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

Dr. Terri Finkel discusses the Multisystem Inflammatory Syndrome (MIS-C) showing up in children, how it's related to COVID-19, symptoms to watch out for, and when to seek medical attention.
Multisystem Inflammatory Syndrome (MIS-C): What Parents Need to Know
Terri Finkel, MD, PhD
Terri Finkel, MD, PhD is the Vice Chair of Clinical Affairs, Le Bonheur Children's Hospital / Professor and Associate Chair of Pediatrics, University of Tennessee Health Science Center. 

Learn more about Terri Finkel, MD, PhD

Bill Klaproth: As we learn more about COVID-19 and the way it affects children, Vice chair of clinical affairs at Le Boneheur children's hospital and associate chair of pediatrics at the university of Tennessee health science center. Dr. Terri Finkle answers some commonly asked questions about multi-system inflammatory syndrome in children and how the virus is manifesting in our youngest population. This is the Peds Pod by Le Bonheur Children's Hospital. I'm Bill Klaproth. Dr. Finkel, thank you so much for your time. It's great to talk with you. So, first off, what is multisystem inflammatory syndrome in children or what is known as Mis-c and the C standing for children.

Dr. Terri Finkle: Thank you for allowing me this opportunity. When a child is infected with a virus. The body immediately mounts its well-tuned defense system. That's called the immune system or the immune response to kill that virus as quickly and as efficiently as possible. The immune system Triggers thousands and thousands of chemical pathways that send out a call to our immune cells and what are called inflammatory proteins. That's where the inflammatory in Mis-c or multi-system inflammatory syndrome comes from. And those proteins and cells spring into action to clear that virus from the body. But there's a delicate balance between turning the immune response on, to clear the virus and then turning it off once it's done its work and that balance is achieved. Generally most of the time when a child has the flu or a common cold. And in fact, even in most children who are infected with the virus that causes COVID-19, but in a very few children with COVID-19 that immune response goes out of control. It doesn't stop. And it leads to toxic levels of those inflammatory proteins and cells that can attack the child's own multiple body systems.And that's where that multi-system comes in. Those multiple body systems. That runaway immune response is called multi-system inflammatory syndrome. And you can think about it like a runaway train that can quickly get out of control. And I'll say that fortunately, our Le Bonheur physicians have a lot of experience in heading off that kind of reaction, that kind of inflammatory train with medications that can slow it down and in fact, stop it in its tracks.And that's the good news.

Host: That is the good news. However, as a parent, this is worrisome. What is the likelihood that a child will get Mis-c. 

Dr. Finkel: The likelihood that your child will get Mis-c is very, very low. So worldwide. Less than 4%. That's four of, 100 of the cases of COVID-19 are in children. So 96 of those  hundred cases are in an adults. Those in our population who are 18 years or older, but only four are in children. And only a very few of those children have been diagnosed with Mis-c. It would be very unusual, but still have enough concern that we want our families to be aware of this.

Host: Well, that is also good to hear that this is very rare. So of course we're talking about COVID-19 and as a parent, we're all worried about that right now. What signs or symptoms of Mis-c? Should we look for in our children?  

Dr. Finkel: A prolonged fever is the best clue and generally a high fever. So 103, 104 Fahrenheit. And if that fever goes on longer than a parent is comfortable with, or is typical for that child more than three to four days, for example, then that's the time to seek, help seek care or talk to your pediatrician. The other very characteristic feature of Mis-c is abdominal pain. Sometimes very severe, sometimes severe enough to act like appendicitis. As well as other abdominal symptoms like nausea, vomiting, diarrhea, those two things, the fever prolonged fever lasting longer than typical for a common cold or a flu and abdominal pain are, are the most common, but there are many other features that we've seen in these children. So many will have a dry cough or difficulty breathing. The kinds of things that. are more typically seen with, most individuals who have COVID-19 rash eye redness. We call that conjunctivitis a very red tongue, or it's often called a strawberry tongue or red dry chapped lips may be a clue swelling of the hands or feet and have a considerable concern with this. A problem with Mis-c are signs of shock. So a very fast heartbeat or a low blood pressure. That would be hard to know without a blood pressure cuff at home. But sometimes that can cause confusion or what we call mental status changes where. The child's thinking may not seem to be quite right. Obviously, those are in the more severe cases, but we do see children coming into our emergency room who haven't been very sick, but in fact are beginning to go into shock. And that's why when a parent has serious concerns about their child, reach for the phone and call 911, or call your pediatrician.

Host: Wow. That is a long list of things to look out for. And I know myself as a parent and other parents, we always struggle. When is it time to see the doctor? So you just gave us a list of symptoms and signs to look for as a parent. When do we know, when is it time to see the doctor?

