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Singapore is dealing with a wave of infections from the highly transmissible Omicron variant of COVID-19. While vaccinations have proved effective in limiting the incidence of serious illness, children under the age of 12 have been increasingly making up hospitalisation numbers, with some 14,380 children under 12 years old infected with COVID-19 between October 2021 and January 2022.
Naturally, as a parent, you might be worried, especially about the risks of catching COVID-19, its effects on your child, concerns about vaccination, and how to care for your child should they get infected by the virus.
Dr Mohana Rajakulendran, paediatrician and mother of two, provides evidence-backed answers to 12 practical questions parents and caregivers might have about COVID-19.
Infants under the age of 1 have a slightly higher risk of having more severe COVID-19 symptoms. This is why they will be monitored more closely. Children who have underlying medical conditions such as congenital heart disease, neurological or metabolic disorders, certain genetic conditions, obesity or asthma may also be at higher risk of more severe symptoms and require closer observation.
As with any viral illness, some children may need to undergo investigations for prolonged fevers, or unusually high temperatures. They may also require fluid support for symptoms such as poor appetite, vomiting and diarrhoea, as this may lead to dehydration. Children who develop respiratory issues with shortness of breath, or low oxygen levels, may require oxygen support.
While many of the children who develop COVID-19 infections may be asymptomatic, or experience mild symptoms such as fever, cough, diarrhoea or fatigue, a small number of them may develop complications.
Amongst the 14,380 children under 12 years old infected with COVID-19 in Singapore from October 2021 to January 2022, 15 developed Multisystem Inflammatory Syndrome in Children (MIS-C), or at an incidence rate of 0.1%. MIS-C is an inflammatory syndrome that may develop 2 – 6 weeks after the initial COVID-19 infection, affecting multiple organ systems such as the heart, kidneys, lungs, intestines, brain and bone marrow. These children usually present symptoms such as prolonged high fevers, rashes, red eyes and lips, swollen lymph nodes, dizziness, stomach pains, vomiting and diarrhoea. Some may have poor heart function and low blood pressure, requiring support in the Intensive Care Unit.
With regard to the incidence of long COVID-19 in children, a study conducted in Rome from March 2020 to October 2020 has shown that up to 42.6% of children continue suffering from symptoms such as fatigue, muscle aches, headaches, insomnia, respiratory issues or palpitations for months after recovery from the initial COVID-19 infection.
More recently, Yale Medicine has reported that their doctors are treating children with long COVID-19 who face joint pain, fatigue and brain fog amongst other symptoms. These symptoms are presenting themselves in different intensities and durations, and in some cases last for months. While doctors have made progress in learning about the causes of long COVID-19 in children and the solutions, research is underway to learn more. Challenges include tracking the incidence of long COVID-19 in children, as young children may have trouble verbalising the symptoms they face, leading to it falling under the radar.
Children with COVID-19 may experience any of the following symptoms 2 – 14 days after exposure:
They may also be asymptomatic but still be infected with COVID-19.
The symptoms of COVID-19 in children are similar to that of many childhood viral illnesses. If your child is displaying mild symptoms, it is advised to perform a home Antigen Rapid Test (ART) on them.
Visit your nearest swab-and-send-home (SASH) GP clinic to be assessed non-urgently. The list of clinics may be found at this website: https://flu.gowhere.gov.sg/.
Call ahead to check that the clinic is able to perform ARTs or polymerase chain reaction (PCR) tests for the age of your child and their operating hours for swabs.
Take your child to the clinic using private transport, taxis or private car hires with air-conditioning turned off and windows wound down to get to and from the clinic.
Bring your child to see a doctor. Further testing with a PCR test may be required to ascertain COVID-19 or otherwise.
Following this assessment by the doctor, children who are unwell or have risk factors may be conveyed to hospital or a care facility. The majority of children would be eligible to recover from home.
