COVID-19 Multisystem Inflammatory Syndrome

Published September 10th, 2020 by Dr. Miriam Opara, PharmD
Fact Checked by
Chris Riley

Seven months have passed, but it seems like forever ago that we were living in the “pre-COVID” times. When shaking hands was a common greeting and hugging friends was normal, and we didn’t think about bringing a mask and hand sanitizer with us as we left the house. 

Since then, we have gained a lot of information and knowledge about the SARS-CoV-2 virus (a.k.a. COVID-19), the disease it causes, and how it affects us. 

Early in the discovery of COVID-19, it appeared that children did not develop the severe symptoms that were sending adults to hospitals. It was proposed that people with underlying conditions, like diabetes, hypertension, heart disease, and asthma, were at higher risk of severe illness, while kids were not contracting the disease as often as adults did. 

COVID-19 has proven to be complicated, and our knowledge is continually evolving. While deaths among children and adolescents remain low, we have learned that they are not invulnerable. 

An analysis of pediatric COVID-19 hospitalizations found that although hospitalizations were lower than adults, 1 in 3 hospitalized children was admitted to an intensive care unit (ICU). 

Continue reading to learn more about COVID-19 in children. 

Multisystem Inflammatory Syndrome in Children

In the past three months, there have been increasing reports describing children with COVID-19-associated multisystem inflammatory conditions that develop after rather than during the COVID-19 infection. 

This rare, serious health condition is called Multisystem inflammatory syndrome in children (MIS-C) and appears to be linked to SARS-CoV-2. 

MIS-C causes fever and inflammation that can affect the heart, lungs, kidneys, liver, skin, eyes, and gastrointestinal organs. 

The U.S. Centers for Disease Control & Prevention (CDC) issued an official definition for MIS-C

  • Individual < 21 years of age with fever, inflammation, and severe illness that requires hospitalization with ≥ 2 organs involved 
  • No alternative diagnosis 
  • Positive for SARS-CoV-2 (either current or antibody test) 

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Symptoms of MIS-C

Not all children have the same symptoms, but children with MIS-C who become very ill may present with symptoms, including: 

  • Fever lasting for more than 3 days 
  • Abdominal pain
  • Diarrhea 
  • Vomiting 
  • Rash 
  • Bloodshot eyes 
  • Extra tired 
  • Redness or swelling of the hands or feet 

Emergency warning signs of MIS-C include: 

  • Trouble breathing
  • Pain or pressure in the chest 
  • Confusion 
  • Unable to stay awake 

If your child shows any of the emergency warning signs of MIS-C, call 911 or take your child to the nearest emergency department. If your child begins to develop symptoms of MIS-C, contact your doctor immediately. 

Treating MIS-C 

If doctors suspect MIS-C, they will run tests to check for inflammation. Diagnosing MIS-C can be done with a blood test, chest x-ray, heart ultrasound, or abdominal ultrasound. 

Children that develop symptoms of MIS-C may test negative for COVID-19, yet evidence indicates that many children were infected with COVID-19 in the past. 

Most children with MIS-C eventually get better with medical care, and many require treatment in a hospital. Treatment typically involves medication that targets the immune system, reduces inflammation, and provides supportive care depending on the symptoms present in the patient. 

MIS-C does not appear to be contagious, but if your child has an active infection, like COVID-19, MIS-C may be a complication of that infection. 

Children who were diagnosed and treated with MIS-C should follow-up with a pediatric cardiologist 2 to 3 weeks after discharge to properly monitor their recovery. 

MIS-C Prevention 

The best way to prevent MIS-C is to follow the guidelines for COVID-19 prevention and teach your child the same. 

  • Wash your hands for at least 20 seconds with soap and water 
  • Wear a face mask. Cloth face masks can be safely worn by all children 2 years of age and older.
  • Watch your distance by keeping 6-feet apart from people outside your household 

It is important to avoid people who are sick, particularly those who are coughing and sneezing. Cleaning and disinfecting highly touched surfaces every day is a great strategy to kill the virus. Washing clothes and stuffed animals regularly is another way to prevent MIS-C. 

Although there is a lot of unknowns with MIS-C, experts are continually collecting data to understand the causes and improve treatment. Providers can report cases of MIS-C by submitting reports to their local health department. The CDC’s 24-hour Emergency Operations Center can be reached at 770-488-7100 for additional reporting. 


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Published September 10th, 2020 by Dr. Miriam Opara, PharmD
Fact Checked by
Chris Riley

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