Jun 27, 2021

Amidst Covid-19: Safeguarding children from MIS-C

The Sri Lanka College of Paediatricians (SLCP) has been highlighting a post-Covid-19 paediatric disease a child could develop after two to six weeks of getting infected by the virus, known as Multisystem Inflammatory Syndrome in Children (MIS-C). 

As explained by the Centres for Disease Control and Prevention (CDC), MIS-C is a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. Children with MIS-C may have a fever and various symptoms, including abdominal (gut) pain, vomiting, diarrhoea, neck pain, rash, bloodshot eyes, or feeling extra tired.

While the CDC does not yet know what causes MIS-C, it has observed that many children with MIS-C had the virus that causes Covid-19 or had been around someone with Covid-19.

According to Lady Ridgeway Hospital for Children (LRH) Consultant Paediatric Intensivist Dr. Nalin Kithulwatta, about 20 children between the ages of eight and 15 are currently receiving treatment for MIS-C and were detected from the Colombo, Kurunegala, Karapitiya, Walasmulla, and Welimada areas. Out of them, six are receiving intensive care at the LRH.

Dr. Kithulwatta noted that in order to prevent a child from contracting MIS-C, parents should ensure the child does not contract Covid-19 – that is by encouraging children above the age of two to wear a facemask when going outdoors, teaching them to wash their hands often, and avoiding taking them out of the house for non-essential activities.

SLCP Secretary and Consultant Paediatric Respirologist Dr. Channa De Silva noted that when considering the number of adults who deal with complications due to Covid-19, the number of children who develop complications post Covid-19 is far less.

“The tendency for children to develop complications post Covid-19 will be based on how strong their immune system is and the level of exposure they presently have to the outer environment due to the guidelines in place,” he said.

Dr. De Silva further noted that in a study paper that was recently published after studying the number of children below the age of 14 who contracted Covid-19 during the first wave, the findings had stated that 55% of the children that were infected did not even show symptoms (asymptomatic). It was only after an adult in the household was tested positive for Covid-19 and when the child was subjected to PCR tests that they were able to detect that the child too carried the virus.

“We are yet to see any studies on children who contracted Covid-19 in the second and the third waves. However, the number of children contracting Covid-19 is still at a lower percentage. Many children will only show symptoms of a flu, fever, sore throat, muscle pain, and respiratory illnesses,” Dr. De Silva noted.

He added that about 10% of these children that would develop respiratory illnesses due to Covid-19 will also develop illnesses relating to the digestive system, such as vomiting, stomach aches, and diarrhoea.

However, the SLCP has recognised a small group of children that are below the age of one and children who have hereditary diseases in their lungs, kidneys, and liver, as well as cancer and other chronic diseases and those with weakened immune systems could develop complications if they contract Covid-19.

Turning his focus to MIS-C, Dr. De Silva noted: “Cases of MIS-C started to emerge a year ago among children that were above the age of eight that were infected by Covid-19. When considering the children that were infected with Covid-19, so far in the country, only about 1% had developed complications presented due to MIS-C.”

Dr. De Silva assured that parents need not be alarmed about MIS-C at present and elaborated that if any illness is neglected and not treated, it could turn into a critical state. “What parents should note is that it is normal for a child to have bouts of flu at least six times a year. However, they should be vigilant about MIS-C symptoms that would surface, apart from the regular flu symptoms, such as the child’s skin, lips, or nail beds turning grey or blue; showing inability to wake up or stay awake; severe stomach pain or vomiting; and should seek immediate medical attention.”

According to Dr. De Silva, most of the Covid-19 deaths reported in children were caused by various complications in the child, due to a germ infection or due to the delay in admitting to the hospital. He stressed that MIS-C, if detected early, can be treated and noted that if the child has fever for over two to three days, is continuously tired, shows loss in appetite, and develops a rash along with the flu symptoms, the parents should bring the child for a medical check-up immediately.

“Even amid the pandemic, if your child needs to be taken for monthly clinics for their hereditary diseases, you need to continuously take the children for such clinics, as it is vital to routinely assess their health. If children with hereditary diseases contract Covid-19, the tendency to develop complications is higher than in a healthy child,” Dr. De Silva elaborated.