Dr. Finkel: If your child has an urgent problem, if something seems to be very wrong, a prolonged fever or severe abdominal pain, or really anything that makes you concerned that something's not right. Call 911, or bring your child immediately to the closest emergency room. Otherwise, if you're worried about your child's health, if you're not sure if it's urgent or emergent, please contact your pediatrician, he him, or he, he or she is there to help you and guide you as to what the right thing is to do. 
And they are familiar with this syndrome and they can help.

Host: So if something is concerning you Don't hesitate. It sounds like, call your pediatrician, make that appointment,

Dr. Finkel: Right. Parents should trust their gut.

Host: Okay. I like that. That's good. So let me ask you, this is Mis-c specific to COVID-19. Does a child have to test positive for COVID-19 to have Mis-c?

Dr. Finkel: Mis-c is the severe inflammatory syndrome that we see very rarely. Appears to be associated with COVID-19 infection. In other words, a child has a clue. There is a clue. We can find that the child had Mis-c sometime in the recent past, generally four to six weeks after the acute infection and the child may not have had symptoms at that time. The. Children are very effective at clearing the virus that is becoming clearer and clearer. And therefore, interestingly, when children present with Mis-c, it's unusual for them to show that they still have the virus in their system. But if a blood test is done, almost all of these children will test positive for antibodies to COVID-19 suggesting that they have matched that kind of immune response to clear the virus and that they were previously infected with that virus.

Host: Right. So once Mis-c is diagnosed, what are the treatment options?

Dr. Finkel: Yes. Depending on how ill the child is when they arrive at the hospitals, we may treat Mis-c with medicines that reduce the immune response, that inflammatory response, those drugs can include what are called corticosteroids or steroids for short, it can include. A medicine called intravenous gamma globulin. And those are antibodies similar to those found in patients who've recovered from COVID-19, or other anti-inflammatory drugs. Some of those are used to treat arthritis or other types of inflammation. I'm a rheumatologist. And I use many of those drugs in treating children with arthritis or other autoimmune diseases where again, the immune response is out of control and we have to bring it back to baseline, correct that train that's running out, down the tracks without any breaks. We provide the breaks that way.

Host: So in the list of symptoms, you mentioned high fever. Traditionally we're taught that if someone has a fever kind of stay away, they're contagious is Mis-c contagious to siblings or other people around the child.

Dr. Finkel: Mis-c, isn't contagious to siblings, but the virus that causes COVID-19 is very contagious. And as I mentioned earlier, Mis-c is not because of the viral infection itself. It's not the virus that's out of control at that point. It's the risk body's response, healing response that has. Going out of control. And that, that is not, that response is not contagious to siblings. It's when they are infected, actively infected with the virus, maybe four to six weeks earlier that they might have been contagious.

Host: How long does Mis-c last in general?

Dr. Finkel: Generally Mis-c lasts about one to two weeks. Some children may be hospitalized longer. If there are cases more severe in some children, the inflammation can take a month or more to resolve even after they're discharged from the hospital.

Host: Is this dangerous? How serious can this get? And are there any known lasting effects to children after Mis-c?

Dr. Finkel: We've found that the heart is affected in some children with Mis-c. And that usually resolves quickly that effect on the heart usually resolves quickly, but some children may have lasting cardiac effects, lasting affects on the heart, and we continue to follow these children for weeks or months to confirm that the heart problem has either gone away. In those very unusual circumstances in which it continues that we're treating the child appropriately for that problem. Many of the studies that have reported many of the hospitals, children's hospitals that have reported cases of Mis-c in those. Children a hundred percent of them recover even before they leave the hospital. So I think it's our experience with this type of inflammatory reaction that is really paying off for us and allowing us to help. Children with this condition.

Host: Well, that is great news about recovery, and I know that will put a lot of parents' minds at ease. And then last question, Dr. Finkel, and thank you so much for your time. Is there anything that can be done to prevent Mis-c?

Dr. Finkel: The providers out Le Boneheur are studying why the immune response doesn't stop in those children with it's How we can predict which children are at risk of Mis-c and what we can do to prevent COVID-19 infection. That is the trigger for Mis-c and we're collaborating with the national institutes of health and with pharmaceutical companies to bring our children clinical studies of safe and effective COVID-19 vaccines. Once these have been deemed safe in adults and use those, be able to help the children of Memphis with those treatments and preventative vaccines.

Host: Right. Well, Dr. Finkel, this has really been informative. Thank you so much for your time and talking with us about Mis-c today. Thank you so much. We appreciate it.

Dr. Finkel: Thank you for the opportunity. 

Host: That's Dr. Terri Finkel, and to learn more, please visit and be sure to subscribe to the Peds Pod in Apple Podcasts, Google Play, or wherever you listen to your podcasts, you can also check out to view our full podcast library. And if you found this podcast helpful please share it on your social channels. This is the Peds Pod by LeBonheur Children's Hospital. Thanks for listening.