For parents, one of the most reassuring aspects of the coronavirus has been that it mostly does not affect children and only causes mild symptoms; however, recent reports of a new life-threatening pediatric inflammatory syndrome are causing concern in many families. Children in Europe, the United Kingdom, and now the United States are hospitalized for this mysterious disease that can damage children's hearts and other organs, causing them to need intensive care..
According to the governor Andrew M. CuomoAs of May 12, New York was investigating 102 cases of this syndrome and three deaths, and so far cases have also been reported in fourteen other states. Fortunately, this new syndrome continues to occur very infrequently and is treatable, and most children who develop it make a full recovery. Here is what parents should know and do if they are concerned about their children's health.
Doctors suspect that COVID-19 is involved, but are not sure.
No one is sure if this new syndrome, now called multi-system pediatric inflammatory syndrome (PMIS), is related to the coronavirus, but many doctors believe that it is. "I do believe it is related to COVID," said Eva Cheung, a pediatric cardiologist and intensive care specialist at the Morgan Stanley Presbyterian Children's Hospital of New York, which has so far treated more than 35 patients with the syndrome.
The vast majority of children who have become ill in New York tested positive for active COVID-19 infection or had antibodies that suggested they were exposed to the virus at some point. Some children have tested negative for both active infection and antibody, and it is not clear what it means.. It is possible that these negative tests were imprecise, Cheung said, because many coronavirus antibody tests are unreliable.
What is interesting, however, is that the majority of children who have become ill (even those whose tests indicated previous exposure to the coronavirus) did not report recent respiratory illness. This suggests that these children may have been exposed to the coronavirus, but did not become ill or have very mild symptoms, said George Ofori-Amanfo, head of the pediatric intensive care division at the Kravis Mount Sinai Children's Hospital.
Even if COVID-19 is not involved, it is unclear what is happening that makes children so ill.
Ofori-Amanfo suspects that children who develop this syndrome were exposed to the coronavirus and that, for some reason, their body produced an exaggerated (and basically dangerous) immune response, much like the "cytokine storms" that have caused some adults become seriously ill in the later stages of infection.
They could "present an abnormal and aggressive immune response to COVID ... and that immune response is so aggressive that it affects the function of other organs and their ability to maintain their blood pressure"Ofori-Amanfo said. This could then cause their bodies to quickly go into progressive shock and require medications and, in rare cases, the use of life support systems to take over the work of their heart and lungs.
However, doctors point out that no one yet knows for sure what is going on. "We don't even know exactly what the disease is," said Rebecca Pellett Madan, an adjunct professor of infectious diseases at the Grossman School of Medicine at New York University.
The symptoms are obvious and severe.
The good news is that the new pediatric inflammatory syndrome is easy to detect; their symptoms are severe enough that parents can tell them apart. All patients had a fever of 38 degrees Celsius or more that did not subside, said James Schneider, a pediatric intensive care specialist at the Cohen Children's Medical Center in Queens, which has so far treated more than 40 patients with the syndrome.
Cheung agreed, adding that children with temperatures of 37 or 38 degrees Celsius may not be at risk. “It is not what we have seen here. The patients we have seen who have needed to be admitted to a hospital have moderate to high fevers, "he said.
Most children also develop severe abdominal pain that gets progressively worse over time. It is not common stomach pain in children, but severe pain that is often accompanied by vomiting and diarrhea and is "serious enough to worry the father."Ofori-Amanfo noted. For some children, the pain has been so intense that parents and doctors assumed the child had appendicitis and needed surgery, said Nadine Choueiter, a pediatric cardiologist at Montefiore Children's Hospital in the Bronx.
Many (but not all) children with the syndrome also develop hives. The urticaria is red and appears frequently on the hands, forearms and chest, Ofori-Amanfo said, although it can occur anywhere. It usually turns white when you put pressure on it and returns to red when you stop. It also usually covers a wide area, such as the child's entire face, or an important part of his arms or legs. "It's not like a spot of a rash. It is quite scattered, ”said Cheung.
Children with the syndrome sometimes also have red eyes, chapped lips, sores on the tongue, and swollen feet and hands; Additionally, they may complain of muscle pain and not feel like walking.. However, according to doctors, these symptoms are not as common as fever and abdominal pain, and some of these could be intermittent. "Sometimes the skin and eye symptoms go up and down to the point that a doctor could come into the room and claim to have seen a hives, while another doctor could come in three hours later and notice that the hives are completely different. Choueiter said.
If your child develops fever and discomfort, contact your pediatrician.
If your child has a constant fever above 38 degrees Celsius (and especially if he develops other symptoms consistent with the syndrome such as severe stomach pain) contact your pediatrician. "Request a phone call or video conference consultation and ask them to explain the steps on what to look forPellett Madan suggested. Cheung agreed, noting that in geographic areas where this syndrome has arisen, hospitals are making sure that local pediatricians know what symptoms to look for and how to proceed.
If your child has a fever but is in a good mood and eats and drinks fluids without complaining of any pain, you don't need to take him to the emergency room, but — we insist — keep in touch with your doctor. On the other hand, if your child looks very bad (if he does not eat or drink liquids, he does not want to move much and especially if he develops hives or red eyes along with fever), it would not be a bad idea to go directly to the emergency room, he said Pellet Madan.
Remember that this syndrome is rare and that most children recover.
It is estimated that hundreds of thousands of children across the country have been infected with the coronavirus, and that the vast majority had only very mild symptoms. This severe syndrome "continues to occur very infrequently," Schneider said. Your son will probably be fine.
The new COVID-related inflammatory disease affecting children is alarming, but luckily it is very rare and easy to detect. (Ariel Davis / The New York Times)
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