Has your little one gotten sick in a strange way after COVID? Let's be aware of this dangerous (MIS-C) condition!

We all know how much the COVID-19 pandemic has changed our lives. Often, when young children get COVID, we think it won't be as severe as adults. However, some children, a few weeks after recovering from COVID-19, start to develop new, more severe symptoms. This is what doctors call MIS-C, or Multisystem Inflammatory Syndrome in Children. Experts are still researching how it's actually related to COVID-19 and why only some children get it.

What does `(MIS-C)` mean? Let's understand it exactly, shall we?

Simply put, `(MIS-C)` is a condition in which multiple systems in a child's body, such as the heart, lungs, kidneys, brain, skin, and eyes, become inflamed, or swollen, all at once. Imagine it, as if the entire body is hot and swollen from the inside. Doctors currently believe that this can happen when the `(COVID-19)` virus enters the body and our body's defense system (immune system) reacts to it in an exaggerated, slightly panicked manner. This is sometimes called `(PMIS)` or `(PIMS)`, but the name `(MIS-C)` is most commonly used.

What are the symptoms of a child with `(MIS-C)`?

Now let's look at the symptoms that a child with `(MIS-C)` may show. These may vary slightly from one child to another, but the most common symptoms are:

• Persistent fever: This means a fever that persists for several days without decreasing. Perhaps a fever higher than 38 degrees Celsius (100.4 Fahrenheit).
• Severe stomach ache : The child may experience unbearable stomach pain.
• Vomiting or diarrhea : You should be concerned if you are vomiting continuously or if you are passing watery stools.
• Skin rash: Red, sometimes small blister-like rashes may appear in different parts of the body.
• Lips appear red and cracked: The lips may become unusually red, dry, and cracked. Sometimes the tongue may also appear as red as a strawberry.
• Redness of the eyes: The whites of the eyes may become red, as if they were infected with an eye infection. However, the production of tears is less common.
• Redness and swelling of the palms and soles of the hands: The hands and feet, especially the palms and soles of the feet, may become red and swollen.

In addition to these symptoms, some children may also develop swollen lymph nodes in the neck (similar to a sore throat). Severe headaches , body aches, difficulty breathing , and chest pain are also sometimes seen.

When should we see a doctor? When should we go to the hospital urgently?

If your child has had a fever for several days and has more than one of the above symptoms, you should definitely see a doctor immediately . This is because the condition of children with this `(MIS-C)` condition can suddenly worsen. Therefore, it is best to seek medical advice without wasting time. Especially if any of the following symptoms are present, you should take them to the nearest hospital emergency department (ETU) without delay:

• If the child seems to be struggling a lot and is too weak to even look at .
• If you feel like you're having trouble breathing , have a cough, or are breathing rapidly.
• If you're talking about a chest pain , or if you're talking about a tightness in your chest.
• If the stomach ache is so severe , the child may not even be able to stand up straight.
• If your lips or face appear blue (this means that your body is not getting enough oxygen).
• If the child is very sleepy , or seems disoriented , agitated, or doesn't seem to understand what you are saying.

You should also tell the doctor if your child has previously had COVID-19 , or if they have been in contact with someone who has COVID-19. That information is very helpful in diagnosing the disease.

What complications can occur due to `(MIS-C)`?

This condition, called `(MIS-C),` can cause various complications from child to child. Because it does not affect just one part of the body. Mainly, this inflammation can affect many parts of the body, such as the heart, blood, blood vessels, skin, intestines (digestive system), eyes, kidneys, and brain. Sometimes, this can cause temporary or long-term damage to those organs. Doctors are especially concerned about the effects on the heart. Because the heart muscle can become inflamed, the lining around the heart can become inflamed, or problems can occur in the blood vessels that supply blood to the heart.

How do doctors detect `(MIS-C)`?

Now you may be wondering how doctors can tell if this is MIS-C. The symptoms of MIS-C can be similar to other childhood diseases, such as Kawasaki disease, a serious condition caused by a bacterial infection called toxic shock syndrome, or other viral infections. So if a doctor suspects a child has MIS-C, they will first test to see if the child has been infected with COVID-19 or has recently been infected. In addition, they will do a variety of tests to see how much inflammation is present in the body. They will also test to see if there is damage to various organs in the body, especially the heart. These usually include:

• Blood tests and urine tests: These can tell you a lot about inflammation in the body, the function of various organs, and whether there are any blood clotting problems.
• Chest X-ray: Check the condition of the lungs.
• Special tests to check the heart :
• An ``ECG - electrocardiogram'': This looks at the electrical activity of the heart, i.e. the rhythm of the heartbeat.
• An ``echocardiogram``: This is like an ``ultrasound`` scan of the heart. It can look at many important things, such as the structure of the heart, the muscles, the valves, and how well the heart is pumping blood.
• Abdominal ultrasound scan: To check for inflammation or other problems in the organs in the abdomen.

