Amidst recent reports that Covid-19 vaccinations for adolescents (12 to 17-year-olds) might be commencing in mid-September, parents across Malaysia understandably have many questions in mind.
Sense with Science or Apa Kata Sains? excellent discussion last month helps to clarify several of our concerns relating to the impact of Covid-19 on children and adolescents.
Hosted by Karen-Michaela Tan, paediatrician Dr Chin Sheau Yin from Hospital Sungai Buloh, Tan Sri Dr Jemilah Mahmood and Prof Dato’ Dr Adeeba Kamarulzaman answered key questions in this informative session, ranging from the detection and management of Covid in children and adolescents to the possibility of vaccinations.
We share some of their main takeaways below.
Sense with Science’s Children, Adolescents & Covid – Questions and Answers
Are children getting more ill in Malaysia this year with the new virulent strain of Covid-19?
Dr Chin: We see a huge difference in the progress of the disease in these children last year as compared to this year. Last year, they were generally asymptomatic or had very mild symptoms. But this year, what is worrying is that my whole ward is full of children that need oxygen support, some of them are even in intensive care. They are getting more ill.
Management of symptoms
What happens if my child is found to be Covid positive?
Dr Chin: In our system, they will be contacted by the public health side. We have very well-established Covid-19 Assessment Centres (CAC) nationwide that are assessing these children. For now, the children who are asymptomatic will be allowed to be home quarantined, provided their home environment is suitable. At the same time, they will be under follow-up by the CAC centres. If the children do have mild symptoms, advice will be given to the parents on what to look out for. If they do turn ill, there is a contact number for them to contact the CAC centre. Of course, in an emergency situation, parents can always bring them to the emergency department of any hospital, whether private or government, for immediate medical attention.
What are the signs of Covid infection in a child? Is there a different presentation in children as opposed to adults?
Dr Chin: In both adults and children, the commonest presentation will be fever and respiratory symptoms. Fever in children typically occurs within the first 5 days of the illness. Some of them have prolonged fever, or the fever may come later on. Some may also have cough, runny nose, sore throat, and the loss of sense of taste and smell.
For children, especially young toddlers and infants, there might be gastrointestinal symptoms (in particular, diarrhoea) or vomiting. Some may also have febrile seizures or an inflammation among their vocal cord region, which can be seen through hoarseness of voice and noisy breathing. The rarer symptoms would be rashes and conjunctivitis.
What can I do if my child is Covid positive with mild symptoms?
Dr Chin: What a parent can do to help is no different than with any other infection. Make sure that children hydrate themselves enough. Encourage small but frequent feeds, with various beverages that they prefer. When they do have a fever, tepid sponging [and] paracetamol will help. It is also very important for parents to recognise when children need immediate medical attention.
What are the signs that a child is becoming sicker?
Dr Chin: One thing that needs immediate emergency attention is shortness of breath. In children, [this means] breathing [that is] faster than usual, recession between the rib bones or noisy breathing, like wheezing. Besides respiratory symptoms, the hydration of the child is also important. Anytime the child has reduced oral intake, less than half of his or her normal self, diarrhoea is persistent, the child looks lethargic, diapers look dry, the child isn’t urinating enough, not active, tongues and lips look dry, persistent fever – [this] means a child needs medical help to hydrate the child. If a child presents with persistent fever, longer than the first five days, parents should seek medical help during that time as there might be [a risk of] co-infection with other viruses.
How do parents care for their children if they are admitted into the Covid ward?
Dr Chin: Locally, we don’t isolate children from their parents, mainly because of the psychosocial attachments that children need from their caregivers. We do allow caregivers to be in to take care of their children. We do our best to selectively get caregivers who are or have been infected with Covid-19, instead of bringing in caretakers that are negative and exposing them further in the ward. If the child is the only positive one in the family, we will try to isolate them in the isolation room. We will advise the caregivers in terms of hygiene, sometimes even putting on barrier clothing while they need to take care of the children, and wearing masks all the time.
