Multiple sclerosis diagnosed in people under 18 is called pediatric MS or pediatric-onset multiple sclerosis (POMS). It’s associated with more frequent relapses but a slower accumulation of disability.

Multiple sclerosis (MS) is an autoimmune disease. The body’s immune system mistakenly attacks a substance called myelin that surrounds and protects the nerves in the brain and spinal cord.

Myelin allows signals to move quickly and smoothly through the nerves. When it’s injured, the signals slow down and miscommunicate, causing the symptoms of MS.

While uncommon, somewhere between 3 and 5% receive an MS diagnosis before 16 years old.

Keep reading to learn the symptoms of pediatric MS, special considerations for this population, and information about treatment and outlook.

MS symptoms depend on which nerves have been affected. Because the myelin damage is spotty and can affect any part of the central nervous system (CNS), the symptoms of MS are unpredictable and vary from person to person.

Most children diagnosed with POMS receive a diagnosis of relapsing remitting MS (RRMS).

How is RRMS different in children?

RRMS involves relapses, periods during which symptoms worsen, followed by remission, or periods where symptoms become stable. During relapses, new symptoms can appear, and existing symptoms can worsen. But during remission, those new symptoms typically resolve or improve.

However, symptoms and disability accumulate over time.

Children tend to have 2 to 3 times more frequent relapses in the first 6 years after diagnosis than adults. However, they typically also have less accumulation of disability and recover more quickly from relapses.

Most symptoms of MS in children are the same as in adults, including:

Symptoms like weakness, numbness and tingling, and vision loss often happen on only one side of the body at a time.

Some children with MS may also experience seizures.

Mood and cognition

Children with MS commonly experience mood disorders, such as:

About one-third of children with MS experience some cognitive changes.

Some of the most frequently affected activities include:

  • processing incoming information
  • memory
  • attention span
  • speed and coordination in performing tasks
  • planning, organizing, and decision making

The exact cause of MS in children (and adults) is unknown.

MS is not contagious and cannot be prevented. However, several factors may increase the risk of developing it:

  • Exposure to the Epstein-Barr virus (EBV): This virus may act as a trigger that sets off MS. However, most people with EBV exposure do not develop MS. It likely contributes to other risk factors.
  • Genetics/family history: While a child does not inherit MS from their parents, if a child has certain combinations of genes or a parent or sibling with MS, they’re slightly more likely to develop it.
  • Low vitamin D levels: Research suggests that adults with a vitamin D deficiency had a 54% higher risk of MS.
  • Exposure to cigarette smoke and air pollution: Cigarette smoke, both firsthand and secondhand exposure, has been shown to increase the risk of developing MS. Exposure to air pollution can also increase the risk.

Diagnosing MS in children can be difficult for several reasons.

Other childhood diseases can have similar symptoms and are hard to differentiate. Because MS is so uncommon in kids and teenagers, doctors may not be looking for it.

There isn’t a specific test for diagnosing MS. Instead, a doctor uses information from the history, exam, and several tests to confirm the diagnosis and rule out other possible causes of the symptoms.

To make a diagnosis, a doctor needs evidence of MS in two parts of the CNS at two different times. A diagnosis can be made after only one episode with abnormalities seen on magnetic resonance imaging (MRI) if there’s evidence of MS in the spinal fluid and all other possible causes of symptoms and MRI findings are ruled out.

The tests a doctor may use to diagnose MS include:

  • History and exam: A doctor will ask detailed questions about the kinds and frequency of the child’s symptoms and perform a thorough neurologic examination.
  • MRI: An MRI shows whether parts of the brain and spinal cord are damaged. It can also show if there’s inflammation in the optic nerve between the eye and the brain, called optic neuritis.
  • Lumbar puncture: Also known as a spinal tap, this procedure involves collecting a sample of the fluid surrounding the brain and spinal cord and examining it for evidence of MS.
  • Evoked potentials: This test shows how fast the signals move through the nerves. These signals will be slower in children with MS if there’s a history of optic neuritis.
  • Optical coherence tomography: This test takes an image of the optic nerve to look for thinning. It can detect past optic neuritis that might not have caused symptoms.

