What is AFM?

As recently as 2018, parents have been alarmed by news stories describing a mysterious neurological condition that typically affects children. As with every medical development, some basic knowledge can address those fears and help caregivers understand what to look for.

Here, we’ll answer the most common questions fielded by health officials in the wake of the reports:

  • Exactly what is acute flaccid myelitis?
  • What are the symptoms of acute flaccid myelitis in kids, and in general?
  • What treatments are available, and how successful are they?
  • Are there any ways to prevent AFM? What risk factors are within your control?

AFM Defined: What is Acute Flaccid Myelitis?

Acute flaccid myelitis is an extremely rare spinal inflammation disorder that causes severe muscle weakness and limb paralysis, usually in children. This serious neurological condition first made headlines in 2014 when the Centers for Disease Control and Prevention (CDC) confirmed 120 total cases across 34 states. During 2016, and again in 2018, cases of AFM surged, giving health officials concern.

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Risk Factors and Symptoms of AFM in Kids

The term “acute” in medicine means the condition appears abruptly, progresses quickly, and requires urgent care.

Suspected AFM certainly fits this description. Parents and caregivers of children are often first to notice the symptoms, which include:

  • Muscle weakness in the arms and legs, often with one side more affected.
  • Drooping facial features.
  • Neck stiffness.
  • Difficulty speaking, swallowing, or breathing.

Doctors can diagnose AFM by checking for abnormalities in the spinal cord gray matter on an MRI.

“Children who present with AFM often have fever and/or respiratory symptoms in the seven to 10 days before the onset of weakness,” says Megan Freeman, MD, PhD, an infectious disease specialist at UPMC Children’s Hospital of Pittsburgh and an expert on enteroviruses. “AFM is a rare condition, but new onset weakness is always serious and should be evaluated by a doctor.”

While more research is needed to determine clear risk factors, AFM has coincided with two types of enteroviruses in many, but not all, of the confirmed cases. Enteroviruses are known for causing mild, short-lasting illnesses including colds and hand, foot, and mouth disease. Occasionally though, they can develop into neurologic illnesses such as meningitis, encephalitis, and now, AFM. Other viruses associated with AFM include West Nile virus.

Even though AFM is thought to be caused by a virus, paralysis is not contagious. Instead, it is considered to be a rare complication of other factors, since it’s triggered by disease, the environment, and genetic variables.

Treatment and Prevention of AFM

There is no specific treatment for acute flaccid myelitis in kids, but supportive care has helped in many cases. Some patients make a full recovery, but others need ongoing care.

Most treatments focus on alleviating the symptoms. A neurologist might prescribe occupational or physical therapy. The CDC is actively investigating the spike in cases of AFM and is keeping health care providers updated on relevant developments.

One final bit of good news: You are not powerless.

Watch for the symptoms of acute flaccid myelitis and share this article with other parents and caregivers. The condition may progress quickly, but potential AFM cases can be identified and treated promptly.

Since the exact cause of acute flaccid myelitis is still unknown, the CDC also recommends taking standard precautions against conditions that have coincided with AFM:

  • Wash hands often and properly. Opt for hand sanitizer only when soap and water are not available.
  • Stay current on vaccines, particularly the poliovirus vaccine. Before the Salk poliovirus vaccine (invented at the University of Pittsburgh), there were tens of thousands of cases of children becoming paralyzed from polio each year in the United States.
  • Protect yourself and your kids against mosquito bites with protective clothing and mosquito repellent, and avoid stagnant water. Mosquitos may carry the West Nile virus.

“One reassuring fact is that the social distancing guidelines recommended to combat COVID — like masks, hand hygiene, and keeping a six-foot distance — also are effective at preventing the transmission of other illnesses that infect via respiratory droplets, including enteroviruses that are associated with AFM,” adds Dr. Freeman.

For more information about acute flaccid myelitis, talk to your health care provider. If you notice the symptoms of AFM in your child, make an appointment with one of our specialists at the UPMC Children’s Hospital of Pittsburgh.

Editor's Note: This article was originally published on , and was last reviewed on .

About Pediatrics

From nutrition to illnesses, from athletics to school, children will face many challenges growing up. Parents often will make important health care decisions for them. We hope to help guide both of you in that journey. UPMC Children’s Hospital of Pittsburgh is a national leader in pediatric care, ranking consistently on U.S. News & World Report’s Best Children’s Hospitals Honor Roll. We provide expert treatment for pediatric diseases, along well-child visits, urgent care, and more. With locations across Pennsylvania, Maryland, and West Virginia, you can find world-class care close to home. We also work closely with UPMC Magee-Womens Hospital, a national leader in care for newborns and their mothers. Our goal is to provide the best care for your children, from birth to adulthood and beyond. Visit our website to find a doctor near you.