Table III.

Consensus treatment guidelines for children with coronavirus disease 2019

Country	Consensus guidelines/position statement - salient features
China
Updated diagnosis, treatment and prevention of COVID-19 in children: experts, consensus statement, second edition38	Supportive treatment
	Control of body temperature with antipyretics and expectorant drugs to avoid respiratory tract obstruction.
	For hypoxia, effective oxygen therapy with nasal catheter, mask oxygen. Nasal high-flow oxygen therapy, and non-invasive or invasive mechanical ventilation as appropriate.
	Prone position and lung protective ventilation strategy is preferred. ECMO may be tried in refractory cases.
	Glucocorticoids in severe cases 3-5 days for ARDS.
	Increased D-dimer and at high-risk of thrombosis - low molecular weight heparin and anticoagulants may be initiated.
	Oseltamivir and other anti-influenza agents for co-infection with influenza and others.
	Specific treatment
	IFN-alpha spray/nebulization; plasma exchange, immunoglobulin or convalescent plasma on case-to-case basis. Traditional Chinese medicine may also be given.
	Updated guidelines do not recommend lopinavir/ritonavir, ribavirin or chloroquine phosphate in paediatric patients.
Iran
An Algorithmic	Supportive treatment
Approach to Diagnosis and Treatment of Coronavirus Disease 2019 (COVID-19) in Children: Iranian Expert’s Consensus Statement46	Supportive therapy with antipyretics, fluids and electrolytes replacement, analgesia and ventilation as per requirement.
	Specific treatment
	ICU-admitted patients: Treatment for patients who were admitted in ICU included combined antiviral agents and immunomodulators [oseltamivir + hydroxychloroquine + kaletra (lopinavir + ritonavir)] ribavirin and if necessary, antibiotics according to the patient’s situation.
	Moderate to severe pneumonia: Treatment for these patients included combined antiviral agents and
	immunomodulators [oseltamivir + hydroxychloroquine + kaletra (lopinavir + ritonavir)], and if necessary antibiotics according to the patient’s situation.
	Mild pneumonia with risk factor: Treatment for these patients included combined antiviral agents and immunomodulators (oseltamivir + hydroxychloroquine), and if necessary antibiotics according to the patient’s situation.
	Mild pneumonia without risk factor: These patients should be placed in a watchful waiting programme and followed. Treatment in these groups is optional and related to physician’s decision according to the situation. It may include oseltamivir-hydroxychloroquine, and if necessary, antibiotics.
UK and Ireland
Allergy immunity and infection group Position British Paediatric Statement: Management of novel coronavirus (SARS-CoV-2) infection in paediatric patients in the UK and Ireland60	Mild to moderate disease: Supportive care only.
	Severe disease (mild - moderate ARDS): Supportive care, treatment with antivirals may be considered.
	Treatment with immunomodulatory therapy if evidence of hyperinflammation (raised CRP, ferritin, IL6, sCD25).
	Critical disease (severe ARDS or septic shock or altered consciousness or multi-organ failure): Supportive care treatment with antivirals. Treatment with immunomodulatory therapy may be considered if evidence of hyperinflammation (raised CRP, ferritin, IL6, sCD25).
	Antiviral therapy: Lopinavir, ritonavir + ribavirin or chloroquine or remdesivir.
	Immune modulation therapy: Tocilizumab and anakinra.
India
Clinical management protocol: COVID-19. Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India45	Supportive treatment
	Mild cases: Antipyretics/analgesics/antitussives/appropriate hydration and adequate nutrition.
	Moderate cases: Antipyretics/analgesics/antitussives/appropriate hydration and adequate nutrition.
	Oxygen support (target SpO292-96%), prophylactic anticoagulation, corticosteroids (methyl prednisolone/dexamethasone), Close monitoring for worsening.
	Severe cases: Supportive therapy to continue as in moderate cases. On failure of standard oxygen therapy, consider HFNO/non-invasive mechanical ventilation or mechanical ventilation.
	Lung protective ventilation - prone position, low tidal volume, lower inspiratory pressures, higher PEEP.
	Management of septic shock, bacterial infection
	Anticoagulation
	Specific treatment (investigational therapy/repurposed or off-label therapy)
	Mild cases with risk factors and in moderate cases - Consider hydroxychloroquine (dose 400 mg BD - for 1 day followed by 200 mg BD for 4 days) in patients above 12 yr. These drugs should be administered under close medical supervision, with monitoring for side effects including QTc interval.
	In severe cases hydroxycholorquine is to be avoided.
	In selected moderate cases with worsening and severe cases, remdesivir (children above 12 yr), convalescent plasma or tocilizumab may be considered.

ARDS, acute respiratory distress syndrome; ICU, intensive care unit; ECMO, extracorporeal membrane oxygenation; CRP, C-reactive protein; SpO₂, oxygen saturation; HFNO, high-flow nasal cannula oxygenation; PEEP, positive end-expiratory pressure