Examining COVID-19 in Pediatrics
As all pediatricians can attest, children are not just small adults. It's important to recognize that COVID-19 has a different disease course in pediatric patients and that COVID-19 can be severe.
In the May 2020 issue of Contemporary Pediatrics, Miranda Hester discusses a retrospective review of pediatric cases of COVID-19 in Hubei, China. Published in the journal Pediatrics, this paper details that although the vast majority of children were without severe symptoms, there were indeed cases of severe and critical illnesses in pediatric patients.1
Why it’s important to recognize that children can become very ill from COVID-19
As all pediatricians can attest, children are not just small adults. Medicine has known that children typically respond differently to infections, medications, and interventions than adults. The thought that COVID-19 would be any different seems unlikely. Although severe pediatric illnesses are rare in COVID-19, we still do not truly know the denominator when it comes to pediatric infections. It is vitally important to test for COVID-19 in our pediatric patients, particularly those who are ill, immunocompromised, or who have underlying health conditions. As data continue to emerge about the complications associated with COVID-19, it is important to watch for complications that have occurred in adults, but also novel complications that may arise within the pediatric community.
Long-term effects post–COVID-19
There has been an increasing awareness of a severe inflammatory syndrome in pediatric patients who are ill with or who have recovered from COVID-19, termed multisystem inflammatory syndrome in children (MIS-C).2 The pediatric patients presenting with this disorder may require high levels of medical support, with some cases resulting in death. The risk for a patient developing MIS-C after COVID-19 infections is unknown, again given that we do not yet perform routine testing for infections or antibodies in children. With this current information, I think back to several cases of severe inflammatory illnesses that were seen in our pediatric intensive care unit since January and wonder if these were secondary to a previous COVID-19 infection. Perhaps this illness was lurking in our hospitals before anyone was able to categorize it.
What does the future hold?
Although there is much to be studied and much still to learn about COVID-19 and its effects on pediatric patients, our health care community is working quickly to collect and analyze the information we do have. The intense research efforts into COVID-19 will aid our understanding of this disorder, including the complication of MIS-C. In the coming months and years, the understanding of MIS-C will perhaps shed light on other inflammatory syndromes that plagued our patients prior to COVID-19.
Susan Kirk, Member-at-Large and Board Member of SPAP, received her Bachelor of Science in Biological Engineering at Mississippi State University and Master of Physician Assistant Studies at the University of Kentucky. She has practiced in pediatric hematology/oncology for her entire PA career, currently at Texas Children's Hematology Center and Baylor College of Medicine. She enjoys sharing her passion for hematology with the next generation of medical providers.
References:
1. Dong Y, Mo X, Hu Y, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. In press. 2020; doi: 10.1542/peds.2020-0702
2. Multisystem inflammatory syndrome in children and adolescents with COVID-19. World Health Organization (WHO) Global Team. Published May 15, 2020. Accessed May 18, 2020. https://www.who.int/publications-detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19.
