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 Eventually diagnosed with the rare multisystem inflammatory syndrome
in children (MIS-C), also known as pediatric inflammatory
multisystem syndrome, or PIMS, Eran was hospitalized in October for
a week and has fully recovered, Bittan said.
"It is important for me to tell parents, mothers, all over the world
that there is a risk. They should know," said Bittan. "He suffered a
lot and I suffered with him."
Two years into the COVID-19 pandemic, doctors worldwide are learning
more about how the illness impacts children.
While cases of severe illness and death remain far more rare among
pediatric patients than adults, tens of thousands of children may
struggle with its effects. The U.S. Centers for Disease Control and
Prevention (CDC) cites COVID-19 as one of the top-10 causes of death
among children age 5 to 11.
A very small portion can suffer badly from complications, such as
PIMS, which affects fewer than 0.1% of infected children. "Long
COVID" - the persistence of symptoms weeks or months after infection
- affects children as well as adults.
A growing number of countries are making COVID-19 vaccines eligible
for younger children. The European Union will begin a campaign to
inoculate 5- to 11-year-olds next week, while a similar U.S.
vaccination drive that began in November appears to be losing
momentum.
Doctors hope the knowledge they have gained will not only improve
treatment, but also help parents understand the risks of COVID-19 as
they consider vaccinating their children.
"Long COVID and PIMS are a major consideration in getting
vaccinated," said Liat Ashkenazi-Hoffnung, who heads the post-coronavirus
clinic at Schneider Children's Medical Center of Israel.
PIMS, which typically occurs a few weeks after coronavirus
infection, is caused by the immune system suddenly going into
overdrive, creating inflammation in the heart, lungs, kidneys,
brain, and gastrointestinal organs. Affected children may spend up
to two weeks in hospital, some requiring intensive care.
The CDC cited close to 6,000 PIMS cases nationwide, including 52
deaths. It is roughly estimated at 3 cases per 10,000 children,
according to Boston Children’s Hospital's Audrey Dionne, about in
line with some European statistics and with the Israeli estimate of
one in every 3,500 children infected and a fatality rate of 1%-2%.
Singapore's Ministry of Health cites six cases of PIMS among more
than 8,000 pediatric COVID-19 cases.
'VERY DISHEARTENED'
Doctors say they have learned how to better treat the condition with
most children recovering. UK studies of children six months and one
year after PIMS show that most problems had resolved.
"Children from the second wave and now from the third wave (of
COVID-19) are benefiting from the information of the first wave,"
said Karyn Moshal, a pediatric infectious diseases expert at
London's Great Ormond Street Hospital.
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 A six-month assessment by
Moshal and colleagues published in the Lancet
found organ damage to be uncommon in children
who were hospitalized with PIMS. Lingering
symptoms including mental fatigue and physical
weakness often persisted, but resolved with
time.
"They get tired more quickly. So schoolwork is
affected because they can only concentrate for a
shorter period of time," Moshal said.
"Understanding this is important both for the
families and for the young people because they
can get very disheartened, and also for schools
and teachers to understand how to deal with it."
Several UK and U.S. studies have found that PIMS
is more likely to affect Black, Hispanic and
Asian children, although the reasons for that
are still unknown. Identifying
long COVID in children presents more of a challenge. Determining its
prevalence depends on what symptoms are looked at, and from whom the
information is collected - physicians, parents or the children
themselves, said Ashkenazi-Hoffnung.
Cautious estimates find about 1% of children with coronavirus will
suffer long COVID, said Zachi Grossman, chairman of the Israel
Pediatric Association.
Ashkenazi-Hoffnung said her clinic has treated around 200 children
for long COVID.
She believes that is likely only the "tip of the iceberg" among
previously healthy children and teens, who months after being
infected suffer symptoms such as shortness of breath, fatigue, chest
pain, headaches, tremors and dizziness. "It can
dramatically affect quality of life," she said.
Simple actions like climbing stairs, running for a bus or simply
standing or walking are intolerable, Ashkenazi-Hoffnung said. Some
children have developed asthma-like symptoms or hearing loss, and
some toddlers who had been walking reverted to crawling because they
were so tired and achy.
Most children do recover with time, she said, aided by physiotherapy
and medication. Around 20% are still struggling.
Ashkenazi-Hoffnung and Moshal noted an extra burden observed in
children who suffered PIMS or long COVID - a sense of stigma and
shame.
 "I was quite shocked by this,” said Moshal. "You can't ascribe blame
or shame for being infected with a disease."
(Additional reporting by Rami Amichay in Tel Aviv, Hannah Confino
and Rinat Harash in Jerusalem; Aradhana Aravindan in Singapore;
Alistair Smout and Josephine Mason in London and Stephanie Ulmer-Nebehay
in Geneva; Writing by Maayan Lubell; Editing by Michele Gershberg
and Bill Berkrot)
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