Understanding ABCs of Multisystem Inflammatory Syndrome in Children
By Dr. Duminda Pathirana
Multisystem inflammatory syndrome in children (MIS-C) is a rapidly evolving medical condition that is overtaking news headlines all over the world today, as a critical complication incited by an initial COVID-19 infection. While most young children who become infected with the COVID-19 virus only suffer from a mild illness, those who go on to develop MIS-C often take a turn for the worse, as it causes organs and tissues such as the heart, lungs, blood vessels, kidneys, digestive system, brain, skin or eye to become severely inflamed and reduced in function.
In Sri Lanka alone, Media reports confirm a growing number of confirmed diagnoses of MIS-C among children initially diagnosed with COVID-19. Children between the ages of 8 – 11 years who were infected with the virus run the highest risk of developing Multisystem inflammatory syndrome within two to six weeks after recovering from the initial viral infection. It is reported that over two per cent of children infected with this syndrome could lose their lives unless they are brought to a Hospital at the proper time. While MIS-C is still being researched and studied across the world, the best way to avoid infection at this time is to take stringent and necessary precautions to prevent a COVID-19 infection.
Identifying MIS-C in your child
It is critical to identify the symptoms of MIS-C early to seek immediate care. Parents and caregivers are urged to pay close attention to the following symptoms, as some children may not present with all the general symptoms of a COVID infection but only with symptoms of MIS-C. These include a persistent fever lasting for over 24 hours, stomach pain, diarrhea, vomiting, extreme tiredness, rapid breathing and heartbeat, redness on the tongue and lips, swollen and red hands or feet, muscle pains, or redness in the eyes. It should also be noted that a cough is not the most common symptom of MIS-C. Besides these symptoms, caregivers should also look for the following signs that call for prompt medical attention. This includes the child’s nails, skin, or lips appearing pale or a greyish or bluish hue, continuous sleeping as well as a difficulty to stay awake, or severe stomach pain with breathing difficulties.
What happens at hospitalisation?
Soon after symptoms are identified, most children with MIS-C require close attention and treatment in a hospital; while some go on to require treatment in a paediatric intensive care unit. Medical treatment usually involves supportive care aimed at reducing inflammation in any affected vital organs to protect them from permanent damage. These treatments also depend on the type and severity of each symptom and the organs that are affected by inflammation. Further, supportive care may include the administering of fluids if the child is dehydrated, oxygen to help with breathing, blood pressure medication to normalise low levels of blood pressure, ventilator support, and medication that reduce the risk of blood clots. This is combined with antibiotics or steroid therapy, to reduce swelling and inflammation along with other targeted therapies to reduce proteins called cytokines which cause inflammation.
Within the tense and challenging conditions in Sri Lanka at the moment, great care must be taken to protect children from infection by COVID-19. If one person in a household becomes infected with the virus, there is a very high risk of the infection spreading across the house to all other residents. Visitors should also be kept to a minimum whenever possible during this time. A child is more likely to become infected with the COVID-19 virus whenever a non-resident engages with them in close contact. Further, it is natural that children are unhappy about not being allowed to socialise during this time. Parents should then try to keep them as active and happy as possible at home within a peaceful and child-friendly home environment which encourages children to relax and help boost their intellectual development as the country and its people work hard to bring an end to this pandemic.
[The writer Dr. Duminda Pathirana is Consultant Paediatrician at Nawaloka Hospitals]