A Serious Pediatric Complication of COVID-19

Dear families and friends,

Some of you have been asking about a newly discovered complication of COVID-19 in children. Since this is a brand new disease, the medical community is learning more and more about it every day. We had been working under the assumption that while children are certainly able to spread the virus, those with no significant underlying health issues were unlikely to develop the severe infections and sickness seen in adults.

While that is STILL TRUE, a pediatric condition has recently been identified, which can be much more serious, and in VERY rare cases, even lethal. It seems to be something like other inflammatory conditions that affect the body, such as Kawasaki disease or toxic shock syndrome. This condition is called Multisystem Inflammatory Syndrome in Children (MIS-C), although it was recently referred to as Pediatric Multisystem Inflammatory Syndrome (PMIS).

While it is still not clear exactly what is happening in these patients, it seems most likely that the inflammation that causes damage is an overreaction of the body’s own natural defenses against infections. While fever and swollen lymph nodes are common, a wide range of organs can be involved, and blood tests can confirm the presence of inflammation. The treatment for Kawasaki disease is supportive care (like IV fluids) and medications which reduce inflammation (such as steroids or intravenous immunoglobulin). Children who have involvement of the heart, kidneys or other organs may require other specific management.

The VAST majority of children treated for Kawasaki disease recover fully with no long term complications. While MIS-C is completely new, it seems that the prognosis is also very good with prompt attention and similar treatment. It is also important to know that children with more limited signs of inflammation may not require hospitalization. Just like in adults, there is a wide range of symptoms associated with this illness.

As of today, 145 children in New York City have been diagnosed with MIS-C, although only 67 of these have tested positive for the COVID-19 virus itself or antibodies suggesting previous infection. Remember that at different times in the course of this illness, both of these tests may be negative even if the virus is (or has) been present, as outlined in the chart below. It's a bit complicated, but the dotted lines are the antibody tests, that show previous infection. The solid blue curve is the nasal swab that is most commonly done to test for active infection And remember, some of these children with MIS-C may have been exposed to individuals with active COVID-19, but still test negative themselves at one point.

So what should you do about this? I know that this seems scary, but don't panic. Remember that even if MIS-C is diagnosed, you child has an excellent chance of a full recovery with treatment. Please contact your chid’s pediatrician if they have any of these signs or symptoms:

  • A fever of over 100.4 that lasts for more than a day
  • Irritability or decreased activity
  • Unexplained abdominal pain
  • Diarrhea
  • Vomiting
  • Rash
  • Pink eye (conjunctivitis)
  • Difficulty feeding
  • Red, cracked lips
  • Red tongue with bumps
  • Swollen and/or red hands or feet

While MIS-C is VERY rare, you should still take all of the appropriate steps to prevent the spread of COVID-19, to protect children and everyone else. That includes the use of masks, good hand hygiene and physical distancing.

I know that many of us are struggling with everything that is going on. Parenting in the COVID era is especially tough, as those of us with young children in school know all too well. Being there for your kids means taking care of yourselves too. I know that’s easier said than done, but I’m doing my best to try to strike a healthy balance with my family, and I'm sure that you are as well.

Remember, this is not home schooling, this is crisis management. Don’t try to live up to unreasonable goals, don’t compare yourselves to others on social media, and don’t ever forget to seek out support when you need it. We are a strong community, and that means more now than ever.

Please feel free to contact me if you have any questions, or if you just want to chat. And stay safe!

Michael Rothschild, MD