What We Know About Serious COVID-19 Symptoms in Kids

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Recently, there have been a lot of news stories about a new condition called pediatric multisystem inflammatory syndrome, which is similar to a rare childhood illness called Kawasaki disease. This new syndrome is starting to appear in children across the U.S. and is thought to be associated with COVID-19 infection. As with so many things relating to this pandemic, there is still a lot we don’t know about this syndrome and what it means—but it’s worth examining what we do know so far about COVID-19 symptoms in kids.

Kids aren’t being infected as much and their symptoms are milder

“In general, kids are not getting infected as much,” says Michael Chang, an infectious disease specialist with UTHealth’s McGovern Medical School. Of the number of reported cases, kids comprise only a small percentage, between 1-2%, with most kids having had exposure to a household member with COVID-19. This observation is holding true for multiple countries.

Overall, given what we know so far, kids don’t seem to get infected quite as much, and when they do, their symptoms are milder. Kids also experience a slightly different range of symptoms. Although many kids have fever and cough as their main symptom, they are less likely than adults to experience these symptoms. Reported symptoms include cold-like symptoms, such as fever, cough and a runny nose, as well as vomiting and diarrhea.

That said, although most kids experience milder symptoms, there are still a small subset who have gotten sick enough to be hospitalized. A recent paper, published in the journal JAMA Pediatrics, looked at 48 kids who got sick enough to be hospitalized. About half of the kids qualified as medically complex cases, which means they required a high level of care. In total, 40 out of 48 had underlying conditions, ranging from obesity and diabetes to immunosuppression that was often related to cancer treatment. The other eight children had no known underlying conditions.

There’s a new inflammatory syndrome similar to Kawasaki Disease

Pediatric multisystem inflammatory syndrome is still very rare, but is something parents should be aware of in the case their child gets sick. Kawasaki disease occurs in about 1 out of 10,000 American children, while the exact frequency of this new syndrome is still emerging. Currently, New York State is investigating 110 probable cases, with patients ranging in age from infants to 21 years old. To put that number in perspective, New York State has had 343,051 confirmed COVID-19 cases to date.

Symptoms of pediatric multisystem inflammatory syndrome include a fever lasting more than 24 hours, abdominal pain, diarrhea or vomiting, a rash or changes in skin color, trouble breathing, or sleepiness and/or confusion. These symptoms are similar to Kawasaki disease, which is a very rare inflammatory disease that occurs in very young children, usually under the age of five.

“Parents need to be on the outlook for development of these symptoms,” says Ashlesha Kaushik, a national spokesperson for the American Academy of Pediatrics and a pediatric infectious disease specialist. “Information is power.”

In pediatric multisystem inflammatory syndrome, the severity of symptoms is greater, with some children also developing heart complications and exhibiting signs of shock, which has not occurred in Kawasaki disease cases. Although the probability that your child would develop this syndrome is still considered very, very low, it’s important to seek out help immediately if your kid gets sick.

“If you have any questions, seek out your pediatrician’s opinion,” Kaushik says.

Inflammatory disease: Immune system gone haywire

“What we think is happening here [is that] the active infection may be gone, but for some reason, the immune system forgets to turn itself off,” Chang says.

A lot of patients with this new inflammatory syndrome either test positive for the virus or for antibodies against the virus. That said, not all patients do. What this means is that doctors are saying this is a syndrome that seems to be associated with COVID-19, but the exact connection is still unclear.

“This seems to be more of an inference and association than clear causation,” Chang says

What is thought to be going on is that kids get infected with COVID-19—sometimes only with a very mild case—but later, their immune systems stay active in spite of the threat being gone, causing an inflammatory disease. Although the exact trigger for Kawasaki disease is still unknown, the symptoms are a result of a failure of the immune system to shut off, leading to inflammation throughout the body.

“When you have an overactive immune system, a lot of the clinical features will be similar,” Chang says.

There are treatments available for this new syndrome

Although this new inflammatory syndrome is worrisome, it is still very, very rare, meaning there is only a tiny chance your child will develop it. If your child happens to be one of the unlucky ones, the good news is that there are treatments available.

“Most children who develop this pediatric inflammatory syndrome are recovering with appropriate treatment,” Chang says. Treatments are similar to the anti-inflammatory treatments used for Kawasaki disease, which include steroids and intravenous immunoglobulin treatments.

In the middle of all this, don’t delay your kids’ vaccinations

We’ve written about this before, but even in the midst of all these worries and fears, it is critical that your kids remain up-to-date on their vaccinations. Although these new symptoms are certainly a new worry, and you may be tempted you to delay taking your child to the doctor for their well visit, continuing with vaccinations is as important as ever.

In order to protect the safety of their patients, pediatrician offices have implemented a number of protective measures, such as separating well visits from sick visits, cutting down on the amount of time spent in the waiting room and having all staff and patients wear a mask.

“Please don’t miss out on immunizations,” Kaushik says. “We don’t want to see another epidemic in the middle of this pandemic.”

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