From the Guidelines
COVID-19 in a 1-year-old should be managed with supportive care, focusing on hydration, fever control with acetaminophen, and rest, while monitoring for signs of multisystem inflammatory syndrome in children (MIS-C) or hyperinflammation, as described by the American College of Rheumatology 1.
Key Considerations
- The majority of children with COVID-19 have mild symptoms, but it's crucial to watch for severe respiratory disease or a hyperinflammatory response.
- Symptoms can include fever, runny nose, cough, decreased appetite, vomiting, or diarrhea, and in severe cases, difficulty breathing, persistent fever, lethargy, or poor feeding.
- Treatment should prioritize supportive care, including adequate hydration and the use of acetaminophen for fever management, with dosing based on the child's weight, typically 10-15 mg/kg every 4-6 hours, as guided by a pediatrician.
- It's essential to avoid giving aspirin or ibuprofen without medical advice due to potential risks.
- Isolation at home for at least 5 days from symptom onset is recommended, with continued isolation if fever persists, and family members should practice good hand hygiene, wear masks around the child, and regularly disinfect frequently touched surfaces.
Monitoring for MIS-C
- Be aware of the signs of MIS-C, which can resemble Kawasaki disease or toxic shock syndrome, and may include fever, abdominal pain, vomiting, diarrhea, neck pain, rash, conjunctivitis, and extremity pain, as noted in the guidance provided by the American College of Rheumatology 1.
- Early recognition and management of MIS-C are critical due to the risk of myocardial dysfunction and other severe complications.
- Pediatricians and healthcare providers play a vital role in the early detection and treatment of MIS-C, and their guidance should be sought promptly if there are concerns about a child's condition.
From the FDA Drug Label
VEKLURY is indicated for the treatment of coronavirus disease 2019 (COVID-19) in adults and pediatric patients (birth to less than 18 years of age weighing at least 1.5 kg) who are
The adverse reactions observed were consistent with those observed in clinical trials of VEKLURY in adults. Infants, children, and adolescents; Cohorts 1–4,8: Adverse reactions (all grades) were reported in 8 (15%) subjects. The most common adverse reaction occurring in at least 5% of subjects was ALT increased (6%)
Treatment of COVID-19 in a 1-year-old:
- Remdesivir (VEKLURY) is indicated for the treatment of COVID-19 in pediatric patients, including those aged 1 year, who are hospitalized or at high risk for progression to severe COVID-19 2.
- The dosage for pediatric patients is weight-based, with different dosing regimens for different age and weight groups 2.
- Adverse reactions in pediatric patients, including infants and children, were similar to those observed in adults, with the most common adverse reaction being ALT increased (6%) 2.
- Laboratory abnormalities, including hemoglobin decreased, eGFR decreased, and creatinine increased, were also reported in pediatric patients 2.
From the Research
COVID-19 in 1-Year-Old Children
- COVID-19 can affect children of all ages, including those as young as 1 year old 3.
- Most cases of COVID-19 in children are mild, but some can be severe and even fatal 3.
- Risk factors for severe illness in children with COVID-19 include underlying medical conditions and other identifiable clinical characteristics 3.
Treatment and Management
- There is no definitive antiviral treatment for COVID-19, but remdesivir has shown promise in reducing disease progression in some patients 4, 5, 6.
- Remdesivir may be effective in hospitalized patients with COVID-19 who require supplemental oxygen, particularly those on low-flow oxygen 6.
- Other treatments, such as lopinavir/ritonavir, hydroxychloroquine, and interferons, have not shown improved efficacy compared to standard care or placebo 5.
- Neutralizing monoclonal antibodies may be effective in reducing the risk of severe disease development if administered early in the course of the disease to patients at risk of progression 5.