By Tempest Wright

While the effects of COVID-19 on children have been reportedly mild, a new condition related to the virus has developed with serious consequences. Multi-symptom Inflammatory Disease in Children (MIS-C) is the result of the immune response to COVID-19. The immune system overreacts to the virus and does more harm to the body than good. Speaking to the Centers for Disease Control and Prevention (CDC), Dr. Michael Levin states that children with MIS-C often test negative for COVID-19 but positive for COVID-19 antibodies, suggesting that MIS-C is an immune response and not a novel viral infection. Dr. Levin also describes MIS-C as a “new and unusual condition” following the heels of the COVID-19 peak. The syndrome can affect children that were otherwise healthy before exposure to COVID-19. Kids don’t need a preexisting condition to be more at risk for this condition.

At the Children’s Hospital in St. Peter’s, New Jersey, a patient as old as 16 was treated for MIS-C. The CDC is currently unsure whether this condition specifically targets children or if adults are susceptible as well. The information surrounding this condition is limited, due to its novelty. The CDC urges healthcare providers to report suspected cases to their local, state, or territorial health department so that the data surrounding MIS-C grows.

Cases of MIS-C from the earlier this year, that were first attributed to Kawasaki Disease (KD), are being reevaluated as new symptoms emerge and new information surrounding COVID-19 reveals itself. Experts now have different criteria for diagnosing MIS-C versus KD. KD, also known as Kawasaki syndrome or mucocutaneous lymph node syndrome, is a children’s disease and a type of toxic shock syndrome. The majority of people who develop the syndrome are under the age of five, according to the American Heart Association. KD can affect the child’s blood vessels and damage the heart and other internal organs. Doctors diagnose this condition through examination and ruling out similar conditions. There is no test for KD, and doctors are unsure of its cause.

According to Elizabeth Murray, D.O., a pediatrician at the Golisano Children’s Hospital in Rochester, New York, speaking with What to ExpectMIS-C is a children’s immune response to COVID-19, as opposed to another manifestation of the coronavirus. While similar enough to be misdiagnosed, MIS-C differs from KD in its severity. While KD typically affects toddlers, older children, typically ages 9 to 11, are being hospitalized for MIS-C. Doctors aren’t certain what causes MIS-C outside of exposure to COVID-19, but they know the syndrome isn’t contagious. Additionally, doctors are uncertain whether or not MIS-C is a form of KD.

The CDC is still learning how best to treat MIS-C, as not much is understood about the condition, beside the fact that it is rare and afflicts children that have tested positive for COVID-19 or have a positive antibody test. Doctors have not yet determined why children are developing MIS-C or why it’s only affecting a small subset of kids.

Although the condition is rare, MIS-C is very dangerous and it’s important that parents know what signs and symptoms to look for in their children. Fortunately, MIS-C isn’t hard to miss. Symptoms include:

  • Fever
  • Fatigue
  • Neck pain
  • Abdominal pain
  • Diarrhea
  • Sore throat
  • Irritation and swelling of the mouth, tongue, and throat
  • Swollen lymph nodes
  • Conjunctivitis (pink eye) or bloodshot eyes
  • Headaches

If your child presents any of these symptoms, it’s important to get them emergency care right away. Advanced symptoms include:

  • Trouble breathing
  • Pain or pressure in the chest that does not go away
  • Confusion
  • Inability to wake or stay awake
  • Bluish lips or face – In darker-skinned children, check the gums, around the eyes, and the nails, as skin discoloration is harder to detect in Black and brown people
  • Severe abdominal pain

While MIS-C sounds frightening, the American Academy of Pediatrics reminds parents that this condition is still rare. ​If a parent has any concerns or questions about their child’s health, they should contact their pediatrician. Medical professionals urge patients not to be afraid of going to the doctor if they are sick. Hospitals are following every protocol to keep their facilities sterile and their patients safe.

The good news is that children with this condition typically respond well to treatment, and average three days to three weeks in the hospital. The treatment protocol for MIS-C is similar to that of KD, since the condition presents many of the same complications. Intravenous gamma globulin (IVIG) is an infusion made up of antibodies and a high-dose aspirin. It is administered to the child every six hours through an IV, and can decrease the child’s risk of developing a coronary aneurysm (a rupture in the heart) down the line. According to The Heart Institute, infusions are most effective as treatment and prevention of future coronary damage if administered in the first 10 days of illness. This is why it’s important to get a child emergency care as soon as symptoms present themselves. After hospitalization, the child will continue taking high-dose aspirin until inflammation and fever subside. Additionally, the child will continue to be monitored by a cardiologist after the illness passes, for signs of heart complications. If no complications arise, the child’s cardiology visits will be spaced out further until no longer needed.

For more information about MIS-C, see this CDC webinar. This source includes a complete transcript of the webinar and presenter slides.

Other resources: Fact Sheet

For Parents:  MIS-C Associated with COVID-19

MIS-C World Health Organization Scientific Brief