Myocarditis in Children: Incidence, Clinical Characteristics, and Outcome

Doctor using a stethoscope to examine a toddler.

Every year, roughly one in every 100,000 children is diagnosed with myocarditis. Though we know a lot about myocarditis in adults, the medical world still has a limited understanding of how it affects children. “We probably have an underestimation of the prevalence of myocarditis in children, simply because it’s so hard to identify,” explains Dr. Jack F. Price, MD, Pediatric Cardiologist at Texas Children’s Hospital. Here, the Myocarditis Foundation and Price explore the incidence, clinical characteristics, and outcomes for children with myocarditis.

Incidence in Children

Though researchers estimate that the myocarditis rate in children hovers around 0.001%, Price says that estimate is likely lower than it should be. “That’s because there are probably a lot of children who are impacted by myocarditis without ever receiving a diagnosis,” he says.

Though it’s difficult to confidently say how many children have myocarditis, it’s easier to pinpoint when they are most at risk. It’s thought that newborns are vulnerable because they don’t have a fully-developed immune system, so they can’t effectively fight off the viral infections that cause myocarditis. Newborns are also at risk of exposure to pathogens while in utero.  There’s also another spike in incidence around puberty and at the onset of adolescence. “In older kids, it’s more difficult to explain,” adds Price, “though some researchers speculate that hormones might play a role.”

Clinical Characteristics

Because myocarditis is so rare in children, few caregivers are aware of its signs. “That makes it all the more challenging for physicians, nurse practitioners, and pediatricians to recognize and treat it,” says Price.

The symptoms of myocarditis can be misleading, however. The earliest signs usually mimic those of a typical viral infection. Children might present with a low-grade fever, runny nose, cough, and other symptoms that are easily mistaken for a common cold or mild flu. It’s only after one or two weeks that they start showing more typical signs of heart disease, such as:

  • Shortness of breath
  • Reduced appetite
  • Fatigue and listlessness
  • Chest and abdominal pain
  • Disinterest in activities usually enjoyed

Treatment and Outcome

Unfortunately, there are not many treatment options for myocarditis. Most doctors simply focus on symptom relief and supportive care. For instance, breathlessness and abdominal discomfort can be helped with diuretics. In more extreme cases, a form of mechanical circulatory support might be necessary. The mechanical support is typically only a temporary measure, but it can be used long-term if the patient doesn’t show signs of recovery.

Further, Price believes that “kids have a much better chance of complete recovery than adults do.” Unlike adult patients, children don’t usually have to fight other issues like chronic kidney disease, diabetes, or high blood pressure. Their bodies are much healthier and have more energy to use for recovery.

Help Us Research Myocarditis

Myocarditis is difficult to identify in children, but researchers are constantly trying to improve our understanding. Myocarditis Foundation is dedicated to promoting the importance of myocarditis research and increasing awareness nationwide. Contact the Myocarditis Foundation to learn more about this mission or to ask us how you can get involved and help children with myocarditis.