COVID-19: RCPCH issues guidance for managing hospitalised children

  • Royal College of Paediatrics and Child Health

  • curated by Pavankumar Kamat
  • Clinical Guidance Summaries
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The Royal College of Paediatrics and Child Health (RCPCH) has published new guidance highlighting key principles for the clinical management of children admitted to hospital with suspected COVID-19.

This guidance targets general paediatricians attending children during the COVID-19 pandemic. It has been collaboratively developed by the British Paediatric Respiratory Society and the British Paediatric Allergy, Immunity and Infection Group.

Key recommendations

  • Paediatric clinicians should reassure parents and involve them in caring for their child, remain updated with emerging evidence and ensure communication with colleagues.
  • Clinicians should remain extra-vigilant when treating children with pre-existing conditions, but at the same time, reassure parents that the risks for co-morbidities are much higher in adults than children.


  • Although chest X-rays, blood tests and blood gas analysis are not routinely indicated in all children, they are warranted in children with persistent fever, fluid imbalance, signs of hepatic dysfunction or respiratory failure.

Medical management

  • The following therapies are not routinely indicated for empiric treatment of COVID-19 in children and should be only used if there is an absolute clinical need: bronchodilators, systemic steroids, antibiotics, antivirals and diuretics.
  • Paracetamol is recommended as the first-line antipyretic; ibuprofen should be administered with caution.
  • Despite emerging concerns about angiotensin-converting enzyme (ACE) Inhibitors and non-steroidal anti-inflammatory drugs (NSAIDs), there is no strong evidence to discontinue these medications in children who have been taking them for pre-existing conditions.

Respiratory support

  • Locally-applicable respiratory failure pathways should be followed.
  • Use of high-flow nasal cannula oxygen (HFNCO) is not recommended if low-flow oxygen provides adequate saturation.
  • HFNCO and nebulisation should be used after careful consideration.

Experimental treatments

  • The use of specific treatments such as antiviral and immunomodulatory therapies is justified within a treatment trial.
  • A paediatric infectious diseases expert should be consulted beforehand.

The complete guidance can be found here.