The COVID-19 pandemic has predominantly affected older adults and individuals with compromised immune systems. Much to the relief of many parents around the world, children seem to be generally safe from severe cases of the virus.
The fact that children have been largely unaffected since the pandemic began has surprised and confused doctors since historically children have been considered to be “super-spreaders” of viral illnesses. It is as of yet unclear why young people are less affected, but scientists have suggested that it could be from a lack of age-related lung damage .
Children also appear to have a better chance of survival if they do contract the virus, even if they have underlying medical conditions. Stories of children beating the virus, like six-year-old Joseph, who has Cystic Fibrosis, and six-month-old Emma, who has a heart and lung condition, are encouraging to many parents.
There is, however, a new condition that doctors are seeing in children that has become a cause for concern.
Multi-System Inflammatory State
Doctors in the UK have noticed an increase in the number of children they are seeing in their ICU’s with a condition they are calling “multi-system inflammatory state”.
This condition is a severe immune response that affects the body in many ways, primarily by causing the blood vessels to leak, a disorder known as Kawasaki disease. This is a very serious problem, because when your blood vessels leak, it causes your blood pressure to drop, which results in a build-up of fluid in the lungs and organs .
In particular, inflammation caused by this disease can damage the coronary arteries, which can lead to aneurysms, heart attack, or heart failure .
Kawasaki disease is rare, but over the last three weeks, doctors in the UK are seeing a rise in the number of children who are presenting with cases that appear to be similar to the disease.
“The cases have in common overlapping feature of toxic shock syndrome and atypical Kawasaki disease with blood parameters consistent with severe Covid-19 in children,” said the NHS .
More than a dozen children in the United Kingdom have fallen ill with the disorder, and have had to be treated in intensive care. There have also been cases reported in Italy and Spain.
“Numbers are small but significant,” said Dr Elizabeth Whittaker, a paediatrician at St Mary’s Hospital in London. “We want primary care/A&E to be vigilant so those affected are in the right place to get appropriate supportive care if needed.” 
Children with the disorder have presented with abdominal pain and gastrointestinal symptoms, as well as cardiac (aka- heart) inflammation . Other symptoms include a fever, a rash, swollen hands and feet, redness in the whites of the eyes and swollen lymph glands in the throat .
Is it Related to COVID-19?
One concern is that this could be a sign that the virus has mutated and is now affecting the body in even more ways, but doctors say this is unlikely. There is no evidence that this is the case, as it would have presented in adults first .
Many of the symptoms of multisystem inflammatory state appear to be the same as those seen in patients with severe COVID-19, however some of the children who have been treated in the ICU have tested negative for the coronavirus.
For this reason, doctors are still uncertain as to whether or not the condition is being caused by the novel coronavirus or another pathogen. Some doctors believe that this illness could be a “post-infection inflammatory response”, wherein the immune system overcompensates after an infection.
It is possible, then, that some of the children who presented with the condition had already cleared the virus before this follow-up infection took hold, which explains why they tested negative. It is also possible that the virus was simply missed during testing .
Professor Russell Viner, president of the Royal College of Paediatrics and Child Health, says that while children appear to be least affected by the virus, it is still important that doctors remain vigilant, since there is still much we do not know about COVID-19.
“New diseases may present in ways that surprise us, and clinicians need to be made aware of any emerging evidence of particular symptoms or of underlying conditions which could make a patient more vulnerable to the virus,” he said .
On April 26th, The Paediatric Intensive Care Society (PICS) published a warning on their Twitter page urging people to share this information.
Doctors are Urging Parents to Stay Calm
Dr. Liz Whittaker, a consultant at St Mary’s hospital in London and a member of the Royal College of Paediatrics and Child Health’s allergy, immunology, and infectious diseases committee, is urging people not to panic .
After reading the warning by the NHS (The National Health Service in the U.K.), many parents are concerned for their children and are asking if they should be worried when their children come to them complaining of an upset stomach.
“The advice to parents remains the same,” said Professor Simon Kenny, NHS national clinical director for children and young people. “If you are worried about your child for whatever reason, contact NHS 111 or your family doctor for urgent advice, or 999 in an emergency, and if a professional tells you to go to hospital, please go to hospital.” 
A statement on the Paediatric Intensive Care Society’s website assured parents that the guidance was meant for doctors, and that they needn’t worry.
“It is important to highlight that, both in the UK and in other countries, there have still been very few cases of critically unwell children with COVID-19 admitted to pediatric intensive care units,” the statement read .
What COVID-19 Symptoms Should Parents Look For?
The symptoms of COVID-19 in children are not generally different from those that are seen in adults, however, they are typically milder. Common symptoms that parents should look out for in their children include cold-like symptoms, such as fever, runny nose, and cough, as well as possible vomiting and diarrhea .
Doctors are now warning of another symptom for parents to keep their eyes open for, known as “COVID toes”.
According to the Canadian Pediatric Society (CPS), doctors are increasingly reporting that children who are presenting with the virus have red, blue, or purple discoloration of the toes and sometimes the fingers, similar to the appearance of frostbite.
“Sometimes, these lesions have no associated symptoms. Sometimes, they’re hot and painful,” said Dr. Charlotte Moore Hepburn, director of medical affairs at the CPS. “Sometimes, the children are otherwise well, and sometimes, they present with mild respiratory symptoms that would be concerning for COVID-19.” 
It is likely that the skin discoloration will dissolve on its own, however Moore Hepburn says that doctors should be aware that the condition could be a sign of COVID-19, and that it could be a way to identify cases, to trigger self-isolation, and to warn people who have been in close contact with that child .
While this can all be very scary for parents, Moore Hepburn wants to remind them that they should remain vigilant and ensure that their children are washing their hands and maintaining a social distance from others, children are at a much lower risk.
“Only a very small percentage of children who test positive require hospitalization,” she said. “That should be very reassuring for parents and families.” 
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