For months it seemed as if COVID-19 was sparing children, much to the relief of parents everywhere. Of the small number of children who do get the virus, most seem to have either mild or asymptomatic illness. But new reports show that some develop a complication called Multisystem Inflammatory Syndrome in Children, or MIS-C, that can be dangerous.
According to the Centers for Disease Control and Prevention (CDC), MIS-C can cause life-threatening problems with the heart and other organs. “Some cases bear a striking resemblance to Kawasaki disease, a post-viral immune response that has been around a long time and is generally treatable,” says Dara Kass, M.D., an emergency medicine physician and associate professor of medicine at Columbia University Medical Center in New York. “It can cause inflammation, rashes, conjunctivitis, and fever, but not all cases look like Kawasaki.”
It’s important to remember that this is not Kawasaki disease, though—it only shares some of the symptoms, so it’s the closest thing doctors have to use for reference. And while medical science has learned a lot about how to treat Kawasaki disease, and similarly they’re largely able to treat MIS-C, it’s still something we should take seriously. “We know it’s a systemic inflammatory response, which means it affects multiple organs and systems, including the heart and lungs. And we know it needs to be treated aggressively, but while most children seem to recover, it’s still a traumatic experience for children to be in the hospital, let alone the Intensive Care Unit.”
Dr. Kass and other experts think this Kawasaki-like immune response could be a reaction to either a current or past COVID-19 infection, but there’s a lot that doctors are still working to understand—including whether there might be a second virus that happens to be circulating at the same time as coronavirus.
Ironically kids who are immunocompromised, such as those with asthma and seasonal allergies, seem to be doing better. “That may have to do with the receptor—that they have a lower level of a certain receptor that the virus holds on to,” explains Dr. Kass. But there is still a “continuum of risk”—kids on medication for organ transplants may have different risks than a child on an injectable for Crohn’s Disease, one who sees a rheumatologist for arthritis or a child on chemotherapy. She recommends talking to your child’s primary doctor and their specialist, who will know more precisely what’s happening within that specialty, so you can get a better understanding of the risk factor for your child.
It’s important to note that MIS-C is both rare and treatable. “The number of cases is low, especially when you consider how widespread COVID-19 has become,” says Claire McCarthy, M.D. a pediatrician at Boston Children’s Hospital and an assistant professor of pediatrics at Harvard Medical School. “Parents shouldn’t panic if their child gets one of these symptoms, or if they’re diagnosed with COVID-19.”
One of the many things we will learn within the next year is why this complication occurs in only a few kids. “The best thing we can do right now is to prevent children from getting infected,” Dr. Kass says. That means plenty of handwashing and social distancing, of course, but also keeping an eye out for certain symptoms. While symptoms of MIS-C vary from case to case, Dr. McCarthy says they can include:
- prolonged fever (more than a couple of days)
- rash
- conjunctivitis (redness of the white part of the eye)
- stomachache
- vomiting and/or diarrhea
- a large, swollen lymph node in the neck
- red, cracked lips
- a tongue that is redder than usual and looks like a strawberry
- swollen hands and/or feet
- irritability and/or unusual sleepiness or weakness
If you notice any of these symptoms, don’t panic. There are many other conditions and viruses that can cause these symptoms. “Doctors make the diagnosis of MIS-C based not just on these symptoms, but also on their physical examination as well as medical tests that check for inflammation and how organs are functioning,” Dr. McCarthy says. The most important thing is to call your doctor if you see these symptoms, whether or not your child has been diagnosed with COVID-19.
The majority of children who’ve developed MIS-C have been treated and recovered. “If your doctor isn’t concerned, that’s great — but if the symptoms get any worse or just don’t improve, call again or bring your child to an emergency room,” Dr. McCarthy says.
Whatever you do, keep in mind that for the most part, kids seem to be OK. However, arming yourself with accurate, up-to-date information is always your best bet. “I think it’s important that we take this effect on children seriously. What this virus is teaching us,” adds Dr. Kass, “it’s that we can’t take anything for granted.”
