Though at present, the coronavirus infection seems to be much milder in babies and children, it’s much important to understand recent reports about Pediatric Inflammatory Multisystem Syndrome (PIMS). It is a very rare condition that might be related to exposure to the coronavirus. We must not trivialise this in Pakistan and, as paediatricians, general physicians and parents, look out for such symptoms in children. What are coronavirus symptoms in babies and children? Generally, COVID-19 symptoms are milder in children than in adults. In recently published studies in Pediatrics of COVID-19 in Chinese children, 90 per cent of those who tested positive for the disease had mild symptoms or none at all. Fever and cough are common COVID-19 symptoms in both adults and children. Shortness of breath is more likely seen in adults. Children can have pneumonia, with or without obvious symptoms. They can also experience sore throat and excessive fatigue. However, serious illness in children with COVID-19 is possible and parents should stay alert if their child is diagnosed with, or shows signs of, the disease. In the study, 10 per cent of infants with a positive COVID-19 test became critically ill. Severe illness rates were lower in older children, but there were rare cases of children in each age group requiring hospitalisation, and one 14-year-old who died. Parents need to follow guidelines if they think their child is sick with coronavirus infection. Parents and caretakers should contact their paediatrician or family care practitioner if their child seems ill, especially if cough or fever is present. Doctors at children’s hospitals in the US and the UK have noted that a small number of children between ages two and 15 have experienced a condition called pediatric inflammatory multisystem syndrome, or PIMS. Doctors are urgently trying to determine if and how PIMS and COVID-19 are related. Pediatric inflammatory multisystem syndrome or PIMS can cause inflammation of the blood vessels throughout the body. The inflammation can limit blood flow; damaging heart and other organs. PIMS has features in common with Toxic Shock Syndrome and an illness called Kawasaki disease. Certain symptoms may mean an inflammatory problem such as Kawasaki disease or PIMS. Parents should look out for: * Abdominal (belly) pain * Vomiting and diarrhoea * A red rash * Red, cracked lips * Red eyes * High fever * Swollen glands on one or both sides of the neck * Swollen hands or feet prolonged fever (more than a couple of days) * Rash * Conjunctivitis (redness of the white part of the eye) * Stomachache * Vomiting and/or diarrhoea * A large, swollen lymph node in the neck * Red, cracked lips * A tongue that is redder than usual and looks like a strawberry * Swollen hands and/or feet * Irritability and/or unusual sleepiness or weakness. PIMS, like Kawasaki disease, is very rare. But if a child has these symptoms, parents must call their doctor. PIMS may be treated with a plasma transfusion to reduce the inflammation and protect the heart and other organs. Children with Medical Conditions Asthma: Children with asthma may have more severe symptoms from COVID-19 or any other respiratory disease, including the flu. As yet, there are no indications that most children with asthma experience severe symptoms due to the coronavirus, but observe them and, if symptoms develop, call the child’s doctor to discuss next steps and to arrange appropriate evaluation as needed. Diabetes: Control of blood sugar is key. Children with well-managed diabetes are not expected to be more susceptible to COVID-19. But poorly controlled diabetes can weaken the immune system, so parents and doctors should watch these children carefully for signs and symptoms that may require evaluation. What are the signs that a child with COVID-19 requires immediate emergency medical attention? Parents or caretakers should immediately contact urgent or emergency medical care if they notice these warning signs in a child: * Difficulty breathing or catching his or her breath * Inability to keep down any liquids * New confusion or inability to awaken * Bluish lips How to Protect Your Children from COVID-19 Children are exposed to COVID-19 when the virus contacts their eyes, nose, mouth or lungs. This usually occurs when a nearby infected person coughs or sneezes, which releases respiratory droplets into the air and onto the child’s face or nearby surfaces such as tables, food or hands.” * Avoid crowds. Keep kids away from crowded areas when possible, don’t take them to grocery stores or visit any one’s house with them. * Stay away from sick people. Keep children at least 6 feet away from anyone who is sick with a cough or fever, including family. * It is advised to parents to teach kids to wash their hands regularly, with soap and warm water, for at least 20 seconds. * If soap and water are not available, the next best option is hand sanitizer * Cough and sneeze with care. “Encourage everyone in the family to cough and sneeze into their elbow, instead of their hands, and to wash their hands after each time this occurs. * Keep hands off faces. Parents should remind children to avoid touching their face as much as possible. Parents should wash toys regularly. * Keep things clean. Wipe down toys and surfaces your child touches regularly, especially when travelling or when near a person who is sick. Clean surfaces at home and store cleaners in cabinets that are either too high for your child to reach or are secured with childproof. Don’t Stigmatise Or Discriminate * If you’re feeling worried about the coronavirus. Talk about it. But fear and stigma will make a difficult situation worse. For example, reports are emerging from around the world of individuals, particularly of Asian people, being subject to verbal or even physical abuse. * Our emergencies and hospitals are in stressful times. It’s important to stay informed and to be kind and supportive to everyone. Words matter and we must use language does not accentuate existing stereotypes that can drive people away from getting tested and taking the actions they need to protect themselves and everyone else. * Remember, viruses can affect anyone, do not associate it with a race, creed or cast. * Don’t be judgmental and don’t say that someone got it because it was a curse or because a person was a sinner etc. Talk positively and emphasise the importance of effective prevention measures, including following instructions on handwashing. PIMS may be treated with a plasma transfusion to reduce the inflammation and protect the heart and other organs Take Away Message: In Pakistan, it is a much-stigmatised disease. People associate disease with conspiracy theories. Misinformation is more believable than the scientific facts for masses, so we must play the role of responsible citizens and only trust information from valid resources. Doctors and parents need to be vigilant about the infection in children and treat it accordingly and report cases. Doctors dealing with pediatric population must report symptoms and outcomes of coronavirus infection amongst Pakistani children and contribute to research so that it could be diagnosed and treated effectively. People need to trust the health care system and take children to healthcare facilities timely. Talk to children about it and let them easily know scientific facts. Most importantly, follow precautions and be a good example so that they will follow into your footsteps. The writer is Resident (Pediatric Surgery) and Vice President of National Society For Women In Science (Pakistan). Disclaimer: The article does not diagnose or treat any medical condition; it is for the purpose of awareness for medical professionals and caregivers in the light of existing evidence. Professionals must look up for current treatment guidelines from valid resources themselves and caregivers should contact their healthcare facility in case of any medical condition. The author is not responsible in case of misuse of this article’s content. Dr. Imbesat Maheen Syed is a resident of Pediatric Surgery(clinician), Vice President National Society Of Women In Science Pakistan, writer, blogger, poet, inspirational speaker and artist.