COVID-19 Inflammatory Syndrome: A New Concern for Children

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Undoubtedly, reporting on COVID-19 has its challenges. What we might know medically as I begin to write a blog might change, or at least have new information, by the time I finish it. And in the last few weeks, there has been some emerging data that appear to shed some new light on how the disease can show up in infants and children.

Before I continue, let me make one thing clear: serious disease from COVID-19 in our youngest patients still appears to be quite rare—much less common than in adults. That said, there’s a newly reported illness that is appearing in a small number of infected kids—and it happens to resemble another unusual illness known as Kawasaki disease.

Kawasaki Disease—the Basics

Kawasaki disease is a condition we’ve known about for several decades. It tends to affect mainly toddlers and preschoolers, although it is also seen in infants, particularly after 6 months of age. Despite knowing of the disease, we don’t really know what causes it; ironically, our knowledge of what causes COVID-19 came much quicker!

However, pediatricians have been trained to look for features of Kawasaki disease for a long time. The most common symptom is a high fever that can last 5 days or longer and usually produces a cranky, irritable child. Often there’s a rash, redness to the eyes and lips, swollen glands, and peeling of the fingers. Not all kids with Kawasaki disease get all the symptoms, but if there are even a few of them—especially a high, persistent fever—most providers would start to think about the disease.

The initial symptoms of Kawasaki disease generally get better on their own. However, for some kids, things don’t end there. It turns out that the disease can damage the blood vessels in the heart by causing aneurysms, or small pouches that form in the walls of the arteries. Damage to the heart—really like having a heart attack—can result. Although this isn’t common, it’s enough of a risk that doctors treat children with the disease to prevent the problem.

Since the fundamental problem with Kawasaki disease appears to be related to inflammation of the blood vessels, providers give medications to stop this inflammation. One medicine might be very familiar to you: it’s aspirin. Normally a no-no for children, it has been shown to be beneficial in these patients. The other treatment normally used is immune globulin, which consists of antibodies which stop the inflammation.

Realize that COVID-19 inflammatory syndrome, like all serious disease from COVID-19, still appears to be pretty rare in children, and current thinking is that the great majority of kids with COVID-19 will remain without symptoms.

A COVID-19 Kawasaki-Like Disease?

Let’s talk a little more about why we’re concerned about Kawasaki disease during the COVID-19 pandemic.

A few weeks ago, a group of physicians reported a case of Kawasaki disease in a 6-month-old who tested positive for COVID-19. Since that time, a number of cases have been reported worldwide.

There do appear to be some differences between the disease physicians are seeing with COVID-19. First, most affected kids are between the ages of 5 and 15. Second, this “new” Kawasaki disease seems to more often affect multiple organs, including the kidneys and the muscles in the heart (classic Kawasaki disease hits mainly the heart’s blood vessels), and kids seem to have the potential to get sicker earlier. It’s also worth noting that the kids generally didn’t have those early-on COVID-19 symptoms with which we’ve become familiar; most had mild or no symptoms.

As I write this, we don’t know why kids are getting sick in this manner. We do suspect that COVID-19 triggers some bad stuff in our immune systems, in addition to the infection-fighting stuff. And experts have always theorized that “classic” Kawasaki disease might come from an immune response to an otherwise mild infection.

Lessons for Parents

It’s always good to be aware of what emerging illnesses are out there. And although most of the cases of multisystem inflammatory syndrome in children, as the illness is called by the Centers for Disease Control and Prevention, seem to be in school-age and teenage patients, we can’t ignore the risk for infants, as witnessed by that first case report in a 6-month-old.

If you’re concerned about this illness affecting your children, by all means, discuss it with your provider. Meanwhile, consider the following:

  • You’ll likely want to consult your pediatrician for any concerning symptoms in an infant (or child or teen, for that matter). Although not an all-inclusive list, fever, rash, unusual reddening of the eyes, lips, or hands, and unusual fussiness or crankiness are worth a call earlier rather than later.
  • Realize that COVID-19 inflammatory syndrome, like all serious disease from COVID-19, still appears to be pretty rare in children, and current thinking is that the great majority of kids with COVID-19 will remain without symptoms.
  • Stay tuned as researchers continue to study this new wrinkle in the COVID-19 story.
Stan Sack
Dr. Stan Sack has 29 years’ experience as a primary care pediatrician in Massachusetts and Florida. A medical writer since 2015, he enjoys blogging on topics that are on parents’ minds but are covered less often in books and on websites. He lives in the Florida Keys with his family and enjoys healthy cooking, fitness activities and singing in his spare time.

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