The crisis of coronavirus disease (COVID-19) pandemic is the greatest challenge we have faced since World War II [1]. Although children are less commonly infected, and severity of disease in children is usually mild, no one is completely immune to this disease [2]. Most of the reported cases of COVID-19 infection in children show a complete recovery in one to two weeks; however, those with serious underlying medical conditions are at a higher risk [3].

The reason behind the lower prevalence of COVID-19 among children compared to adults is still unclear. Latest studies suggest that less exposure, less vigorous immune response, and incomplete functionality of Angiotensin-Converting Enzyme II (ACE2) in children – as the potential receptor for SARS-CoV-2 – are responsible for the significantly fewer severe cases in children [4]. Generally, children with mild symptoms and no risk factors should be managed at home [5]. Obstructed or absent breathing, central cyanosis, and cold skin are emergency signs that need immediate airway management and oxygen therapy to the target SpO2 ³ 94% [6]. The children with moderate and severe symptoms, along with the children with mild symptoms but with underlying risk factors, are recommended to seek hospital admission, and emergency treatment should be started according to the disease severity [5,7].

Due to a possible transmission from asymptomatic patients, children should avoid playgrounds and use a face mask in public settings. Current evidence suggests that SARS-CoV-2 is not transmittable by breast milk [8]. However, in the case of suspected or confirmed COVID-19 positive mother, feeding the expressed breast milk by a healthy caregiver is more favorable than direct breastfeeding [9]. The mother should use a mask and maintain strict hand hygiene to prevent transmission during the breast milk expressing by using alcohol-based hand rubs or soap and water. Proper disinfection should also be applied to the equipment by a healthy person.

Lockdown, along with school and playground closures, and more time spent in front of screens like video games and television, can affect children’s mental health, and the lack of physical activity could result in overweight. To overcome this issue, children should be encouraged to achieve the 60-minute daily goal of physical activity, recommended by WHO, by sticking to in-door exercises [10]. Also, the quality and quantity of food should be considered seriously by the families, as the children eat unhealthier foods and the underprivileged children are undernourished due to the discontinuation of mid-day meal facility. Therefore, close supervision on physical health, nutrition, and mental health should be performed. Compared with the other groups of society, children are more vulnerable and are in need of great support [11]. It is our duty to provide support to children and families to assist them in overcoming the current situation.

Funding: None; Competing Interests: None stated.

REFERENCES

1. United Nations Development Program. COVID-19 pandemic: Humanity needs leadership and solidarity to defeat the coronavirus 2020. Available from: https://www.undp.org/content/undp/en/home/coronavirus.html. Accessed April 13, 2020.

2. Balasubramanian S, Rao NM, Goenka A, Roderick M, Ramanan AV. Coronavirus disease (covid-19) in children – what we know so far and what we do not. Indian Pediatr. 2020 Apr 9. Available from: https://www. indianpediatrics. net/CONVID29. 03.2020/SA-00159.pdf. Accessed April 24, 2020.

3. Wei M, Yuan J, Liu Y, Fu T, Yu X, Zhang Z-J. Novel coronavirus infection in hospitalized infants under 1 year of age in China. JAMA. 2020. Available from: https://jamanetwork.com/journals/jama/article-abstract/2761659. Accessed April 13, 2020.

4. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. 2020. Available from: https://pediatrics.aappublications.org/content/pediatrics/early/2020/03/16/peds.2020-0702. full.pdf. Accessed April 13, 2020.

5. World Health Organization (WHO). Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts. Available from: https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts. Accessed April 21, 2020.

6. World Health Organization (WHO). Clinical management of severe acute respiratory infection when COVID-19 is suspected. Available from: https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected. Accessed April 21, 2020.

7. Meena J, Kumar J. Fecal shedding of SARS CoV-2: Implications for disease spread and quarantine. Indian Pediatr. 2020. Available from: https://www.indian pediatrics.net/CONVID29.03.2020/CORR-00160.pdf. Accessed April 24, 2020.

8. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: A retrospective review of medical records. Lancet. 2020;395:809-15.

9. Centers for Disease Control and Prevention (CDC). Considerations for inpatient obstetric healthcare settings 2020. Available from: https://www.cdc.gov/ coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance. html. Accessed April 21, 2020.

10. World Health Organization (WHO). Global strategy on diet, physical activity and health: Activity and young people. Available from: https://www.who.int/ dietphysicalactivity/factsheet_young_people/en/. Accessed April 21, 2020.

11. World Health Organization (WHO). Environmental health in emergencies: Vulnerable groups. Available from: https:// www.who.int/environmental_health_emergencies/vulnerable_groups/en/. Accessed April 21, 2020.