Multisystem Inflammatory Syndrome (MIS-C): What Parents Need to Know

As we learn more about COVID-19 and the way it affects children, we asked Vice Chair of Clinical Affairs at Le Bonheur Children’s Hospital and Associate Chair of Pediatrics at University of Tennessee Health Science Center, Dr. Terri Finkel, to answer commonly asked questions about Multisystem Inflammatory Syndrome in Children (MIS-C) and how the virus is manifesting in our youngest population

Q: What is Multisystem Inflammatory Syndrome in Children (MIS-C)?  

When a child is infected with a virus, the body immediately mounts its well-tuned defense system (called the immune response) to clear the virus as quickly and efficiently as possible. The immune response triggers thousands of chemical pathways that send out a call to immune cells and inflammatory proteins to spring into action to clear a virus from the body. But there is a delicate balance between turning the immune response on to clear the virus, and then turning it off once its work is done. This balance is achieved whenever a child has the flu or common cold, and even in most children who are infected with the virus that causes COVID-19. 

But in a very few children with COVID-19, the immune response doesn't stop, leading to toxic levels of inflammatory proteins that can attack the child's multiple body systems. That runaway immune response is called Multisystem Inflammatory Syndrome, and, like a runaway train, can quickly get out of control. Fortunately, our Le Bonheur physicians have experience in heading off that inflammatory train with medicines that can slow it down and stop it in its tracks.

Q: What is the likelihood that my child will get MIS-C?

Very low. Worldwide, less than 4 percent (4 of 100) of cases of COVID-19 are in children and only a very few of those children have been diagnosed with MIS-C. 

Q: What signs or symptoms of MIS-C should a parent look for?

• Prolonged fever lasting more than 3-4 days*
• Abdominal pain, nausea, vomiting, diarrhea*
• Dry cough, difficulty breathing
• Rash
• Eye redness
• Very red tongue (called a "strawberry tongue") or dry chapped lips
• Swelling of the hands or feet
• Signs of shock, like a very fast heartbeat, low blood pressure, or confusion.

 *most commonly reported

Q: Does my child have to test positive for COVID-19 to have MIS-C?

No, since MIS-C occurs later in infection - after the immune response has begun to clear the virus - the child with this syndrome may test negative for the virus. But if a blood test is done, almost all of these children test positive for antibodies to COVID-19, suggesting they were previously infected with the virus.

Q: If my child is sick, when should I take them to a doctor?

If your child has an urgent problem, call 911 or bring your child immediately to the closest emergency room. Otherwise, if you're worried about your child's health at any time, please contact your pediatrician. Feel free to discuss with your pediatrician the steps they are taking to keep you and your family safe while you are in their care. Ask about wearing masks, cleaning routines and other preventative measures so you are comfortable going to their office.

Q: Is MIS-C contagious to siblings?

MIS-C is not contagious to siblings, but the virus that causes COVID-19 is very contagious. Your pediatrician can recommend ways for you to try to keep the rest of your family from catching the virus.

Q: Is there any treatment for MIS-C?

Yes. Depending on how ill the child is when they arrive at the hospital, doctors may treat MIS-C with medicines that reduce the inflammatory response, including corticosteroids, intravenous gamma globulin (antibodies, similar to those found in patients who have recovered from COVID-19) or other anti-inflammatory drugs. 

Q: How long does MIS-C last?

Generally, MIS-C lasts about 1-2 weeks. Some children may be hospitalized longer if their case is more severe, and in some children the inflammation can take a month or more to fully resolve after their hospitalization.

Q: Are there any known lasting effects to children after MIS-C?

The heart is affected in some children with MIS-C. This usually resolves quickly, but some children may have lasting effects. 

Q: Is there anything that can be done to prevent MIS-C?

Le Bonheur providers are studying why the immune response doesn't "stop" in children with MIS-C, how we can predict which children are at risk of MIS-C, and what can we do to prevent COVID-19 infection, the trigger for MIS-C. Le Bonheur physicians are collaborating with the National Institutes of Health and pharmaceutical companies to bring clinical studies of safe, effective COVID-19 vaccines, once available, to the children of Memphis.

Staying healthy and protecting you and your family from COVID-19 are the best ways to prevent MIS-C. 

How can you protect your family from COVID-19? The answer is simple: 

• social distancing 
• washing your hands frequently, and 
• wearing a mask when in public

These three simple steps, if followed every day by you and your children, will do more to prevent infection (and MIS-C) than anything else.