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A rare complication called Multisystem inflammatory syndrome in children (MIS-C) is a serious condition that appears to be linked to coronavirus disease.

As we speak, the COVID-19 virus is still spreading rapidly across the world.
The risk of severe disease and death has been the highest in older people and in persons with underlying chronic conditions such as cardiac disease, chronic lung disease and cancer.
Thankfully, the condition is largely mild in children even though COVID19 vaccination for children under the age of 12 has not begun in most of the world.

However, as of mid-2020, clusters of children in Europe and North America have been reported to require ICU care with a multi-system inflammatory condition due to COVID19 that bears some resemblance to Kawasaki disease and toxic shock syndrome.
This condition is now known as Multisystem Inflammatory Syndrome in Children associated with COVID-19, ( or MIS-C for short )
If you are a parent and you haven’t heard of this condition, make sure you watch till the end of this video.
I will be discussing the diagnostic criteria for this syndrome and what are the signs and symptoms to look out for that should prompt you to bring your child to the emergency department or nearest doctor.
As the number of cases of Children Diagnosed with COVID-19 in Singapore rise, we will start to see more cases of MIS-C.
Multisystem inflammatory syndrome in children is an uncommon illness that can occur 2-8weeks after the initial COVID-19 infection.
The incidence of MIS-c has been reported to be about 0.14% among all children with COVID19 infection.
In Singapore, as of 9 NOV 2021, a total of 5 cases of MIS-C were reported to MOH.

Both the Centre for Disease Control and Prevention ( CDC ) and World health organisation ( WHO ) have published diagnostic criteria.

This is the diagnostic criteria from CDC ( insert picture )
It basically means that we need to suspect MIS-C in someone younger than 21
who has been tested positive for COVID-19 within the past 4 weeks
presenting now with fever and multisystem organ damage that has no other plausible explanation for the signs and symptoms.

This is the diagnostic criteria from WHO ( insert picture ), which Singapore is currently adopting.
It lays out more specific pointers which are easily identifiable.

Age 0-19
With evidence of current or recent COVID-19 infection
High fever of 38.5 degrees Celcius for more than 3 days
Various signs and symptoms of each organ system involvements
Elevated markers of inflammation in the blood such as CRP and Procalcitonin
Excluding other sources of bacteria or viral infection

Now, these diagnostic criteria may seem very confusing to you.
Therefore I will attempt to summarise some of the salient features that you should be looking out for as worried parents.

If your child younger than 19 years old has been diagnosed with COVID-19 within the past 2 months,
And If he or she developed a sudden fever of more than 3 days
Be careful if your child is also having
- lethargy, drowsiness or confusion
- headache
- red and swollen eyes
- red and swollen hands and feet
- rash on the body
- Shortness of breath
- chest pain
- abdominal pain, vomiting or diarrhoea

There are treatments available for MIS-C.
And thankfully, most children recover from it.
At this point, the medical world is still not sure why it occurs and which kids will get it.
And there is evidence that suggests that a small proportion of these kids may get long term heart complications.

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