Prevention and impact
Are there any health precautions parents should be taking to ensure their kids remain safe from Covid?
Dr Chin: Vaccination is the key. We all know that currently overseas, although they are vaccinating adolescents, they haven’t started yet on children less than 12-years-old. In order to protect this vulnerable group, the best thing to do is to vaccinate the key adults around them. Besides that, strict SOPs and hygiene still have to be in place, despite the vaccination rolling on. And parents and teachers at school – don’t just ask children to follow the SOPs blindly. Do explain and educate them properly on why we need to do so. We know this pandemic is not over and we don’t know how long we are going to continue with the SOPs.
Is there a higher prevalence of Covid infections in adolescents than with children and if so, why?
Dr Chin: Yes, definitely. The prevalence in adolescents as compared to the younger age group is higher. Those ranging from 13 to 18 years take up 1/3 of the amount of children infected. There are various theories behind it. As we know, children[‘s reactions] are less severe compared to adults. Some say it’s because [they have] different receptors for the infection to enter their bodies [or] different microorganisms in their respiratory tract that protect them from getting severe illnesses. Adolescents are the transition from children to adults. Therefore, all these protective mechanisms change as they grow; hence, the way they present with the disease mimics young adults.
Does contracting Covid in adolescence have more long term effects than getting it as a child?
Prof. Adeeba: The whole scenario with long Covid is still very much research, and I don’t think anyone has any firm answers. It’s a big question mark at the moment in adults, as well as children.
Would children and adolescents who have gotten Covid be more immune to the different strains of it?
Dr Chin: This pandemic is not over, and we won’t know what is going to happen next with the virus. But we have actually seen cases of reinfection occurring among children, although it is not common.
Looking to the future
How might Covid impact the health and development of children and adolescents in the future?
Dr Chin: The impact of the quarantine [with] the children at home definitely gives a huge effect, whether physically or mentally on children. Physically, they are less active. They don’t go outdoors as much. For those young children who are still growing up, it will hugely affect their gross motor [skills]. The other aspect that will affect children a lot is their social development, especially children of school-going age who don’t get to be with their peers as much. [More issues of] stranger anxiety and separation anxiety from their parents do set in.
I would like to also bring special attention to our minority group of children with special needs. We all know that these children adhere to structural routines in their therapy, so with this lockdown, everything is interrupted. It will affect them a lot in their behavioural problems, as well as cause more stress in their family. It’s something to be very concerned about.
What are your views on vaccinating children and adolescents?
Dr Jemilah: In an ideal world, if the drug is deemed to be safe for you, you’d want to administer it quickly. But people have held back a little bit because of some reported cases of myocarditis and other complications. Generally, children bounce back very quickly and they recover, but the recent Delta variant and other variants have unfortunately shattered this image. Children actually get quite sick, as Dr Chin has shared with us.
We are still studying this, whether we look at different dosage regimes or other vaccines that might be used, but we need to have clear evidence before we give children the vaccines. We need to vaccinate people around the children; not just the parents, but also the teachers, the janitors in the school, the canteen operators. There are layers of protection to put in place – social distancing, masks, the washing of hands, ventilation, vaccination [and] good nutrition to make sure the immune system is in good shape.
There are no mandatory vaccinations – it’s still voluntary, even for adults. For children, we would need a little more evidence and research, which will be forthcoming. If a child is in a high risk category however – they are morbidly obese, have a very severe metabolic disorder, diabetes and so forth – you could make the case to vaccinate the child, but with very close monitoring.
Some people are already registering their young people [for vaccinations], but as I said, let’s get the adults and vulnerable groups done first, before we move on to the next phase.
*This discussion has been edited for clarity and brevity.
For more questions and answers, please view Sense with Science’s discussion in its entirety. Our article featuring Sense with Science’s session on Covid, pregnancy and vaccines can also be viewed here.