New COVID-19 Complications: Are Children at Higher Risk?

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Recently, a possible link has been reported between COVID-19 and a serious inflammatory response that affects multiple organs, including the heart. Children with this potentially dangerous complication have been reported in multiple states, including Louisiana. While new information is still being discovered, here is what Ochsner Hospital for Children knows about this newly identified syndrome.


How does COVID-19 affect children?


Children are less likely to contract the novel coronavirus than adults. Of the children who are infected with COVID-19, most have very mild symptoms, including cold-like symptoms, fever, headache, sore throat and cough. Some children have abdominal pain, vomiting or diarrhea.


What is pediatric inflammatory COVID-related syndrome?


This syndrome has features that overlap with Kawasaki disease and toxic shock syndrome. Kawasaki disease is caused by inflammation or irritation of blood vessels and tends to affect the coronary arteries, which supply blood to the heart. Toxic shock syndrome is a rare but life-threatening complication of an infection and causes fever, rash and low blood pressure, and can result in damage to multiple organs.


Patients with pediatric inflammatory COVID-related syndrome have fever, abdominal pain, trouble breathing, chest pain, evidence of inflammation on laboratory testing, and dysfunction of at least one organ system (kidney, heart, brain or gastrointestinal tract). This syndrome has been reported in patients who test both positive and negative for COVID-19 by nasal swab as well as both positive and negative for the antibodies to COVID-19 by blood tests. The syndrome has been reported weeks after possible COVID-19 infection.


What are the more common symptoms?

  • Fever
  • Severe abdominal pain, vomiting, diarrhea
  • Sore throat
  • Trouble breathing
  • Chest pain
  • Conjunctivitis (pink eye)
  • Rash
  • Swollen or peeling hands or feet
  • Swollen, red or chapped lips
  • Swollen lymph nodes


How is the syndrome diagnosed?


Children with suspected inflammatory response should be evaluated promptly. In addition to a history and physical examination, patients are likely to need X-rays, blood tests and a nasal swab to test for COVID-19. Some children will need cardiac evaluation with an electrocardiogram and/or echocardiogram.


What is the treatment?


Children may require close monitoring in the pediatric intensive care unit. The primary means of treatment is supportive care, including IV fluids, oxygen or respiratory support, and medications that support blood pressure. In addition, several medications that are commonly used to treat Kawasaki disease and toxic shock syndrome are being used to treat this inflammatory syndrome, including intravenous immunoglobulin, steroids and medications that alter the immune response.