Sometimes, doctors will seek the help of a variety of specialists to accurately diagnose and treat this `MIS-C` condition. This includes infectious disease specialists, cardiologists, rheumatologists (those who treat bones, joints, and the immune system), hematologists, and critical care specialists. They work together to plan the best treatment for your child.

What are the treatments for `(MIS-C)`?

The treatment for a child with `(MIS-C)` depends on the child's symptoms, test results, and the severity of the condition. Not every child is given the same treatment. Doctors usually try to reduce inflammation in the body, prevent blood clots (some children may be at risk for blood clots), and protect the affected organs from further damage. This includes:

• Oxygen: If you are having difficulty breathing, give your body the amount of oxygen it needs.
• Intravenous fluids (IV fluids): This means giving things like saline into a vein. This helps control fluid levels in the body and keep blood pressure stable.
• Different types of medicines (drugs):
• Medications such as steroids or a special antibody called Intravenous Immunoglobulin (IVIG) may be given to reduce inflammation and control the overactivity of the immune system.
• Low doses of medications like aspirin can be given to prevent blood clots.
• If the heart has been affected, special medications can be given.
• If some children's condition is serious, they may need to be admitted to the hospital's intensive care unit (ICU) and given special treatment under constant monitoring.

What else do we need to know about `(MIS-C)`? (Important facts)

It is very important for you to be aware of a few more facts about this situation.

Recovery and follow-up

Most of the time, children with `(MIS-C)` recover after being treated in the hospital. That is really good news. However, some children, especially those with heart problems, may have long-term problems. Therefore, they need to continue to be monitored by specialists even after they go home (follow-up care) .

• For example, a child with MIS-C who has had some heart damage will need to see a cardiologist and have tests like an echocardiogram. They may need to stop exercising, running, and playing sports for a while until the doctor says so.
• Also, children taking certain medications (such as steroids to reduce inflammation) may need to see a rheumatologist or endocrinologist to gradually reduce the dosage and adjust as needed.

This is a very rare situation.

It should also be said that `(MIS-C)` is a very rare condition. That means that not every child who gets `(COVID-19)` develops it. If hundreds of thousands of children get COVID, only a very small number of them will develop `(MIS-C).` Therefore, do not worry or be afraid unnecessarily. However, it is important to be aware of the symptoms.

Prevention is best!

The best way to avoid this `(MIS-C)` situation is to prevent the spread of `(COVID-19)`. That is called:

• Everyone over the age of 6 months should get the `(COVID-19)` vaccine on time. The latest vaccines now available provide good protection against even the most common viral variants. Vaccination can reduce the risk of severe complications from `(COVID-19)` as well as `(MIS-C)`. (As far as we know, this is not available in government hospitals in Sri Lanka, and I have no idea if it is available in the private sector)

Besides, to stay safe from diseases, it's a good idea to do these things every day, right?

• Wash your hands thoroughly with soap and water for at least 20 seconds. Use soap or a hand sanitizer that contains at least 60% alcohol.
• Stay away from people who seem sick, especially those with coughs and colds.
• Keep frequently touched surfaces (doorknobs, counters, tables, phones, etc.) as clean as possible.
• Try to breathe as much fresh air as possible. This means opening doors and windows to allow for good ventilation, and spending time outdoors.

The most important thing we all need to remember! (Take-Home Message)

So, I hope you now have a better understanding of what we have been talking about, `(MIS-C)`. The most important thing to remember is that `(MIS-C)` is a somewhat serious, but very rare , condition that some children can develop after being infected with `(COVID-19)`.

If you recognize the symptoms correctly, don't panic, and show them to a doctor quickly, you can give your child the necessary treatment and make him or her well. Also, preventing `(COVID-19)` is the best way to prevent `(MIS-C)`. Therefore, let's all follow health habits, protect our children and ourselves! If you have any doubts, ask your family doctor or a pediatrician.