The kids aren't all right

16-Anaisha-with-her-parents-Khushboo-and-Apurv-Mehta Long recovery: Anaisha with her parents, Khushboo and Apurv Mehta, at their Mumbai home. She "took months" to return to full health after a bout of Covid | Amey Mansabdar

Last month, four-year-old Aditya, from Thrissur in Kerala, did not go to school for 20 days. Persistent cold, acute throat infection and intermittent fever kept the boy at home, making him irritable and restless, says his mother, Sreedevi Menon, a teacher. In Mumbai, Arjun, a 10-year-old student of EuroSchool in Airoli, has been visiting the doctor “every other day” for the past three months, says his mother, Namrata Sharma. He had to skip school for a week because of fever, ear pain and infection. The mother also observed fatigue, reduced focus on studies and exhaustion in her first-born. In Delhi, Tanmay, 11, was hospitalised two months ago because of “aggressive pneumonia,” says his mother, Ritu Khurana. She adds that most of the children in her Paharganj colony have missed out on studies and playtime because of illness.

“The age group for obesity is mostly adolescence, but now it is also being seen in younger children. In every OPD we have three or four new cases of obesity [every day].” - Dr Shashank Joshi, consultant diabetologist, Lilavati Hospital.
Doctors and counsellors are advising parents to spend more time with their children to help them cope with physical, emotional and psychological pressures that accompany a changing world.

Numerous cases of hand, foot and mouth disease (HFM, also called tomato flu) in children under six were reported in the past two months in Mumbai, prompting many parents to ask for online classes to limit the spread. A mild yet highly contagious viral infection common in young children, HFM causes sores on the mouth and rashes on the hands and feet. It is accompanied by fever, a sore throat, a runny nose, mouth ulcers and a loss of appetite. In a particular class of the Arya Vidya Mandir school in Mumbai's Bandra Kurla Complex, 20 kindergartners recently were down with HFM at one go, says a parent.

Ever since schools reopened earlier this year, children have been grappling with viral infections, mental and physical fatigue, lack of attention and contagious diseases. “In the past five months, we have observed a surge in infectious diseases among children aged five and six,” says Dr Tushar Parikh, consultant neonatologist and paediatrician at Motherhood Hospital in Pune. “HFM has been the most common, and has more than doubled in Mumbai and Pune compared with 2019.”

Mild infections have increased “significantly” among children, say doctors, adding that the symptoms are showing in “tangible and visible forms on the body”. “There has also been a severe surge in H1N1 or swine flu infections,” says Parikh. “Most children are testing negative for Covid-19, but positive for swine flu. Of 10 children who get admitted in the ICU for high-grade fever accompanied by fits, hardly one tests positive for Covid-19. In a day, I am now consulting 15 to 20 children who show flu-like symptoms and even dengue and malaria. So, 30 per cent of children come with HFM, 30 per cent show flu-like illness, 20 per cent are diagnosed with dengue and the rest with loose motions.”

Khushboo Mehta, a chartered accountant and mother to eight-year-old Anaisha, recalls how her daughter “took months” to return to full health after a bout of Covid-19. “In pre-pandemic times, she hardly fell ill and, whenever she did get a cough or a cold, my home remedies would work like magic,” says Mehta. “But, after Covid, she developed an allergy that refused to go until we gave her antibiotics.”

Doctors are also seeing puberty-related issues, more so among girls. Dr Sudha Rao, head of the paediatrics department at Mumbai's Bai Jerbai Wadia Hospital for Children, says that, post the pandemic, they are seeing breast development―the first stage of puberty―in girls as young as six and seven. “If that happens early, menses also starts early,” says Rao. “Often, parents are unaware of breast development as the first stage. They start panicking only when menses starts. Ideally, it should start around 12. But we are observing these changes very early. We are seeing an absolute increase in numbers, almost two to three times in comparison with 2019.”

She attributes this to children sitting at home during lockdown and putting on weight, thereby leading to early pubertal changes. “It is a known fact, especially in the west where food rich in carbohydrates comes cheaper than food rich in proteins,” says Rao. “Children there are obese and obese girls hit puberty as early as six. That is exactly what is happening here as well. I believe parents must bathe their children often so as to be aware of their physical development.”

Family time: Arjun, 10, with his mother, Namrata. He has gone to the doctor "every other day" for the past three months because of fever, ear pain and infection | Amey Mansabdar Family time: Arjun, 10, with his mother, Namrata. He has gone to the doctor "every other day" for the past three months because of fever, ear pain and infection | Amey Mansabdar

The problem with early puberty is that the hormonal changes lead to faster growth and fusion of bones, which in turn hampers the vertical growth of a child. “Bone maturation happens faster, and though children might look tall when they are in their pubertal stage, once they cross menses, the height does not increase much,” says Rao. “They grow only 4cm to 5cm more.”

