Most reports about COVID-19 from around the world have shown that children develop less severe disease and are at very low risk of death. Now come reports, originally from Europe and then New York about a new phenomenon in children. Currently dubbed the “inflammatory syndrome,” signs and symptoms of this phenomenon include fever, rash, abdominal pain, vomiting or diarrhea, along with blood tests showing inflammation. Not all children who have had these symptoms were positive for COVID-19, though, so we can’t say yet that these are caused by the virus.
This new syndrome has features similar to another one that pediatricians are very familiar with, called “Kawasaki” syndrome, named after the Japanese pediatrician who first described it. That condition appears to include a genetic component, because Kawasaki’s is seen more often in Asian/Pacific Islanders and more commonly in boys than girls in the spring and summer. It is called a “syndrome,” because diagnosis requires a constellation of signs and symptoms, such as a rash, lymph node swelling in the neck, swelling of the hands and feet, peeling of the skin, a reddish, “strawberry” tongue, bloodshot eyes, along with a high and persistent fever. One of the major complications of Kawasaki’s is inflammation of the heart and dilation of the blood vessels that feed the heart.
As in the current inflammatory condition, children with Kawasaki’s can also present with vomiting, diarrhea, and abdominal pain. The cause of Kawasaki’s, is unknown, although it has been presumed to be caused by a viral or other infection. The standard treatment is to give an intravenous antibody treatment along with aspirin, which knocks down the fever and reduces the damage to the heart vessels.
If this new inflammatory syndrome is caused by COVID-19, perhaps it will help us learn about the cause of Kawasaki’s disease as well.
COVID-19 disease overall still usually causes mild illness in children and rarely causes complications. So, the majority of children will do fine, but it pays to be aware of this new possible complication. I asked colleague Dr. Ted Cieslak, a pediatric infectious disease specialist at the University of Nebraska Medical Center what things a parent should be on the lookout for. He said: “In addition to fever and the often dramatic rash, peeling digits, bloodshot eyes, and strawberry tongue, children with Kawasaki’s disease are typically extremely irritable. So, if your toddler suddenly seems ready for a starring role in a remake of The Exorcist, contact your Pediatrician.” In this climate where every day we learn something new about COVID-19, that seems like sound advice.
