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

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.

MS diagnosed in childhood is called pediatric MS. Only 3 to 5 percent of people with MS are diagnosed before the age of 16, and less than 1 percent receive the diagnosis before they’re 10.

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

In children, MS is almost always the relapsing-remitting type. This means the disease alternates between relapses, in which someone develops new symptoms, and remissions, in which there are only mild or no symptoms.

Flares can last days to weeks, and remission can last months or years. Eventually, though, the disease can progress to permanent disability.

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

  • weakness
  • tingling and numbness
  • eye problems, including vision loss, pain with eye movement, and double vision
  • balance problems
  • difficulty walking
  • tremors
  • spasticity (continuous muscle contraction)
  • bowel and bladder control problems
  • slurred speech

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

Mood disorders occur frequently in children with MS. Depression is the most common, occurring in about 27 percent of children with MS. Other frequent conditions include:

  • anxiety
  • panic disorder
  • bipolar depression
  • adjustment disorder

Approximately 30 percent of children with MS have cognitive impairment or trouble with their thinking. The most frequently affected activities include:

  • memory
  • attention span
  • speed and coordination performing tasks
  • information processing
  • executive functions like planning, organizing, and decision-making

Some symptoms are more frequently seen in children but rarely in adults. These symptoms are:

  • seizures
  • lethargy

The cause of MS in children (and adults) is unknown. It isn’t contagious, and there’s nothing that can be done to prevent it. However, there are several things that seem to increase the risk of getting it:

  • Genetics/family history. MS isn’t inherited from parents, but if a child has certain combinations of genes or a parent or sibling with MS, they’re slightly more likely to develop it.
  • Exposure to the Epstein-Barr virus. This virus may act as a trigger that sets off MS in children who are susceptible to it. However, many children are exposed to the virus and don’t develop MS.
  • Low vitamin D levels. MS is found more often in people in northern climates where there’s less sunshine than around the equator. Our bodies need sunlight to make vitamin D, so people in northern climates tend to have lower vitamin D levels. Researchers think this may mean there’s a link between MS and low vitamin D. In addition, low vitamin D levels increase the risk of a relapse.
  • Exposure to smoking. Cigarette smoke, both firsthand use and secondhand exposure, has been shown to increase the risk of developing MS.

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 to see evidence of MS in two parts of the central nervous system at two different times. A diagnosis can be made after only one episode with abnormalities seen on 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 any 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, which is called optic neuritis.
  • Spinal tap. For this procedure, a sample of the fluid that surrounds the brain and spinal cord is collected and examined for signs of MS.
  • Evoked potentials. This test shows how fast the signals move through the nerves. These signals will be slow in children with MS if there’s a history of optic neuritis.
  • Optical coherence tomography. This is a test that takes a picture of the optic nerve and can look for thinning. This can pick up a history of optic neuritis that might not have caused any symptoms.

Although there’s no cure for MS, there are treatments aimed at reducing new lesions and relapses and slowing progression of the disease:

  • Steroids can reduce inflammation and lessen the length and severity of relapses.
  • Plasma exchange, which removes the antibodies attacking the myelin, can be used to treat a relapse if steroids don’t work or aren’t tolerated.

Specific symptoms can be treated with other medications to improve quality of life.

Physical, occupational, and speech therapy can also be helpful for children with MS.

The eating plan of someone with MS is important to prevent relapses, especially in children. One 2018 study found that children eating a diet high in fat, particularly saturated fat, were more likely to have a relapse. Eating more vegetables seemed to lead to fewer relapses.

The study showed no association either way with an increase in carbohydrates, cholesterol, dairy, fiber, fruit, iron, or sugar.

It’s possible that excess fat intake could trigger increased inflammatory chemicals or affect gut microbiota.

Another 2018 study suggested a link between low iron intake and pediatric MS cases. Though more research is needed to further understand the link between food and pediatric MS, a healthy diet could be a factor in reducing relapses and symptoms.

Here are some foods and nutrients thought to improve an MS diet for children:

  • A balanced diet. A healthy balance of complex carbs, healthy fats, protein, fruits, and plenty of vegetables promotes general health.
  • Iron. Foods rich in iron include leafy green vegetables like spinach, beans, chicken, turkey, and fortified whole grain breads and cereal.
  • Omega-3 fatty acids. These can be found in supplements and foods like salmon, flaxseed, and walnuts. Omega-3 fatty acids have been linked to lower relapse rates in adults with MS.
  • Vitamin D. Low vitamin D has been linked to a higher incidence of MS. Fatty fish like salmon and cod, canned tuna, egg yolks, mushrooms, fortified foods, and vitamin D supplements are good choices.
  • High fiber vegetables. Dark, leafy greens and other veggies high in fiber can help stabilize blood sugar and prevent relapses. Spinach, broccoli, and kale are also great sources of calcium and iron.

Here’s what to avoid in a pediatric MS diet:

  • saturated fats
  • sugar (which can exacerbate symptoms)
  • ultra-processed foods and refined grains
  • excessive salt (may be linked to lower cognitive function)
  • gluten, if found to be intolerant (some links exist between celiac disease and MS, so testing for intolerance is recommended)

Having MS as a child can cause emotional and social challenges. Living with a serious chronic disease may negatively affect a child’s:

  • self-image
  • confidence
  • performance in school
  • friendships and relationships with others the same age
  • social life
  • family relationships
  • behavior
  • thoughts about the future

It’s important that a child with MS has access to school counselors, therapists, and other people and resources that can help them through these challenges. They should be encouraged to talk about their experiences and problems.

Support from teachers, family, clergy, and other members of the community can also help children successfully manage these issues.

MS is a chronic and progressive disease, but it isn’t fatal and doesn’t 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 irreversible disability. The disease usually progresses more slowly in children and teens, and significant impairment develops about 10 years later than when MS begins in adulthood.

However, because the disease starts at a younger age, children usually need permanent assistance about 10 years 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 can’t be cured or prevented, but by treating the symptoms, addressing emotional and social challenges, and maintaining a healthy lifestyle, a good quality of life is possible.