No treatment can cure MS. Current treatment options focus on slowing the disease progression and managing relapses when they occur.

Disease modifying therapies (DMTs)

Doctors prescribe disease modifying therapies (DMTs) to prevent progression and reduce relapses. Currently, fingolimod (Gilenya) is the only one approved by the Food and Drug Administration (FDA) to treat relapsing MS in children ages 10 years and older. However, doctors sometimes prescribe others off-label if needed.

Many other DMTs approved for adults with MS are currently in clinical trials to determine their safety and effectiveness for children.

Managing relapses

Doctors may prescribe other treatments to shorten relapses and reduce their severity. These can include:

Living well with MS requires careful management and follow-up care. However, the activities, interests, and general life of a child with MS don’t need to change because of their diagnosis.

Adjusting to life with MS might sometimes mean learning to do things differently. An occupational therapist can help set up assistive devices or teach strategies to reduce the impact of MS symptoms.

Because pediatric MS is almost always the relapsing-remitting type, a child with MS will likely have symptoms that come and go. Most people diagnosed with MS in childhood will not develop significant, permanent physical disability for more than 20 years after diagnosis, at an average age of about 38 years.

Every child’s experience of pediatric MS is different. With access to newer medications, the disease course of pediatric MS may improve. Even in the study highlighted above, newer DMTs were not available to participants at diagnosis.

Relapses can happen without warning, and the causes aren’t always known. However, following a treatment plan carefully and living a health-promoting lifestyle may help reduce their frequency. This can include:

  • regular physical activity and strenuous exercise, which may lead to fewer lesions and less frequent relapses
  • avoiding cigarette smoke, including secondhand smoke, which can cause MS to progress faster
  • weight loss, if a child is overweight or has obesity, as these factors can worsen inflammatory diseases
  • reducing and managing stress
  • avoiding illness and infection, which can trigger a relapse, by getting recommended vaccines and avoiding contact with people who have an active illness
  • eating a balanced and nutrient-rich diet, and avoiding highly processed foods, which can reduce the risk of MS getting worse

Learn more about the connection between diet and MS and how to adjust your child’s eating plan. Talking with your child’s doctor before starting a particular diet is best.

Living with a chronic disease like MS is likely to affect a child’s emotional well-being and social life. This can have an impact on:

  • self-image and confidence
  • relationships at school (and work, for teens)
  • friendships and relationships with others the same age
  • family relationships
  • thoughts about the future

As a child learns more about living with MS, ongoing education and support from their doctor can help.

It’s important that children with MS have access to support, such as a school counselor, a therapist, or other people and resources that can help them through possible challenges. They should also be encouraged to talk about their experiences and feelings.

Connecting with other children with MS and their families may be equally important. This can help prevent isolation and provide support and understanding. Some MS organizations offer opportunities to connect with other families locally or online.

MS is a chronic and progressive disease, but it is not fatal and does not usually lower life expectancy. This is true no matter how old you are when it starts.

Most children with MS eventually progress from relapsing-remitting type to secondary progressive MS. While every person with pediatric MS is different, the transition usually happens around 40 years old for most or about 23 years after diagnosis, on average.

Because the disease usually progresses more slowly in children and teens, significant impairment develops later than when MS begins in adulthood. However, because the disease starts at a younger age, children usually need permanent assistance earlier in life than those with adult-onset MS.

Children tend to have more frequent flares than adults during the first few years after diagnosis. But they also recover from them and go into remission more quickly than people diagnosed as adults.

Pediatric MS cannot be cured or prevented, but a good quality of life is possible by treating the symptoms, addressing emotional and social needs, and maintaining a health-promoting lifestyle. Most children are able to manage their symptoms well and continue living a full life.