of minors on an average on a daily basis with mild symptoms. “We are not seeing severe cases unlike the infection rate witnessed in adults,” says a doctor at the ICH. “We are keeping children along with their mothers as in most cases parents, too, get infected and we are taking care of both.” The ICH has allotted a separate block with about 35 beds for treating Covid-19 positive patients. The doctor adds that 150 more beds have been earmarked for this.

Major symptoms

What are some symptoms that have been witnessed in minors? Dr J Rajkumar, consultant, Paediatric Infectious Diseases, Gleneagles Global Health City, Chennai, says that for most children, the disease is self-limiting and they have mild symptoms such as a cough or a fever for two or three days, which then subsides. “But the concern arises when children are ill for more than three days. They should then be checked immediately and admitted to a hospital,” he says.

Dr Rajkumar adds that there have been cases of multisystem inflammatory syndrome in children (MIS-C). This is a potentially severe and dangerous complication, says a study Coronavirus outbreak and kids published by Harvard Health Publishing. “It can lead to life-threatening problems with the heart and other organs in the body. In this condition, different body parts, such as the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs, can become inflamed,” it said.

Way forward

Another major fear that has gripped new parents in this crisis is protecting their baby if one of the parents gets infected with the virus.

“We have seen mothers infected with Covid-19, and within two weeks of delivering their child, the new born is infected too,” says Dr Spoorthi Arun, an internal medicine physician at Promed Hospital, Chennai, and director, Indian Society of Lifestyle Medicine. “We keep monitoring them and label them ‘Covid-19 suspects’. In this period, we encourage them to do breast feeding. It is still the safest way to take care of the baby and it has all the antibodies. Always sanitise your hands before taking care of the baby.”

Babies born prematurely are at a higher risk, Dr Spoorthi adds, possibly because of lower immunity. “Making them wear masks obviously is difficult.” However, the older children can be taught about the virus. “They are quick learners. If we talk to them and let them know about the situation, then they are bound to follow the protocol.”

As the cases continue to mount, many may feel despair. But doctors believe that by just following the basic safety precautions — wearing face masks, washing hands, following social distancing — the virus can be defeated.

Blessing in times of darkness

There are some happy stories coming out of the pandemic, too. When the virus first started spreading in India, Dr Mohamed Aabrez Shams, a general surgeon from Chennai, was posted to a government health programme.

Dr Aabrez recalls that during the early part of the pandemic, Covid-19 was spreading mainly through travellers. “So we had to obtain passenger lists from the Chennai airport and train stations and trace all the passengers,” he adds.

It was during this time that his wife, also a doctor, gave birth to a boy. “We were blessed with our precious baby boy in August 2020 while the country was headed towards the peak of the first Covid-19 wave,” Dr Aabrez says. “This meant that no family members were allowed to visit the newborn and mother at the hospital which was earlier the norm after childbirth. It was a quiet delivery and back to the safety of our home.”

Everything went on well, till Dr Aabrez contracted the virus. “My wife and our five-week old infant had obviously been in close contact with me. This was at a time when data on the effects of Covid-19 in infants was scarce,” he says. “We spent those two weeks in stark terror, trying to reassure ourselves that all would be well with the baby. By god’s grace, the family completed the quarantine without having been infected by me.”

Dr Aabrez says that his son’s only outings have been visits to his doctor for immunisation and adds that a large part of his extended family is yet to see the baby.

“The only consolation is technology that makes video calling and photo sharing possible. That’s the worst part about Covid-19. You cannot be near your loved ones when they need you the most,” he says. “Every single time I step out of the house, not just me, my entire family faces the risk of being exposed to Covid-19. Like the rest of the world, we are waiting for the pandemic to end and for things to go back to normal — for everyone’s sake, especially our baby.”

Safety measures

Dr Ninan stresses the need for parents and guardians of infants to take adequate precautions. “It is indeed a difficult situation. But parents need to adapt to take care of themselves and their children including newborns,” he says.

Limit the number of visitors when there is a newborn baby at home, and connect with relatives and others wishing to see the baby on video calls, he suggests. “Breastfeeding, tender loving care and routine vaccinations on time with well-planned appointments with attending doctors are to be continued uninterrupted for infants. It is essential for parents to get the necessary amount of information and not get submerged in the flood of continuing updates about the Covid-19 situation,” he adds.

Dr Sen agrees. Most children in his hospital have recovered, he says, adding that they largely showed mild symptoms of the infection.

The tiny infant whose report had shocked him is back home, too.

*Name has been changed to protect privacy

Published on April 29, 2021

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