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Covid-19 Primary Care Resources

Management and guidance for febrile children

How to approach possible Covid-19 infection in children and guidance on school attendance

This information is sourced from the The UK Research and Innovation (UKRI), the Royal College of Paediatric and Child Health (RCPCH) and the RCGP:

Symptoms of Covid-19 in children:

  • Most infected children present with mild symptoms or are asymptomatic
  • Children’s symptoms vary slightly from those seen in adults and tend to be milder
  • Cough or fever are observed in around half of symptomatic children, which is less often than in adults
  • In contrast, upper respiratory symptoms such as a runny nose or sore throat occur in 30-40% and diarrhoea and/or vomiting are found in around 10% (sometimes this is the only symptom); this is more often than in adults

Are there any signs that could help differentiate Covid-19 from other childhood respiratory viral infections?

  • Children if unwell with a temperature are more likely to have another pathology rather than Covid-19
  • You cannot reliably differentiate between a cold, flu and Covid-19 over the telephone or by examination alone
  • Whilst there are some symptoms more common with upper respiratory tract infections and the flu, there is significant cross over with Covid-19
  • Covid-19 has been detected in combination with other viral and bacterial infections
  • For this reason, any child or young person with the diagnostic criteria for Covid-19 should isolate with their family and apply for a test

What are the RCGP top tips for assessing febrile children at present?

  • Clinical assessment should include vital signs even when consulting remotely
  • Consider asking if the family own their own thermometer or pulse oximeter
  • Describe to the parent / carer how to perform a capillary refill test and observe it being completed
  • You can count the respiratory rate over a video call and there are apps such as ‘R rate’ that patients can download to count it themselves
  • Ask about signs of deterioration and always check for the risk of sepsis
  • If a child is very unwell, they are much more likely they have another diagnosis than Covid-19. Do not forget other causes of the sick child such as meningitis, DKA or an untreated UTI during the pandemic
  • Stable children presenting with a persistent fever should be discussed as soon as possible with secondary care to determine if blood tests and paediatric review is required in case of PIMS-TS

Which symptoms will warrant testing for Covid-19 and children remaining away from school whilst awaiting results? 

Is it safe to give ibuprofen to a child who has tested positive for Covid-19 or is highly likely to be positive?

  • There is currently insufficient evidence to establish a link between use of ibuprofen, or other NSAIDs, and contracting or worsening of Covid-19
  • Experts at RCPCH recommend that parents treat symptoms of fever or pain related to Covid-19 with either paracetamol or ibuprofen

Atypical Kawasaki disease/ PIMS-TS:

The symptoms are: persistent fever >38.5°C, evidence of single or multi-organ dysfunction (shock, cardiac, respiratory, renal, gastrointestinal or neurological disorder) with signs of inflammation (neutrophilia, elevated CRP and lymphopaenia)  (See clinical and laboratory features page 4)

See also:

How should we approach common childhood illnesses in the context of Covid-19?

11 primary care pathways for remotely assessing children (includes remote assessment of fever, cough and breathlessness)

Tonsillar examination

Evidence on Covid in children