COVID and Multisystem Inflammatory Syndrome in Children (MIS-C)


While COVID-19 is more likely to cause severe illness in adults, it can also affect children. For children, the symptoms can be like what adults may experience - fever, loss of smell, headaches, muscle aches, cough, fatigue, and gastrointestinal upset. Most children will recover with supportive care at home. Unfortunately, some pediatric patients will experience symptoms similar to “long COVID syndrome” where they have months of prolonged fatigue, shortness of breath, and decreased executive function (brain fog). 

Although rare, one of the most concerning results  of COVID-19 infection is Multisystem Inflammatory Syndrome in Children or MIS-C. Simply put, MIS-C means that many organs of the body, including the heart, kidneys, lungs, skin, and glands become inflamed. The COVID-19  virus sets off a delayed but exaggerated immune response in children as their body tries to fight the disease, resulting in more severe illness.

In Tennessee, there have been 194 confirmed cases of MIS-C as of 9/28/2021. Almost half of those cases (45%) have been admitted to the ICU, with an average ICU stay of 4 days. MIS-C tends to appear about 4-6 weeks after initial COVID-19infection. Sometimes, families were never aware that their child had an initial COVID-19 infection.

Symptoms of MIS-C include:

  •   Prolonged high fevers, PLUS one of the following:
  •   Swollen glands
  •    Swollen hands and feet
  •    Red eyes
  •    Cracked lips
  •    Rashes
  •    Abdominal pain, vomiting and diarrhea, often severe
  •    Extreme fussiness, fatigue, and irritability

More severe cases of MIS-C can have:

  •   Confusion and extreme lethargy
  •   Shock (extremely low blood pressure requiring ICU interventions)
  •   Kidney dysfunction
  •   Heart dysfunction
  •   Oxygen dependence and/or mechanical ventilation
  •   Death

If your child has had high fevers that lasts several days without explanation and you are worried that they have MIS-C, DO NOT DELAY. Seek evaluation with your pediatrician or other health care provider immediately. This is an emergency diagnosis which requires expert level care in a hospital. Treatment for MIS-C often includes medications like steroids and intravenous antibodies that decrease the body’s exaggerated immune response. Other  treatment goals are to reduce fever and improve organ function (especially the heart and kidneys). Some children with MIS-C will require monitoring and care by special doctors, even after leaving the hospital.

You can lower your child’s risk of contracting COVID-19 and MIS-C by using several measures:

  •     Parents can choose to have their eligible children vaccinated
  •     Adults can choose to be vaccinated to keep infections from spreading to others, including children
  •     Practice good hygiene of hand washing and covering coughs
  •     Wear a mask in public, and encourage others to do the same
  •     Social distancing
  •     Staying home when sick
  •     Cleaning and disinfecting your environment

All Tennesseans age 12 and older are now eligible for COVID-19 vaccination, free of charge. Here’s how to get your COVID-19 vaccine: 

  • Visit to find a location and make an appointment at a local health department or retail location. You can also contact your physician and ask about the availability of the COVID-19 vaccine at their office. 

Small, common sense steps together can create big changes for all Tennesseans and their neighbors.

*This article was written by Dr. Tobi Amosun, the assistant commissioner of the Tennessee Department of Health Division of Family Health and Wellness.