A man holding a child wearing a mask
A man holding a child wearing a mask

Has your child had COVID-19? Here are the things you should watch out for

We asked two paediatricians on what are the things to watch out for in children who have recovered from COVID-19.

While the second wave of the novel coronavirus is receding now, there are emerging concerns about long COVID – a term that is being used to describe a gamut of post-COVID health effects that linger even after the so-called recovery. In children, one of the emerging worries is that of MIS-C or Multisystem Inflammatory Syndrome. Some states like Kerala have made it a notifiable disease, meaning, the cases of which are required by law to be reported to government authorities.

TNM asked two paediatricians on what are the things to watch out for in children who have recovered from COVID-19, those who have been asymptomatic COVID-19 patients, or those surrounded by COVID-19-infected persons.

Dr Udayakumar, a professor of paediatrics who heads the Karthikeyan Child Development Unit at Sri Ram Chandra Medical Centre in Chennai; as well as Dr Vidya Vimal, consultant paediatrician at GG Hospital and SP Wellfort Hospital in Thiruvananthapuram, note that parents and/or caregivers need to look out for signs of MIS-C in children between two weeks to three months of recovering from COVID-19 or being exposed to the infection even if the children themselves have not tested positive for the virus.

Dr Vidya explains that this is because if the coronavirus antibodies have developed in children even without them testing positive for the infection ever, then the risk of MIS-C is there. Similarly, Dr Udhayakumar notes that many parents may not even have realised if their child had COVID-19 because they would have recovered with a mild infection or could have been asymptomatic.

“However, the immune system, through coronavirus antibodies, could start attacking the child’s system three weeks to three months after recovery from COVID-19,” Dr Udhayakumar notes. He adds that in his experience, MIS-C has happened more in children who have had a mild or asymptomatic coronavirus infection. “We have also seen cases of acute COVID-19 with MIS-C, but those are rarer,” he says.

Dr Vidya says that one challenge they are facing as doctors is to convince parents to take the child for treatment when he/she has not tested positive for the coronavirus. “It is difficult to make them understand that their child is sick because of the COVID antibody response even if he/she may never have tested positive or shown symptoms.”

Signs and symptoms to look out for

MIS-C has an array of symptoms and not all of them will present together necessarily. This is why it is important for parents to seek medical attention sooner than writing it off as a minor reaction or illness during the pandemic time.

Some of the symptoms of MIS-C are:

- High fever

- Rashes on palms and soles of the feet

- Swelling on palms or soles of the feet

- Abdominal pain

- Lethargy

- Seizures

- In babies, a high irritable pitch

- Low blood pressure, presenting as shock                

- Vomiting and/or diarrhoea

- conjunctivitis in the eyes

The doctors explain that MIS-C attacks multiple organs and tissues in the child’s bodies such as heart, lungs, kidneys, blood vessels, thus causing them to become inflamed.

“Most MIS-C cases can be managed and treated well with early detection. But complications and need for intensive care arises if parents bring the children after 4-5 days of high fever and other symptoms. Any kind of rash or fever in this time should not be written off as an allergy. Seek medical attention and rule out other possibilities,” says Dr Vidya urges parents. “Early treatment and management are key. Parents need to be alert,” agrees Dr Udhayakumar.

MIS-C can affect children who are newborns to teenagers. Doctors say they are recording some cases of 19-year-olds too.

Other post-COVID effects in kids

Dr Udhayakumar points out that in some children, one of the post-COVID effects could be insomnia, and he has come across some cases. More immediately post-COVID, children are being seen to have extreme fatigue and diarrhoea. Dr Vidya recommends that young children be given smaller feeds more frequently instead of trying to feed them big meals.

Dr Udhayakumar also stresses that the psychological impact of the pandemic on children needs to be assessed and addressed. “Seeing their family go through such an isolating illness, not understanding why they cannot be with their loves ones, quarantining are all traumatic experiences. If the child is a little older, like 7-8 years, watching the news, growing up hearing COVID-19 and deaths and the devastation it has caused can be disturbing. School also has gone online and only takes up 4-6 hours. Children’s stress should not be discounted.”

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