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What You Should Know About COVID-19 Complications in Kids

a North Texas doctor shares what parents need to know

The recent spike in COVID-19 cases and reports about complications in children may have you even more concerned for your family.

While most known coronavirus cases are in adults, there have been troubling instances of Multisystem Inflammatory Syndrome in Children (MIS-C), a condition associated with COVID-19.

We consulted Dr. Carla Garcia Carreno, a pediatric infectious disease specialist at Medical City Children’s Hospital and Children’s Health, about what parents need to know.


What is MIS-C? We are learning that MIS-C is a rare, but potentially severe condition thought to be related to an immune response to COVID-19 after the active infection has resolved. Because this response develops when the child is recovering or even in cases where the child is not symptomatic for the virus, it can explain how some children test negative for the virus in respiratory samples but most test positive for antibodies found in a blood test. 

MIS-C can affect any child, including those with no other health condition. The condition can be very serious, but most children recover with medical care. However, these children can become very ill and may need respiratory and cardiovascular support—so seeking quality medical care is vitally important. 

Do we know how contagious this is compared to regular COVID-19 transmission in adults? Cases of MIS-C are generally not thought to be actively contagious, as the condition likely occurs after the active infection has resolved. However, we know that COVID-19 is still transmissible to the pediatric population, and parents should remain vigilant in teaching their kids proper hand hygiene, the importance of social distancing and [wearing masks] for children over age 2.  

What’s happening in these children’s bodies? We’ve read about comparisons to Kawasaki disease. One of the criteria that needs to be met for the definition of MIS-C is a link with COVID-19 infection, including a positive test or a close contact with somebody with COVID-19 within the prior four weeks. 

Kids typically have fever for at least 24 hours and can present rash, red eyes, abdominal pain, vomiting, diarrhea, shortness of breath, altered mental status and extreme tiredness (among other symptoms). MIS-C can affect multiple organ systems, like skin and mucous membranes, gastrointestinal, liver, heart and lungs involvement, kidney involvement, blood cells and neurologic systems. 

It has some features that may suggest and even overlap with Kawasaki disease, but it differs in many aspects. The most striking difference is that MIS-C affects older children, including teenagers, whereas Kawasaki usually affects children younger than 5 years of age.

Another difference is that it has more prominent gastrointestinal symptoms than Kawasaki disease, especially abdominal pain. In both [instances], the heart can be involved. 

What can you tell us about cases in North Texas? There are several reports in other parts of the state, but none of the suspect cases of MIS-C in North Texas have tested positive for COVID-19, nor have those patients had any history of contact with anybody diagnosed or suspected to have COVID-19, to my knowledge.

Our North Texas children’s hospitals and providers are closely monitoring for this condition as COVID-19 increases in our community. 

How widespread is MIS-C across the nation? Publications and data collection are ongoing. It’s mandatory to report suspected cases to the local health departments and the CDC. 

What signs should parents watch for? When do you know you need to get immediate help? Now more than ever, a close relationship with your child’s pediatrician or primary care provider is essential. Any fever without explanation, especially if it is persistent, warrants a call to the doctor.

The appearance of other symptom—specifically rash, red eyes, red lips or tongue, severe abdominal pain, vomiting, diarrhea, and extreme fatigue—are other reasons to call the doctor. After evaluation, your child’s pediatrician will know if further studies should be done, including blood tests to assess for inflammation, a heart ultrasound or echocardiogram, and testing for COVID-19.

If your child has any evidence of more serious disease, including difficulty breathing, decreased urination, persistent vomiting without being able to eat or drink, fatigue, changes in skin color or any other signs of dehydration—including no tears while crying or decreased skin elasticity—go to the nearest emergency room as soon as possible. 

Is there anything we can do to protect our kids, beyond the regular social distancing rules? Social distancing, the use of face masks (in kids older than 2 years of age) when outside the home and frequent hand washing will help protect against MIS-C, as it is thought to be linked to prior or recent COVID-19 infection.

We need to continue monitoring and studying this syndrome to further understand why this rare condition develops in some children and not others.  

Based on what we know now, do you anticipate this being a big issue as kids go back to school this fall? It is important to continue practicing safety measures to avoid the spread of infection, including a safe plan for kids to go back to school while maintaining social distancing and mask use. Since MIS-C is likely related to COVID-19, preventing COVID-19 infection in our children should also prevent MIS-C cases. 

What else should parents know? It is very important to mention that we still need to provide influenza vaccination to our kids before the start of influenza season, as the co-circulation of influenza and COVID-19 viruses during the fall may have serious consequences.

Children should also be up to date on recommended childhood immunizations, as the diseases those vaccines help prevent can also be devastating, even deadly. Hospitals, pediatricians and other clinicians are well-prepared in infection control. It is safe and necessary to seek that routine care, in addition to any potential urgent or emergency care for your child.

For more information on MIS-C, visit the CDC’s website.

Image courtesy of iStock.