Children Affected by Kawasaki-like Syndrome: Concerns & Answers

kawasaki-like syndrome

A Pediatrician discusses children affected by Kawasaki-like syndrome and the symptoms to watch out for. As parents, we’d begun to breathe a sigh of relief that the coronavirus has not affected children with the same intensity as adults and the elderly. In fact, until a few days ago, this is what we knew about SARS-CoV-2:

  1. Many children didn’t have symptoms at all (they were asymptomatic).
  2. When kids did have symptoms, they had a mild cough, sore throat, or fever (unlike the prominence of these symptoms in adults).
  3. Children complained of tummy aches, vomiting, diarrhea, fatigue & body aches.
  4. Regardless of symptoms, kids were bouncing back faster with milder complications than adults.
  5. Very few children (mostly infants under the age of 1 year) needed hospitalization.

However, a couple of months into the pandemic we heard about a post-infectious syndrome that’s affecting some children called Multi-System Inflammatory Syndrome in Children (MIS-C). This syndrome seems to show up days to weeks after a child may have had a COVID-19 infection.

Though it seems to be a rare sequela, it was first reported in Europe by April 2020. As of May 15, 2020 there are more than 150 cases of this syndrome identified in children across the United States and more than 100 of them in New York, the state most heavily affected by the virus.


Our understanding continues to grow as we learn more, but here a few answers to questions that might be on the top of our minds:

If children never showed symptoms of Covid-19, can they get Multi-System Inflammatory Syndrome (MIS-C)?

Unfortunately, yes. Even though a child might have had a coronavirus infection and never have shown symptoms, the body would have still created an immune response to the virus. When this happens, there are a lot of inflammatory markers released in the body. Sometimes an “overactive” immune response leads to inflammation in the body. This post-viral inflammatory response can happen even 4-6 weeks after the initial viral infection.

Doctors are finding that a lot of children with this syndrome have antibodies to COVID-19 in their bloodstream but may not test positive for the active disease on nasal swabs by the time the syndrome presents. This means the kids’ bodies have already had a chance to produce an immune response to the virus, but the virus itself is long gone. Doctors are also finding that some children with this syndrome don’t have antibodies to this virus at all.

Therefore, it’s not entirely clear if this syndrome is exclusively related to children who’ve had coronavirus. This syndrome is not contagious to others. It is a response of the immune system within one’s body that leads to this syndrome.

What is Kawasaki Disease? Is MIS-C similar?

children affected by Kawasaki-like syndrome

At first, doctors thought they were seeing an unusually greater number of children with a version of Kawasaki Disease. Now the medical community is seeing more cases and recognizing that Multi-System Inflammatory Syndrome in Children (MIS-C) seems to be a combination of Kawasaki Disease and Toxic Shock Syndrome.

Kawasaki Disease was first described in 1967 by Dr. Kawasaki, a pediatrician in Japan. It occurs more commonly in boys and children under the age of 5. What characterizes Kawasaki Disease is a persistent high fever and inflammation/swelling in the medium-size arteries and glands. Swelling from this inflammation can be seen in hands/feet and mucus membranes like tongue/lips (see list of symptoms below).

When blood vessels get inflamed, we worry that blood won’t flow to our organs the way it’s supposed to. With Kawasaki Disease, we know that the coronary arteries supplying blood to the heart can be affected, leading to heart problems if not treated promptly. Initiating treatment within ten days of fever significantly reduces the risk of heart complications in the future.

Toxic Shock Syndrome appears when the body’s immune system is “overwhelmed” after having had an infection. During this type of response, chemicals released by our immune system damage our body’s tissues on a cellular level. This can present with high fevers, low blood pressure, rash, and multiple organ failure.

Symptoms of Kawasaki Disease combined with the intensity of Toxic Shock Syndrome is what’s making this rare new syndrome demand attention in the Pediatric Intensive Care Units of our hospitals.

What symptoms should I be looking out for in my child?

  • Persistently high fevers
  • Abdominal pain (vomiting/diarrhea)
  • Bloodshot eyes
  • “Strawberry tongue” with swollen red cracked lips
  • Rash on body
  • Swollen hands/feet
  • Enlarged lymph nodes on one side of the neck
  • Fussiness and irritability
  • Pale or bluish skin

All of these symptoms may not appear, but the persistent fever seems to be always present.

Are children recovering from this Kawasaki-like syndrome?

children affected by Kawasaki-like syndrome

Yes. Hospitals are quickly responding to these children by placing them in pediatric intensive care units to support their heart function and blood pressures, making sure organs keep getting the blood flow needed to avoid irreparable damage. They’re also treating children with the same medication regimens used to treat Kawasaki Disease and the majority of children seem to be recovering. Not all children with this syndrome have other underlying health conditions. Many have been perfectly healthy until this syndrome occurred.

What should I do if I’m concerned my child may have this syndrome?

Seek help from your pediatrician if your child is having ongoing fevers or any of the symptoms listed above. Your doctor may want to order blood work or even talk to a pediatric specialist to determine the best management plan for your child. If you worry that your child looks really sick, take them to your local ER. The pediatric community of the world is collaborating to share information so that everyone learns quickly and efficiently how to care for children affected by Kawasaki-like syndrome.

What does this mean for summer camps and schools next fall?

We’re learning more every day how COVID-19 and its sequelae are affecting our plans, routines, and lives. Though we may not have an answer this very instant on what to do about summer activities, we can aim to remain calm, so our children also stay stress-free and happy. Remember, children’s attitudes are often a reflection of what they see and sense happening around them. This pandemic has allowed us to focus on our family. In the meantime, let’s stay safe and inform ourselves as we keep moving forward.


While children affected by Kawasaki-like syndrome may raise concerns, parents should not despair. Multi-System Inflammatory Syndrome in Children (MIS-C) is still a very new and extremely rare syndrome. Though it can be frightening, most won’t be affected by COVID-19 nor this syndrome.

While you’re on the front lines with an eye on your kids, remember you’re supported by pediatric professionals who are working worldwide to make sure you get evolving but accurate guidance as it becomes available.

*Stay tuned; I will update this post as needed.

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