Important Information for Parents: Pediatric Inflammatory Multisystem Syndrome (PIMS): A Possible COVID Complication in Children

While children seem to be less susceptible to SARS-CoV-2 (this is my guess at this time) or alternatively, if they are just as susceptible but tend to disproportionately get asymptomatic disease from the novel coronavirus that causes COVID, there is a rare complication that may be caused by COVID that we are only seeing in children – Pediatric Inflammatory Multisystem Syndrome (PMIS).

PIMS resembles a disease that we are already familiar with – Kawasaki disease, but yet there are important differences. Kawasaki disease is a vasculitis, i.e., an inflammation of blood vessels, in this disease typically inflammation of mid-sized arteries, which can lead to one of the worst complications of Kawaski disease – aneurysms of the coronary arteries and impairment of heart function.

In Kawasaki disease, children often have recent respiratory or gastrointestinal symptoms, and then become more ill and present with fever, redness of the eyes (conjunctivitis), red and cracked lips, a red and swollen tongue and redness inside the mouth, rash, swollen lymph nodes in the neck, painful joints, redness of the palms of the hands and the soles of the feet, peeling of the skin over the hands and feet, abdominal pain, vomiting and/or diarrhea. Most often these children are under the age of 5.

Although there can be serious complications, most children recover fully from Kawasaki disease.

We don’t know what causes Kawasaki disease, but it seems to follow an infection in children (which suggests that it may be a consequence of an overactive immune response) who possibly are genetically predisposed to developing Kawasaki disease. We treat Kawasaki disease with gamma globulin and aspirin, but many children will get better within two weeks, even without treatment.

During the SARS-CoV-2 pandemic, and as far as I know, just since April, we have seen children in Europe and the U.S. who have presented with an illness similar to Kawasaki disease, but in older children and often in a more severe form, often exhibiting signs of both Kawasaki disease and toxic shock syndrome (circulatory dysfunction), which can manifest as cardiac dysfunction and kidney injury.

While the greatest number of cases have been reported in the New York City Metro area, cases have been reported in California, Connecticut, Delaware, Georgia, Illinois, Kentucky, Louisiana, Massachusetts, Mississippi, New Jersey, Ohio, Oregon, Pennsylvania, Utah, Washington and Washington D.C., and perhaps in more states by the time of this writing.

While we are still learning about the many twists and turns associated with the SARS-CoV-2 virus, and have only recognized this newest manifestation of infection with this virus in the past month, here is what we can tell concerned parents today:

  1. Children seem to be less susceptible to infection from this virus than adults. If, in fact, they are just as susceptible, then they seem far more likely to have asymptomatic infections.
  2. Children typically only account for 1 – 2 percent of all the recognized cases of COVID in most populations, and at worst, perhaps up to 7 percent.
  3. Even if children do get sick with COVID, they tend to do well, have mild illness and children rarely need the critical care serves and ventilators that are more commonly seen with middle-aged and older adults.
  4. We still don’t know what role children play in transmitting the disease. That is to say, even if children do not get sick, but are infected, do they shed the virus and transmit it to other children and those in the household? So, while you don’t have to worry excessively about your children becoming seriously ill, you still need to be cautious about children, even those that appear well, coming into contact with those who are at high risk for this disease (the elderly and those with high medical risk).
  5. This is an excellent time to teach your child, if old enough, about proper hygiene, hand washing, and how and why to cover their coughs and sneezes.
  6. With all this said, even though most children will be just fine, if your child is sick, keep your child home. Contact your child’s doctor to let the office know about your child’s symptoms so that they can determine whether your child should be tested. Kids do manifest symptoms differently than adults and with COVID may be less likely to have fever or respiratory symptoms than is typical of adults.
  7. If your child does test positive for SARS-CoV-2, you should assume there is high risk to everyone else in the household. Someone from the public health department will contact you and give you specific instructions, but two things – if it is practical, keep your child in one room of the house and have the child use one bathroom and everyone else use a different bathroom. Meticulously clean surfaces and regularly wash linens and pajamas. Minimize the number of other family members who come into that room and be extra careful about handwashing. If your child will tolerate it, have them wear a mask when anyone else needs to be in the room. And, secondly, you must consider that anyone at home living with the child is at high risk of being infected. Thus, it is best if everyone in the household remains isolated for 14 days to determine whether anyone else will develop symptoms.
  8. The new condition I described above is still rare at this time, but we are seeing new cases all the time, so if your child does develop any of the symptoms I listed above, let your child’s doctor know right away.
  9. It is always good to know where your closest children’s hospital is. If you need to go to the emergency room for evaluation and it does not appear to be imminently life-threatening, go to a children’s hospital if it is reasonably close by and call ahead to let them know you are coming. Of course, if the situation appears to be life-threatening or emergent, call 9-1-1 and go to the nearest hospital.

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