Pediatric infectious disease specialist Rosemary Olivero, MD, shares warning signs of the inflammatory condition in children that is linked to COVID-19. (Taylor Ballek | Spectrum Health Beat)

It’s a perplexing piece of the COVID-19 pediatric puzzle.

Although children rarely get seriously ill from COVID-19, there appears to be an offshoot that’s more prevalent among young people—a rare Kawasaki disease-like syndrome that causes fever, rashes and an inflammatory process that can be serious. It’s called Multisystem Inflammatory Syndrome in Children (MIS-C).

Rosemary Olivero, MD, section chief for infectious disease at Spectrum Health Helen DeVos Children’s Hospital, said there are potential links to novel coronavirus infections, but cautioned there is much to be learned about the connection.

“It’s still relatively rare,” Dr. Olivero said.

There are fewer than 100 cases in New York, the area that has the most cases in the United States. There have been 17 cases in Detroit. These are small numbers compared to what the adult world is experiencing. Three children have died in New York.

“But still, this is not a cause for panic,” she said.

Dr. Olivero shares answers to common questions about this rapidly evolving situation.

Q: What risks are associated with MIS-C?

MIS-C is an emerging illness that has been seen in children in Europe and certain parts of the United States that has been linked to current or recent novel coronavirus infections.

“Some of these children have symptoms that are typical for Kawasaki disease, which is a rare but well-known inflammatory condition in children,” Dr. Olivero said.

In some areas of the United States, children and adolescents have come down with a more severe condition similar to a disease process called toxic shock syndrome.

And in Europe, New York and Detroit, there has been an association between recent or current COVID-19 infections and these inflammatory conditions.

“These inflammatory presentations are important to recognize and treat, as children can either become very ill with them, or they can have risk for damage to the coronary arteries, which supply blood to the heart,” she said.

Q: What are the symptoms?

Inflammatory symptoms in children may occur up to six weeks after exposure to COVID-19, and more typically within two to four weeks.

Watch for a fever of at least 101 degrees for four or five days, a rash anywhere on the body, reddened eyes, swelling of hands and feet, swollen and cracking lips, a beefy red tongue that can look like a strawberry, enlarged lymph nodes in the neck. Also watch for behavioral changes, such as increased irritability.

Older children may present with a fever for two or three days, a rash and diarrhea.

Q: What should I do if my child has some of these symptoms?

Call your pediatrician’s office immediately, or visit the emergency department.

“We’re recommending that children with these symptoms seek medical care that day,” Dr. Olivero said. “It doesn’t mean they will be diagnosed with Kawasaki disease or MIS-C, but these children need to be assessed and followed very closely to make sure it doesn’t turn into one of these more severe cases.”

“Immediate treatment is key,” she said. “Possible treatment includes pooled antibodies from blood donors that offers potent anti-inflammatory properties.”

Q: Is this kind of like a children’s version of COVID-19?

The vast majority of children who have become infected with COVID-19 have had a mild form of what adults have: fever, cough and shortness of breath. Most children haven’t required hospital care.

Similar to how there are some adults who experience more severe inflammatory responses to COVID-19, we now are seeing that a very small subset of children also have severe inflammatory responses to this virus.

“What I mean by inflammatory response is a virus, like many other types of germs, sets off the immune system in an exaggerated way, and usually this means that the virus itself is not doing as much damage to the body as the inflammatory response,” Dr. Olivero said.

“For MIS-C, this happens because a child has a genetic predisposition to developing the condition, then the virus triggers the condition.”

Q: Do underlying health conditions play a role in this?

For the cases of MIS-C reported so far, underlying conditions do not seem to be a significant risk factor.

Otherwise healthy children can develop this condition.

Q: How rare is this?

At the moment, it appears this condition is rare. There are about 100 cases confirmed to be linked to COVID-19 in the United States, and that number changes often.

So, compared to what we are observing in adults, this is extremely rare in children.

Q: What precautions can parents of young children put in place?

Following the current public health guidance for limited exposure and spread of the novel coronavirus is your best defense.

“At this time, no additional preventive measures for children are needed, but parents and pediatric providers need to be aware of the condition so that prompt medical attention can be provided,” Dr. Olivero said.

Q: What does testing for this look like?

Children who have symptoms for MIS-C should get medical care immediately.

“Your pediatrician or the medical providers in the emergency department will do a thorough exam of the child’s body to look for clinical signs of this condition,” Dr. Olivero said. “Blood and urine will be sent for labs, which can help confirm these potential diagnoses, and also help to decide if the child needs to be treated in the hospital.”

Q: What is the prognosis for children who experience pediatric inflammatory issues?

These conditions are treatable.

Treatment usually involves multiple pediatric specialists with expertise in treating these inflammatory conditions, as well as hospital-based pediatricians, intensive care unit physicians and cardiologists.

“If the condition is diagnosed and treated promptly, children will recover,” Dr. Olivero said. “There have been a few deaths in children related to this condition, but I do not think this warrants panic. As we are learning more about this condition and treating it effectively, children should be able to survive and recover.”