COVID-19 – Pediatric Multi-System Inflammatory Syndrome

Until recently, doctors and public health officials believed that children were at a decreased risk of severe COVID-19 symptoms. However, a new disease seen among children and young adults is thought to be linked to the virus. Over 50 cases of pediatric multi-system inflammatory syndrome were reported in European countries such as Belgium, France, Switzerland, Italy, Spain, the Netherlands, and the United Kingdom. As of May 11, 85 children in New York alone have been diagnosed with the illness, which has also been reported in five other states in the United States. It has left up to five children dead in New York and three dead in the United Kingdom.

Persistent fever is the most common symptom of pediatric multi-system inflammatory syndrome.  Children tend to present with some features of Kawasaki disease, a rare disease in which blood vessels become inflamed. The patients develop a high fever, rash, red tongue or red eyes, swollen red palms and soles of the feet, abdominal pain and heart complaints.

Photo: Pediatric multi-system inflammatory syndrome

Signs of shock are also common, including low blood pressure and lessened ability to circulate oxygen to vital organs as well as inflammation of coronary arteries and other blood vessels. While respiratory symptoms such as cough and shortness of breath are common in COVID-19 patients, they are not prominent features in pediatric multi-system inflammatory syndrome. Fewer than half of the patients in the United States reported respiratory symptoms and only the most severe cases require ICU admission and mechanical ventilation for respiratory support.

It is estimated that 15 out of 100.000 children are affected by Kawasaki every year, but there is an increase. In mid-April, according to leading medical journal The Lancet, eight patients ended up in hospital in South East England in ten days, while normally there should only be one or two. Since the start of the coronavirus crisis, 30 children have been admitted in Belgium with symptoms of Kawasaki. It is also striking that Kawasaki usually affects children between 1 and 5 years old, while some of the patients admitted now are now between 8 and 16 years old.

A few weeks ago, the coronavirus was very rarely found in Kawasaki patients, but that has changed. While most children with this disease tested negative for SARS-CoV-2, some had antibodies, which could indicate that they had been exposed to the virus four to six weeks earlier but did not show symptoms. The mechanism of the disease is still unknown, yet it is speculated this is a bodily response to viral infection. The acquired immune response to the coronavirus is exaggerated and activates an inflammatory process in children. This degree of inflammation is not typically seen in common childhood illnesses. It should be noted that not all children have positive serological tests for SARS-CoV-2. Still the uptick in cases is remarkable, making it highly plausible that the syndrome is associated with COVID-19.

If parents see some of the symptoms below in their children, they should take them to a doctor immediately, as children tend to deteriorate quickly once the symptoms start. The long-term effects of pediatric multi-system inflammatory disease are currently unknown, so early recognition and anti-inflammatory treatment are essential to decrease or prevent the risk of long-term damage. At the same time, we would like to emphasize that it is still very rare.


Indications are high fever for three or more days combined with other symptoms that may include:

  • Abdominal pain without another explanation
  • Both eyes appearing pink or red
  • Enlarged lymph node on one side of the neck
  • Red, cracked lips or red tongue that looks like a strawberry
  • Rash
  • Swollen hands and feet, which might also be red

* The information you read here should not be considered medical advice, when in doubt please contact a healthcare professional.

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