A Parental Guide to Acute Flaccid Myelitis
Tags: Acute Flaccid Myelitis, Coronavırus, Covid 19, Healthcare, Parenting

With our continued struggle with the COVID-19 infection, there is yet another condition we as parents have to pay attention to in our kids. This is called Acute Flaccid Myelitis (AFM), a polio-like illness that results in sudden paralysis in healthy kids. Since 2014, we have noticed an upsurge in the number of cases of AFM in an alternate year pattern between August and November, as indicated by the graph below. Unfortunately, 2020 is the next year in line for an upsurge. So we have to manage the coronavirus pandemic along with a possible surge of AFM.

Source: Center for Disease Control and Prevention

What is AFM?

AFM is a rare but severe neurological disorder that affects the spinal cord's anterior horn cells located in the grey matter, causing flaccid or floppy weakness of one or more limbs. There have been 22 confirmed cases of AFM as of September 30, 2020. More than 90% of cases occur in children. The disease can cause permanent paralysis and the need for mechanical ventilation.

What causes AFM?

AFM’s actual cause is unknown, but viruses have been implicated. The alternate year surge is associated with Enterovirus D68, found in patients’ respiratory specimens. Although the disease is described as polio-like, non of the patients' specimens have grown the poliovirus. The paralysis is, however, similar to that seen in polio. AFM does not spread from person to person, but the viruses associated with it can be transmitted from person to person.

Symptoms parents should look out for include

Sudden weakness of arm or leg

Sudden loss of muscle tone

Sudden loss of reflexes

Gait difficulty

Facial weakness

Slurred speech

Neck or back pain

Arm or leg pain

Difficulty swallowing

Fever

Numbness or tingling

Headache

Drooping eyes

Difficulty passing urine

Breathing difficulty

Temperature changes

Blood pressure instability

It is reported that more than 90% of patients with AFM had a preceding mild respiratory illness or fever, which suggests a viral cause. So if your child had a recent viral illness and then developed arm or leg weakness, let a doctor evaluate the child.

Where should you take your child if you notice these symptoms?

Once you notice sudden arm or leg weakness in your child that is not caused by an injury, the best place to go is to the Emergency Room because the disease progresses rapidly, and the child can become really sick very fast. You need to be in a place that can provide advanced care in case it is necessary. In a study done on the 2018 outbreak, 98% of the kids were hospitalized - 54% in the intensive care unit, and 23% needed intubation.

Prevention

We do not know how COVID-19 will affect AFM; however, since AFM is associated with viruses, we hope the usual preventive actions against viral infections will suffice to reduce the circulation of enteroviruses and thus result in fewer cases of AFM. Especially with the preventive measures being advocated for COVID-19- facemask, handwashing, social distancing, and avoiding crowds- we hope these will help.

Being up to date with vaccines is also important.