Paediatric inflammatory multisystem syndrome (PIMS)

My child has been diagnosed with PIMS.

What is PIMS?

‘PIMS’ or ‘PIMS-TS’ is a name used to describe a new condition that has been seen in children recently linked to the coronavirus pandemic. It stands for ‘paediatric inflammatory multisystem syndrome’ and means that your child has had too much inflammation in the body. Inflammation normally happens when the body is trying to fight an illness or injury. In PIMS the inflammation itself is harmful and requires treatment. Some children can be seriously unwell with PIMS.

PIMS can affect many different parts of the body including the heart, lungs, abdominal organs, skin and eyes which is why your child might have had lots of different symptoms and have lots of different medical tests and procedures. Doctors with different areas of expertise are often involved in treatment, depending on symptoms. For the most seriously ill, treatment is provided in our paediatric intensive care unit.

Is it caused by COVID-19?

The research to date suggests that this condition is related to COVID-19. Most of the children who have had PIMS either have blood tests showing they had previously been infected with the COVID-19 virus or they know they have had close contact with someone who has had the infection. This might have been several weeks before they developed PIMS and they might have not known they had COVID-19. A small number of children with PIMS have no evidence of ever being infected with COVID.

We do not yet fully understand why COVID-19 can trigger inflammation several weeks after infection.

Children with PIMS will have a swab for COVID-19 when they are in hospital (just like all other patients who are in hospital during the pandemic). If this is negative then we do not consider them to be infectious to other people. However, due to the heightened general risks of infection, you will see all staff wearing protective clothing and equipment as they work in ward areas.

Why do children become unwell with PIMS?

Children can experience low blood pressure, high temperatures or abdominal pain, which can mimic appendicitis symptoms.

This is to do with the inflammation to the heart and blood vessels because of PIMS. It can occur in all parts of the body, but most dangerously in the heart. We want to prevent serious damage to the heart and other organs which is why we sometimes need to start treatment quickly and do regular tests to monitor your child to make sure the inflammation has stopped.

How do you know how to treat it?

Although PIMS is a new condition, is it similar to other conditions we have been treating for a long time, such as Kawasaki disease. We are using our knowledge of treating these other conditions to help us treat PIMS.

NHS Hospitals across the UK have also been sharing ideas of how to look after children with PIMS and our treatments at Sheffield Children’s Hospital are the same or similar to what is being used elsewhere.

What is the treatment for PIMS?

There are a number of treatments we may consider and discuss with you:

• Steroid medications work on the inflammation, by dampening down the body’s response to inflammation.
• IVIG (intravenous immunoglobulin) is a blood product that is collected from a number of different blood donors. We have found this helps reduce the inflammation.
• Biologic medicines, which work on the immune response or inflammation pathway, to prevent further inflammation.
• Aspirin and blood thinning medicines. This is because there is a risk of blood clots in PIMS.
• Most childern also receive antibiotics in case there are other infections causing them to be unwell.

Will my child have long term problems from PIMS?

This is a new condition. However, what we know from other children that have had PIMS in the country is that the outcome is usually good and most recover fully with no long-term problems so far. It is possible that the recovery will be slower than for other illnesses. It is unlikely your child will have the same condition again.

Research

It is vital that we learn how to treat PIMS in the best way possible for all children who are diagnosed with this condition.

Like many hospitals in the UK we are involved in research and there are a few different projects ongoing. It may be that some of our colleagues from the research team approach you to ask if you would like your child to be involved in a trial.

What is important to know is that your child will not have different access to medications or treatments because of being in a trial. If we decide your child needs a certain medicine we will always give it regardless of the trial they are in.

We all believe that the research is very important and would welcome your support in allowing us to gather as much information as possible.