What Pediatricians Want Parents To Know About A COVID-19-Related Illness Affecting Kids

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Researchers and health officials are working quickly to study a new inflammatory health condition that’s impacting kids who’ve had coronavirus. In parts of the U.S. and Europe, a small but increasing number of children have come down with symptoms similar to Kawasaki disease or toxic shock. Doctors have determined it’s a brand new condition — which some are calling “pediatric multisystem inflammatory syndrome (PMIS)” and which the U.S. Centers for Disease Control and Prevention has dubbed "multisystem inflammatory syndrome in children (MIS-C)" — is associated with COVID-19. It’s causing kids to develop fevers, as well as inflammation of the skin, blood vessels, and heart. On Thursday night, the CDC told doctors they should report suspected cases to state and local health officials. Here’s what we know so far about the condition, and what parents should look out for. 
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What are the symptoms parents should watch for? 

The overwhelming hallmark of this syndrome is a persistent fever, typically greater than 102 degrees Fahrenheit, explains Tara Greenhow, MD, a pediatric infectious disease physician at Kaiser Permanente in San Francisco. The CDC warns that even fevers above 100.4 Fahrenheit that persist for 24 hours or more should be watched.
Kids with MIS-C are also experiencing abdominal pain, diarrhea, vomiting, and nausea. Some will have a rash, a tongue that’s bright red and enlarged, red eyes, and swollen hands. Like Kawasaki disease, these issues can impact a child’s heart if untreated. (Unlike Kawasaki disease, MIS-C doesn’t seem to induce coronary aneurysms when it’s left untreated, Steven Kernie, MD, chief of pediatric critical care medicine at Columbia University and NewYork-Presbyterian Morgan Stanley Children’s Hospital, told The New York Times.) MIS-C has also sent some children into a certain kind of toxic shock that leads to low blood pressure, Kernie explained. 
The CDC says children can be diagnosed with this if they show "clinically severe illness requiring hospitalization," that's impacting more than two organs (including the heart, kidney, renal, respiratory, blood, gastrointestinal, dermatologic or neurological). They also must have tested positive recently for SARS-CoV-2 and have no alternate plausible diagnosis.

How is it related to COVID-19?

You may find these symptoms surprising, because they’re not consistent with what you’d commonly experience with COVID-19, including shortness of breath and a cough. But Dr. Greenhow says most data is showing that this syndrome is hitting kids after they’re already recovering from the coronavirus. “Data that’s coming out of Europe is highly suggestive that these cases follow the initial [coronavirus] infection, which you can determine by checking for antibodies in the child’s blood,” she says. “The current thought is that it’s a hyper-inflammation following the acute infection.” It’s unclear how long after a COVID-19 infection MIS-C symptoms will show up, and some kids are testing positive while they’re still infected. 
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How common is it? 

It’s rare. But more than 180 cases have been confirmed in 17 states and Washington D.C., CBS News reports. There are also more than 50 cases in Europe. So far In New York, at least three children have died, as the state's Governor Andrew Cuomo reported on Saturday. One teen in England also passed away — a 14-year-old boy — according to a study in the Lancet journal.

Who does PMIS affect?

The CDC has defined the condition as one that affects people 21-years-old and younger, though they're not ruling out that adults could be impacted by MIS.
So far, most reports say it's just kids getting the infection, but it’s impacting children of all ages, from teenagers to infants. Dr. Greenhow says it’s unclear why it does not appear to be impacting adults, but notes that there are differences in the immune systems of kids and their older counterparts. “We don’t know why only children are affected, and we don’t understand if there’s any type of genetic propensity for this syndrome,” she says. It’s also still a question as to why some children are getting sick with this, but not others. 

How is it treated? 

Many doctors are treating it similarly to Kawasaki disease, with intravenous immunoglobulin, Dr. Greenhow says. They’re also using steroids and antibiotics, as well as extra oxygen they’d take in through a mask, or — in the most serious cases — a ventilator, The Times reports. 
Dr. Greenhow says that pediatricians from different specialties are coming together to treat kids presenting with this syndrome and are taking it very seriously. So, there might be a pediatric cardiologist, a rheumatologist, and an infectious disease expert on your child's team. 
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How can you protect kids from catching this? 

Of course, it seems that one of the best ways to prevent this from happening is to do everything in your power to ensure your child doesn’t catch COVID-19 in the first place. Maintain social distancing, and shelter in place. Make sure they’re washing their hands, and wearing a mask if they’re out in public. 

What should parents do if their child shows symptoms?

If you notice your child has a fever, rash, or abdominal pain, Dr. Greenhow recommends calling up your pediatrician — even if the symptoms are mild. If something is severely wrong, parents shouldn’t be afraid to call the emergency room and take their kids in. “Worrisome signs are any changes in the child’s mental status, or energy levels — not waking up or acting irregularly,” She says. “Look for signs of dehydration or decreased urine output. I think that often a parent knows when their child seems more acutely ill and it’s often not just related to the height of the fever. If a child is a lot of pain, that’s another common reason they’re brought into the emergency room for this condition.” 

I’m a parent — am I right to be freaking out about this?

Dr. Greenhow says that it’s important to be vigilant, but to remember that this is rare. “More data is coming every day for what appears to be a complication of COVID-19,” She says. “Now that we’re recognizing this new syndrome, we’re anticipating being better able to manage it and see even fewer deaths reported.” 
Another thing to keep in mind: If your child is having irregular symptoms that don’t fit the description of MIS-C, you should still talk to a pediatrician. “There are a lot of other conditions that should have parents bringing their children in,” she says. “We’re still seeing appendicitis and other common infections. Unfortunately, we’re seeing a lot of families who are delaying medical care because they’re worried they’re going to get exposed to COVID-19. It’s very important if a family is concerned, they reach out to their provider and are seen in a timely manner…  It’s important to remember there are other more common things that may affect your kids, even if they’re not a focus in the news right now.” 
Editor's note: This story has been updated to reflect a CDC statement put out shortly after this story was written.
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