Most children are asymptomatic or exhibit mild symptoms from COVID-19 infection. However, in the last two months a small number of children have been identified who develop a significant systemic inflammatory response. Affected children may require paediatric intensive care and input from paediatric infectious diseases, cardiology, and rheumatology.

This rare syndrome shares common features with other paediatric inflammatory conditions including: Kawasaki disease, staphylococcal and streptococcal toxic shock syndromes, bacterial sepsis and macrophage activation syndromes. It can also present with unusual abdominal symptoms with excessive inflammatory markers.

Guidance on the identification and management of suspected cases has been issued by the Royal College of Paediatrics and Child Health.

Early recognition by paediatricians and specialist referral including to critical care is essential.

Case definition

  1. A child presenting with persistent fever, inflammation (neutrophilia, elevated CRP and lymphopaenia) and evidence of single or multi-organ dysfunction (shock, cardiac, respiratory, renal, gastrointestinal or neurological disorder) with additional features (see listed according to highest frequency in Appendix 1 of RCPCH guidance). This may include children fulfilling full or partial criteria for Kawasaki disease.
  2. Exclusion of any other microbial cause, including bacterial sepsis, staphylococcal or streptococcal shock syndromes, infections associated with myocarditis such as enterovirus (waiting for results of these investigations should not delay seeking expert advice).
  3. SARS-CoV-2 PCR testing may be positive or negative

All stable children should be discussed as soon as possible with specialist services to ensure prompt treatment (paediatric infectious disease/cardiology/rheumatology). There should be a low threshold for referral to Paediatric Intensive Care using normal pathways.