In general, children tend to be only mildly affected by the novel coronavirus. However, recent news reports have described a rare and potentially serious inflammatory syndrome in children that has been linked with COVID-19, with 100 cases reportedly identified in at least six countries.

The syndrome is said to share features with other paediatric inflammatory reactions of the blood vessels and other organs, such as Kawasaki disease and toxic shock syndrome.

The UK’s Royal College of Paediatrics and Child Health (RCPCH) has advised doctors to be alert to children presenting with high temperature, low blood pressure and other signs of inflammation such as swollen glands or rash.

It is important to highlight that this syndrome, although serious, is very rare. Professor Russell Viner, president of the RCPCH, has said: ‘Parents should be reassured that children are unlikely to be seriously ill with [COVID-19] but if they are concerned about their children’s health for any reason, they should seek help from a health professional.’

Where did the story come from?

The Guardian in the UK are among media outlets to have reported on this ‘unusual syndrome’ saying that 19 children in the UK had been affected as of the end of April 2020, but there had been no deaths. They said that cases were also being investigated in the US, France, Italy, Spain and Switzerland.

What is the basis for the claim?

A BMJ editorial reported on an urgent alert from NHS England tweeted by the Paediatric Intensive Care Society at the end of April. This warned of a rising number of children with a current or recent coronavirus infection, being admitted to intensive care with inflammation (an extreme immune system response) affecting multiple systems of the body.

The children’s features were similar to those seen in toxic shock syndrome (a severe bodily reaction to a bacterial infection) and Kawasaki disease (inflammation of the blood vessels of unknown cause).  As well as fever, children often had signs of inflammation of the heart and some had abdominal symptoms (such as stomach pain, vomiting and diarrhoea). NHS England said, ‘There is a growing concern that a SARS-CoV-2 related inflammatory syndrome is emerging in children in the UK or that there may be another yet unidentified [infection] associated with these cases.’

Various experts have responded to these reports. The BMJ quoted paediatric infectious diseases specialist Professor Adilia Wallis from the University of Exeter, who explained that these syndromes are caused by an excessive reaction of the immune system. This affects multiple bodily systems, causing blood vessels to leak, lowering blood pressure and damaging organs.

The specialist, however, cautioned ‘Please do consider that the absolute number of those cases are very low, a handful at the moment. The call to ask if other colleagues have comparable experiences over the past week is so we are able to define what is going on.’

What do trusted sources say?

The UK’s Royal College of Paediatrics and Child Health has issued guidance for doctors on what to look for and how to manage this paediatric multisystem inflammatory syndrome associated with COVID-19.

They advise that doctors should suspect the syndrome in children presenting with persistent fever (>38.5°C), low blood pressure, needing oxygen, and with other suspicious signs such as abdominal symptoms, rash, lymph node swelling, or blood tests showing abnormal clotting or increased white blood cells.

They advise carrying out investigations to rule out other infectious disease causes, but that this should not delay referral to specialists and treatment with prompt admission to intensive care if needed.

Analysis by EIU Healthcare, supported by Reckitt Benckiser

 

Citation

1.      Covid-19: concerns grow over inflammatory syndrome emerging in children. BMJ 2020;369:m1710

Reading list

1.      Royal College of Paediatrics and Child Health. Guidance – Paediatric multisystem inflammatory syndrome temporally associated with COVID-19.