Do kids show COVID-19 symptoms differently?
Anika H. Ahmed, MD
The multi-spike, highly contagious, highly infectious, and highly dangerous Coronavirus causing COVID-19 spares no one. It can be transmitted to anyone and everyone by a symptomatic or an asymptomatic individual. The pattern of its victims seen so far shows that it takes a heavy toll on the elderly and those with underlying medical conditions. Children can also be infected through close contact with either a carrier or a sick person positive with Coronavirus. Until early April 2020 the good news was that the symptoms in infected children were mostly either mild or not present at all. COVId-19 infection usually resulted in mild common cold-like symptoms with runny nose, fever, aches, and cough. However, things changed by mid-May when a different pattern was seen in children. In the United States, in May 2020, 100 cases of inflammation were recorded in children in 14 states, with most of the cases seen in New York. The pattern of serious inflammatory reaction seen in children was labeled as Pediatric Multi-symptom Inflammatory Syndrome (PMIS).
PMIS is an inflammatory syndrome seen in COVID-19 positive children between the ages of 1- 15 years. The syndrome shows multiple inflammatory symptoms of fever, abdominal pain, rash, red eye, cold extremities, low blood pressure and breathing problems. PMIS is caused by the inflammation of the coronary arteries labelled as Kawasaki Disease, which is due to over reaction of the immune system to infection, leading to inflammatory cells storming the vessels. Children usually develop PMIS symptoms a few days to weeks after a COVID-19 infection, exhibiting mostly rashes, swollen hands, enlarged lymph nodes and poor circulation. They usually complain of abdominal pain with vomiting and diarrhea. Research indicates that the pattern of these symptoms appears differently in children of different ages due to COVID-19. Symptoms of Kawasaki disease are generally seen in children under 5 years of age. However, COVID-19 positive children up to 15 years old have been seen with PMIS exhibiting typical Kawasaki symptoms of rash, red eye, abdominal pain, vomiting and diarrhea. Initially some of these children with abdominal symptoms were also sent to surgery upon suspicion of Appendicitis or Intestinal Obstruction; there were no findings of these maladies. Currently physicians are also studying closely the pattern of PMIS in older children who may need hospitalization due to severe bleeding disorders with clotting complications in addition to severe breathing disorders leading to respiratory failure, requiring ventilators and life support.
Parents are cautioned to keep a close eye on children especially young children with underlying medical conditions. They must watch out for any rashes, swollen extremities, fever, or red eye. What appears to be a case of food poisoning with vomiting, diarrhea and abdominal pain can actually have underlying fatal COVID-19 infection. Testing may be needed for confirmation. This is why it is important for all parents and guardians to immediately contact their doctor on a telemedicine platform and discuss the symptoms seen in the children and any possible exposure to Coronavirus.
COVID-19 may also be seen in neonates either born to mothers positive with COVID-19 or being handled by positive caregivers. The resulting symptoms are usually due to an immature immune system resulting in an inflammatory reaction in weak, immature lungs, giving rise to severe respiratory distress. This is why all newborns caregivers must wear a mask, wash hands frequently and maintain a high standard of hygiene. Neonates born to positive COVID-19 mothers must be tested and monitored closely, especially for symptoms of PMIS.