New warning on coronavirus symptoms in children — what parents need to know

While most children who get COVID-19 have a mild or even asymptomatic illness, there are new reports that some children may have a complication that can be severe and dangerous.

Called pediatric multisystem inflammatory syndrome (PMIS), it can lead to life-threatening problems with the heart and other organs in the body. Early reports compared it to Kawasaki disease, an inflammatory illness that can lead to heart problems. But while some cases look very much like Kawasaki’s, others have been different. Experts think that PMIS is likely a reaction of the body to either a current or past COVID-19 infection — but there is much we don’t understand, including why some children with PMIS have negative tests for COVID-19.

What are the symptoms of the new inflammatory syndrome known as PMIS?

Symptoms of PMIS vary from case to case, but can include

• prolonged fever (more than a couple of days)
• rash
• conjunctivitis (redness of the white part of the eye)
• stomachache
• vomiting and/or diarrhea
• a large, swollen lymph node in the neck
• red, cracked lips
• a tongue that is redder than usual and looks like a strawberry
• swollen hands and/or feet
• irritability and/or unusual sleepiness or weakness.

There are many other conditions that can cause these symptoms. For example, strep throat can cause fever, rash, swollen lymph nodes, and a “strawberry tongue,” and there are plenty of common viruses that cause stomachache, vomiting, and diarrhea. Doctors make the diagnosis of PMIS based not just on these symptoms, but also on their physical examination as well as medical tests that check for inflammation and how organs are functioning.

What parents need to know about PMIS

We are just learning about PMIS. At this point we have many more questions than answers. But here is what parents need to know about this syndrome:

• It is rare. While there is a lot about it in the news, the number of cases is actually low, especially when you consider how widespread COVID-19 has become. Parents should not panic if their child gets one of these symptoms, or if they are diagnosed with COVID-19.
• It is treatable. Doctors have had success using various treatments for inflammation, as well as treatments to support organ systems that are having trouble. While there have been some deaths, most children who have developed this syndrome have recovered.
• It is serious. That’s why it’s important to be vigilant. Call the doctor if your child develops symptoms on the list above, particularly if they have a prolonged fever (more than a couple of days). While it’s especially important to call if your child has been diagnosed with COVID-19 and develops one or more of these symptoms, you should call even if they haven’t. If your doctor isn’t concerned, that’s great — but if the symptoms get any worse or just don’t improve, call again or bring your child to an emergency room.

Many parents are afraid to take their children out of the house during the COVID-19 pandemic, let alone to a doctor’s office or hospital. That’s understandable, but it’s important not to let that fear endanger your child’s health. If you are worried about your child — for this or any reason — call your doctor. Together you can figure out how to get your child the care they need.

Follow me on Twitter @drClaire

For more information on coronavirus and COVID-19, see the Harvard Health Publishing Coronavirus Resource Center.

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