Regardless of your child’s age, seek medical attention immediately at your nearest Children’s Emergency if he or she is displaying any of the following symptoms:
While there is no standard directive on how often your child should be tested, I would advise that if you suspect your child is displaying either COVID-19 or respiratory symptoms, they should be tested at the onset of symptoms with an ART kit.
They should also test daily before going outdoors until the symptoms fully subside upon a full recovery. It is also advisable to repeat an ART just prior to sending your child back to school.
Your child may recover at home if his or her test results return positive and:
However, while recovering at home your child would need to adherne to the following:
Should your child’s symptoms worsen during this period, do not hesitate in seeking immediate medical attention at your nearest A&E department. If your child’s symptoms persist, do seek for help via the telemedicine links provided instead by the Ministry of Health.
If your child is showing mild or no symptoms, they may not need any specific treatment. While your child recovers at home, you can support their recovery in the following ways:
If your child develops more severe symptoms from COVID-19 or MIS-C, they would need urgent hospital care. They might need oxygen supplementation or intravenous fluids to support their recovery. Seek medical attention immediately.
Most hospitals are adopting a single accompanying parent policy for all unwell children who are admitted to hospital. If your child is isolated for suspected COVID-19, one parent is allowed to accompany the child.
Since your child will be isolated, you will need to remain in the isolation facility throughout your child’s stay as well. If your child tests positive for COVID-19, you will be placed under quarantine and closely monitored for the development of any respiratory symptoms.
Vaccinating your child is advised to reduce the chances of them contracting COVID-19 and developing severe disease. Vaccination also protects children from transmitting the virus to others and keeps their family members and school mates safe. At present, Singapore has rolled out vaccination efforts for children aged 5 years old and above.
Imparting good hygiene practices is paramount in keeping the virus at bay. Encourage your family, including your child, to incorporate these practices into their daily routine:
The Health Sciences Authority (HSA) has endorsed the safety, efficacy and quality of the Pfizer-BioNTech/Comirnaty COVID-19 vaccines on children 5 years and above. The HSA and Expert Community on COVID-19 Vaccination (EC19V) have also reported that in totality, the benefits of the Pfizer-BioNTech/Comirnaty vaccine outweigh the risks when used in a paediatric dosage (10 micrograms) for children aged 5 – 11 years, which is a third of the dosage given to children aged 12 and above. Clinical trials also show a 90% reduction in the risk of symptomatic infection in infected children.
Side effects are mild to moderate, and tend to resolve in a few days. Your child may experience more side effects after the second shot, which is a sign that their body is building defences against the virus. Serious adverse effects are rare. However, if you notice that your child has any of the following symptoms, seek medical attention immediately:
Based on experience with other respiratory viruses, the transmission of viruses via breast milk is likely to be less significant in comparison to the benefits of breastfeeding.
However, if you have been diagnosed with COVID-19, you should take extra precautions to prevent transmission of the virus to infants through respiratory droplets and contact. This would include wearing a face mask when breastfeeding and taking strict hand hygiene measures when handling your baby. Take adequate hygiene precautions when handling expressed milk as well.
If your child is diagnosed with COVID-19, you can continue breastfeeding. Wear a mask to protect yourself and practise good hand hygiene. You should seek medical attention early if you develop fever or any respiratory symptoms.
It is important to continue routine vaccinations for your child and regular follow-ups to monitor your child’s chronic medical conditions. You can postpone other non-urgent medical consults.
Some paediatric clinics provide time slots in the mornings only for routine health assessments (for growth and development) and vaccinations. It is recommended that advanced appointments be made so clinic staff can make the necessary arrangements. Routine vaccinations will protect your child from acquiring childhood diseases such as measles, diphtheria, Haemophilus influenzae, pneumococcal pneumonia, all of which have much higher mortality rates in children than COVID-19.
If you have respiratory symptoms (eg. cough, runny nose or fever), please visit your nearest Public Health Preparedness Clinic. It is important to receive timely treatment for your condition.