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Coronavirus disease 2019 (COVID-19) manifests with various symptoms and complications, but it generally presents with milder symptoms in children. There are different published guidelines about the management of COVID-19 in children. We share our experiences in managing moderate to severe presentations and complications of the disease in a tertiary children’s hospital in the north of Iran. Our recommendation for the management of MIS-C (multisystem inflammatory syndrome in children) patients in the presence of coronary artery involvement starts with 2 g/kg Intravenous immunoglobulin (IVIG) and in resistant cases, or the presence of myocarditis methylprednisolone pulse therapy in three consecutive days. Pulse therapy is also recommended in cases without coronary artery involvement as the first step of treatment.  Other essential conservative management strategies are albumin replacement, hemoglobin monitoring, inotropes, meticulous use of antibiotics, and anticoagulants. All cases with MIS-C must be admitted to the pediatric intensive care unit. Moderate to severe cases are managed with supportive care, including hydration, vitamin D, vitamin C, zinc, and, if indicated, supplementary oxygen, and antibiotics. The most important part of the management of MIS-C is close monitoring of cardiovascular function, supportive care, and administration of corticosteroid and IVIG.

Keywords: COVID-19, children, management, antiviral drugs

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