COVID-19 Related Multisystem Inflammatory Syndrome in Children (MIS-C)

Multisystem Inflammatory Syndrome in children, more commonly known as MIS-C, is a rare condition that creates an extreme immune response in some children who have been infected with COVID-19. Considered a syndrome, not a disease, MIS-C generally presents itself as a cluster of symptoms including, swelling, irritation, or pain throughout the body.

MIS-C can be mistaken for other more common illnesses, but if left untreated, it can pose a danger to the vital organs, (eg, heart, lungs, or kidneys). In rare cases, it can be fatal, but most children who develop MIS-C eventually recover with proper medical care.

What are the symptoms of MIS-C?

MIS-C affects each child differently so symptoms can vary quite a bit from child to child. The following is a list of symptoms that may indicate a child has MIS-C:

• A fever greater than 100.4° in children under 2 years old, or greater than 101° in children over 2 years old for more than 2 days in a row
• Headache
• Rash
• Bloodshot eyes
• Cough/Sore throat
• Extreme fatigue
• Belly pain/vomiting or diarrhea
• Redness or swelling of the lips and tongue
  
• Swollen or redness of the hands or feet
• Swollen/enlarged lymph nodes in the neck or neck pain
• Non-responsive to verbal instructions or physical touch
• Loss of consciousness, and/or confusion

When to seek emergency care if you suspect your child has MIS-C

Seek immediate medical attention if your child exhibits any of the following symptoms:

• Extreme stomach pain
• Difficulty breathing/chest pain
• Skin tone is pale/gray or lips, or nail beds appear bluish
• Sleepiness or confusion or an inability to wake up or remain awake

Michael Grosso, MD, Medical Director and Chair of Pediatrics at Northwell Health in New York, reinforces the importance of not delaying care to avoid serious complications, “Inflammation involving the heart is perhaps the most serious feature, and many children come to medical attention with the severe impairment of heart function, known as cardiogenic shock."

Who is at risk for MIS-C?

In general, children most at risk for being affected by MIS-C are between the ages of 3 and 12 years old, with 8 years old being the average. For reasons still not known or understood, Black, Latino or Hispanic, and Asian or Pacific Islander children are more likely to be infected by MIS-C as compared to White children.

As with adults, children with underlying health conditions are also considered to be at high risk for contracting COVID-19 and, subsequently, MIS-C. Often, medically fragile children will need additional in-home medical care post-infection and home health companies, such as BAYADA Pediatrics, can assist with those needs.

How is MIS-C diagnosed?

Because MIS-C symptoms can be similar to other illnesses, such as Kawasaki Disease (an illness causing blood vessels to become inflamed), or toxic shock syndrome, doctors must conduct a battery of tests to properly diagnose MIS-C. Consultation with other health care professionals specializing in infectious disease, cardiology, rheumatology, and critical care is often necessary to make an accurate and timely diagnosis. Diagnostic tests may include:

• Blood or urine tests
• COVID-19 test
• Chest X-ray
• Various cardiac tests
• Abdominal ultrasound
• CT Scans

In this University of Michigan article, Christine Mikesell, M.D., a pediatric hospitalist who helped drive the MIS-C clinical guidelines at Michigan Medicine C.S. Mott Children’s Hospital said that MIS-C is sometimes diagnosed at the same time as COVID-19—not necessarily afterwards.

“This condition initially appeared to only be observed in children weeks after recovering from COVID-19 and who tested positive for antibodies, but now we’re also seeing cases where there’s an overlap—some children are showing signs of MIS-C at the same time as testing positive for COVID-19.”

How is MIS-C Treated?

Treatment for MIS-C depends on the symptoms the child has been exhibiting, as well as the results of the tests conducted. There are several treatment options for MIS-C, ranging from oxygen treatments, intravenous fluids to help reduce the inflammation in the body, medicines to help avoid blood clots and maintain the health of vital organs, as well as treatments to improve heart function and breathing. There are some cases, however, where some children may need to be treated in the hospital in an Intensive Care Unit.

How to prevent MIS-C

According to the Pennsylvania Department of Health, implementing best practices to avoid infection of the COVID-19 virus will help prevent being infected with MIS-C.

• Wash hands often. Use soap and water and wash hands for at least 20 seconds. (Use sanitizer with at least 60% alcohol if soap is not available)
• Avoid sick people. Remove yourself from the company of someone who shows signs of sickness or who may be at high risk of contagiousness.
• Keep your distance. Practice social distancing by staying at least 6 feet from other people in public places.
• Wear a face mask. It has been shown that wearing a face mask in public settings can greatly reduce your chances of getting COVID-19.
• Avoid touching your face. Touching your nose, eyes, and/or mouth can increase one's chance of contracting COVID-19.
• Practice covering your mouth. Sneeze or cough into a tissue or your elbow to prevent spreading your germs to others.
• Keep disinfectant wipes readily available. Keep high-touch surfaces clean—doorknobs, light switches, remotes, countertops, tables, chairs, desks, keyboards, faucets, sinks, and toilets.

What are the long-term effects of MIS-C?

The good news is that most children will recover from MIS-C. While some studies—such as the one published in The Lancet Child & Adolescent Health Journal (May 2021)—noted that a small number of children who had severe MIS-C symptoms still had problems six months post-infection, long-term damage to organs is rare.

The medical community and researchers continue to work in conjunction with the CDC to learn more about risk factors and improved treatments and diagnostics for MIS-C.

The experts at BAYADA Pediatrics are always available to help. Please do not hesitate to call us at (888) 340-3222 if you need assistance for your child.