Obesity is the number one negative outcome of Covid-19 on children, says Dr Shashank Joshi, consultant diabetologist at Mumbai's Lilavati Hospital. “The age group for obesity is mostly adolescence, but now it is also being seen in younger children. In every OPD we have three or four new cases of obesity [every day].”

According to The Hidden Impact of Covid-19 on Children: A Global Research Series published by Save the Children carried out in 2020, the pandemic had a “significant impact on the psycho-social wellbeing of children”. More than eight in 10 children reported an increase in negative feelings and one-third of households had a child or caregiver reporting violence in the home. And now, with things changing suddenly, children are grappling with a mixed bag of emotions coupled with confusion and anxiety to perform well at home, in school and on the playground, say experts. Almost all the parents THE WEEK spoke to seemed to agree that fatigue remains a major post-Covid problem among their children. This has been backed by research, too. In a study published in Frontiers in Paediatrics, fatigue continues to be the most “frequent symptom of post-Covid condition in children and adolescents with percentages varying between 10.8 and 20.1”. Although this is not an India-specific study, experts say that the percentage is “significantly high” here, too. “I can see such a glaring change in my son,” says Namrata. “Earlier, he used to be quite playful but now he is more exhausted than ever. Maybe it has to do with an overwhelming change in routine with school, classes, play, etc, but I don't think this exhaustion is normal.”

Says Neha Kare Kanabar, mother to Vyom and Ved, aged 16: “My twins have become more forgetful and are having problems focusing on tasks. They both take frequent breaks from studies, which was not the case earlier.” Founder of UNIMO (Universe of Moms), a community with more than five lakh mothers on Facebook and WhatsApp, Kanabar says the forums are filled with messages from mothers complaining of frequent headaches and infections in their children.

Shortness of breath and bluish discoloration of fingers among infants is also being seen, say Dr Devi Shetty, founder of Narayana Health, and Dr Supratim Sen, a paediatric cardiologist. But the cases haven't gotten worse post-Covid, they add. “It is the post-Covid inflammatory syndrome that we are more concerned about at the moment,” says Dr Sen. He has published a research paper on the presence of multi-system inflammatory syndrome (MIS-C) among Covid-positive children between eight and 14 from the Mumbai metropolitan area. “This is the new thing we are seeing in a small percentage of children who were exposed to Covid and these children become quite sick. They do recover if treated in time, but Covid does get to them in the form of inflammation of the body leading to skin rashes and high fever and, at times, can also dilate their coronary arteries.”

A cardiologist at AIIMS, who did not want to be named, says he also saw some extremely rare cases, like blood clots in the kidneys of children with Covid. “We had the most unusual cases among children as a result of Covid-19,” he says. “Fortunately, all is well now. We are only witnessing a high incidence in the number of congenital heart defects among infants and that continues to remain an area of concern.”

A large number of pulmonary, behavioural and neurological issues in children top the areas of concern at Kochi's Amrita Institute of Medical Sciences, says paediatrician and medical director Dr Sanjeev Singh. “There are chronic obstructive and restrictive lung diseases that we are observing in high numbers at the moment,” he says. “The second is behavioural changes. Having been cooped up inside the house with limited social interaction, children are facing attention deficit disorder and the urge for companionship is diminishing. Group work has taken a hit.” The third aspect he points out is neurological issues and uncontrolled rise in glucose levels as a result of post-Covid impact or arising out of steroids administered to children as part of self-medication. “Many children are coming to us with antimicrobial resistance,” he says. “Cases have definitely increased lately, post Covid. Because these children were given antibiotic pills for any and every viral infection. Now they are reporting lower respiratory tract infections for which first line antibiotics do not work.”

He talks about two boys he saw recently. “One is nine and the other, six,” he says. “They were going to school and got into a fight. This kind of belligerent behaviour was absent in both during pre-Covid times. But, of late, the issue became hugely concerning because the boys were underperforming at school and their behaviour necessitated therapy.”

Agrees Dr Avinash Desousa, a Mumbai-based psychiatrist. He has seen children who are finding it difficult to adjust to school even when an entire semester is now almost over. “I'm seeing a lot of hyperactivity, academic difficulties and the inability to perform in offline examinations. It is a straight result of the lockdowns.”

He also says that the consumption of pornography among teens has gone up. “I have seen children on their gadgets for over five hours a day,” he says. “They are addicted to video games and play well into the night. It is a very sad state of affairs at the moment.”

Doctors and counsellors are advising parents to spend more time with their children to help them cope with physical, emotional and psychological pressures that accompany a changing world. Says Dr M.R. Lokeshwar, a paediatrician from Mumbai: “Just ensuring that they maintain a healthy diet and an active lifestyle can help alleviate a lot of stress. Besides, it is important that children receive the influenza vaccine and annual flu shots.”