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Last Updated: May 7, 2020, 5:00 pm

What Parents Need to Know About COVID-19 and Kids

Pediatric expert at Touro’s New York Medical College breaks down Multi-System Inflammatory Syndrome in Children (MIS-C)

May 19, 2020
Persistent fever is a symptom of MIS-C
Persistent fever is a symptom of MIS-C

Multi-System Inflammatory Syndrome in Children (MIS-C) is a COVID-related condition that now has parents everywhere concerned about the health and safety of their children. Dr. Michael Gewitz, pediatric expert at Touro’s New York Medical College, answers the most commonly-asked questions about this syndrome.

What are symptoms of MIS-C?

The symptoms are multi-faceted. Children show signs of intense body inflammation involving multiple organ systems. There may be  evidence of cardiac illness, kidney disease, neurological issues or unfortunately, all of these.

Affected children have either already had COVID-19 or been exposed to it. They also experience fever in addition to: either severe organ involvement or shock or, if not critically ill, at least two of the following symptoms—abdominal pain and vomiting, skin rash, cracking of skin on hands and feet, red (”strawberry”) tongue or dry pink eye.

Parents should contact their family doctor or pediatrician if a child has persistent or recurrent fever especially if any of the other symptoms are present.

Who can contract MIS-C?

MIS-C can affect all age groups, from babies through teenagers. In NY state the largest number of children with the syndrome have been in the 6- to 12-year-old age group.

What is the connection between MIS-C and COVID-19?

The current cases are affecting children with a history of close exposure to someone who has or had COVID-19 infection or have evidence of having had COVID-19 themselves as documented by blood antibody testing or molecular testing with a swab.

MIS-C occurs several weeks after having coronavirus or being exposed to it. It is an antibody-induced  inflammatory response to the infection, a “post-infection” syndrome .

Children have, in fact, been contracting acute COVID-19, but most haven’t been getting sick. In New York State alone, over 16,000 children under age 21 had evidence of infection and only 5% have been hospitalized. Many, many have been asymptomatic.

Which children are most at risk?

MIS-C has been occurring in children without prior existing conditions. It appears that Hispanic and African-American children may have a higher incidence of MIS-C but, as of now there isn't enough data yet to be sure.

How is it diagnosed and treated?

MIS-C is diagnosed by a combination of presenting features– fever, headache, abdominal pain, rash, breathing problems, cardiac and neurological issues—and lab tests (bloodwork) that shows acute inflammation and blood clotting abnormality.

The treatment is evolving but it seems that immunoglobulin (IVIG) is helpful as well as anticoagulation, or blood thinners, with a form of heparin. Steroids may also have a role in treatment.  

Treatment must also support the other organ dysfunction issues, so physicians will prescribe heart medications to improve cardiac function and support the child’s need for oxygen. Often, intensive care is needed.

The goal is to treat the inflammation, treat coagulation problems and treat underlying organ dysfunction.

What can parents do to protect children?

Prevent them from being exposed to COVID-19 and try to keep them away from anyone with the virus, following the general rules established for social distancing, frequent hand hygiene, and when older than age 2, even mask-wearing.

Although MIS-C is a relatively rare complication of COVID-19 that has so far affected a few hundred children across the country (compared to the many, many thousands who had the virus or were exposed to it), children can get quite ill from MIS-C and parents should be on the alert for the above listed medical issues and call their pediatrician or family health care professional with any concerns.

What is recovery rate from MIS-C?

The recovery rate is high. With appropriate treatment, most children recover and do well. There have been very few deaths and very few kids who have not been discharged even if they needed the ICU. Long-term follow-up is only just beginning as we continue to learn about this new complication to the COVID-19 story.