Autoimmune diseases are still very much a mystery, but our understanding of these disorders is growing every day. Because autoimmune diseases display a wide-range of (sometimes overlapping) conditions, it can be especially difficult to correctly identify, diagnose, and treat those afflicted. This is why parents are such valuable resources when it comes to recognizing that something isn’t right with a child.
Being knowledgeable about common pediatric autoimmune conditions may help you detect autoimmune disease and make tasks easier and more efficient for the doctor and your little one.
Fortunately, with certain exceptions, pediatric autoimmune diseases are relatively rare, and some may even “disappear” clinically as the child ages. This means that while the antibodies attacking tissues are still likely in the body, the patient seems to “outgrow” the disorder (as in many cases of juvenile idiopathic arthritis and dermatomyositis) with complete remission of symptoms as the child ages. Learn more about the autoimmune diseases more commonly seen in the pediatric population, and how they might present themselves.
What are some red-flag symptoms that may be indicative of juvenile autoimmune conditions?
This is a particularly difficult question to answer, because symptoms of autoimmune disease often remain vague and non-specific for quite some time (possibly forever) until perhaps the patient has a clearly identified flare consistent with one or a few diseases. Many symptoms also tend to overlap with those of other conditions. Even with a more specific symptom cluster, autoimmune diseases can still be tough to recognize and differentiate from other disorders as well as from one another. However, there are some symptoms that definitely point in the autoimmune disease direction, and should prompt a visit to the doctor.
Autoimmune symptoms depend somewhat on the disease pathology, since they may be generalized or more organ-specific. Generalized symptoms will likely appear first, before other more distinct abnormalities, and should be seen as suspicious when there are no other clear explanations. Some common examples are:
- weight loss
- slight fever
- diffuse joint pain
- dry eyes/mouth
Frequently, symptoms will be less specific, with a complaint of “just not feeling right”. More targeted symptoms would depend on the body systems affected, but may include characteristic rashes, eye problems and/or specific joint pains.
Is the intensity or duration of symptom(s) important?
Autoimmune diseases vary in their presentations, and the demonstration of symptoms may be more telling in some children than in others. Between intensity and duration, duration is more important, because intesity is so subjective—one child’s severe may be another child’s mild, and vice versa.
Along with duration of symptoms, other indicators you should monitor are:
- timing (the onset of the symptoms)
- are symptoms constant or intermittent?
- the time of day when symptoms present themselves and any patterns in symptom intensity throughout the day
Also important to ascertain is the nature of the problems experienced, along with location in the body. Being able to recognize and describe any symptoms to the physician, in terms of the type of feeling (stabbing vs. squeezing vs. throbbing, etc.), along with pinpointing the areas affected, can be of great use to clinicians. In addition, it is extremely important to mention any and all other symptoms that may have occurred recently. Many times patients withhold such information, through no fault of their own, because they assume it’s unrelated. But what appears unconnected to the patient may contain vital pieces of information for the doctor.
What are the most common autoimmune conditions among kids?
The list of possible juvenile autoimmune diseases includes most of the 80+ autoimmune diseases recognized in adults. However, there are several conditions that are seen more often in children, including:
- type-1 diabetes
- celiac disease (often discovered in childhood these days)
- juvenile dermatomyositis
- idiopathic (rheumatoid) arthritis
One syndrome that has received much attention over the past couple of decades is Pediatric Autoimmune Neuropsychiatric Disease Associated with Strep infection (or PANDAS), which is a cluster of signs and symptoms relating to obsessive-compulsive and tic disorders, thought to be triggered by infection with a certain strain of the Strep bacteria. It is not fully understood, but there is a good deal of research currently underway so that more successful prevention and/or treatment can be achieved.
To seek diagnosis, is it best to start with our family’s pediatrician, or take my child directly to a pediatric specialist?
While you are certainly free—depending on insurance coverage—to visit any doctor you want, it is best to start with your child’s pediatrician or family doctor, rather than jumping straight to a specialist. Symptoms you believe are autoimmune in nature may not be indicative of an immune pathology; and conversely, symptoms you have ignored because they appear unrelated may acutally offer crucial information. Rather than trying to make these assessments and decisions on your own, visit your pediatrician first, so s/he can utilize her or his training to best evaluate the situation and make further recommendations/referrals.
Another reason to start with the pediatrician is because regardless of who ends up managing the patient’s disease, it is important to have one physician acting as a monitor and director of all medical issues for the child, rather than attempting to accomplish this on your own, or leaving the job up to individual specialists, who may or may not complete this task. Once you’ve seen the pediatrician, s/he may then recommend—based on clinical and laboratory findings—that you visit one or more of the following types of clinicians (among others):
- pediatric rheumatologist (for all autoimmune patients),
- dermatologist (for skin involvement)
- orthopedic surgeon
- physical therapist
- nephrologist (for kidney involvement)
- endocrinologist (for hormone involvment)
Regardless, all medical diagnoses and treatments should involve the primary family physician on some level, even if this is only as an intermediary/communicator among clinicians. This is the person who knows your child best, and who will treat your kid throughout childhood, so your pediatrician should be your first stop on the road to investigating any health issue.
Find out more about Dr. Gary Rothbard at AutoimmuneMom.
This post contains opinions of the author and does not serve as a substitute for medical advice, diagnosis, or treatment. If you're concerned about your child, seek diagnosis, treatment, and advice from qualified medical providers.