If your child seems to be constantly feeling unwell, it may be time to ask their pediatrician whether lupus could be the cause. Common lupus symptoms such as fever, fatigue, and joint pains can look a lot like viral infections. Because lupus flare-ups can come and go, it might seem like your child just keeps catching a new bug.

Lupus (short for systemic lupus erythematosus, or SLE) is an autoimmune disease, meaning the immune system attacks the body’s healthy tissue the way it would fight an invading virus. This mistaken response can cause a wide range of symptoms, some mild and others more serious.

Lupus has no cure, but symptoms can be managed with medication and healthy lifestyle changes. Getting an accurate and timely diagnosis is the first step. This article explains five of the most common lupus symptoms and shares important facts to help you understand this disease.

Pediatric Lupus Is Uncommon

Lupus is rare in children. Studies from around the world estimate that 3 to 9 in 100,000 children will develop lupus. In the United States, children under age 18 make up about 15 percent of all people living with lupus.

Although pediatric lupus can appear at any age, it most often begins around ages 12 to 15. In the U.S., lupus tends to show up earlier and more often in African American and Hispanic-Latino children compared with white children.

The exact cause of lupus is unknown, but researchers believe genetics play a role. Around 50 percent of people with lupus also have a parent or sibling with the condition. Researchers are also considering whether hormones, especially estrogen, have a part — lupus mostly affects young women, according to Children’s Hospital of Philadelphia.

Symptoms of Lupus Can Look Different for Each Child

Lupus can cause many types of symptoms, and no two people experience the condition exactly the same way. However, if your child develops any of the following five types of symptoms, it’s a good idea to ask their doctor if lupus could be involved.

1. Rashes and Other Skin Changes

One of the most recognizable signs of lupus is a rash that spreads across both cheeks in the shape of a butterfly. This “butterfly rash” — also called a malar rash — is a key symptom doctors look for when diagnosing lupus.

Lupus can also cause other types of rashes, including:

• Discoid rashes — These round, red, flaky, sometimes itchy plaques usually show up on the face and scalp and may cause scarring, hair loss, or skin color changes. The flat or raised patches may also resemble eczema or ringworm.
• Subacute cutaneous rashes — These scaly patches, often with a distinctive edge, usually appear on the chest, back, and arms. They usually don’t scar but can leave behind discolored skin.
• Acute cutaneous rashes — These discolored patches appear and fade relatively quickly. They may affect the entire body or a small area, such as the cheeks.

Lupus can also cause a range of other skin issues, including:

• Sores in the mouth or nose
• Hives (raised, itchy welts)
• Bruises
• Discolored palms
• Livedo reticularis (lacy or netlike discoloration)
• Spider veins (visible tiny blood vessels)
• Erythema nodosum (discolored, painful bumps, usually on the shins)
• Vitiligo (white patches of skin where pigment is lost)
• Hair thinning or hair loss (temporary or permanent)

Spending time in the sun can trigger lupus symptoms. About 60 percent to 80 percent of children with lupus experience worse skin rashes after sun exposure. Even indoor lighting, like fluorescent bulbs, can sometimes cause flare-ups.

2. Pain and Inflammation

Lupus causes inflammation, which can lead to pain throughout the body and may even affect internal organs. Compared to adults, children with lupus are more likely to experience organ damage. Sometimes, the location of your child’s pain can provide a clue about which organ may be affected:

• Chest pain and shortness of breath may indicate inflammation in the lungs or around the heart.
• Headaches may suggest inflammation in the brain.
• Abdominal pain may be related to swelling in the pancreas, intestines, or stomach.

Lupus can also cause painful, stiff, and swollen joints and muscle pain.

3. Kidney Disease Symptoms

Lupus nephritis (inflammation in the kidneys) affects up to 80 percent of children with lupus, especially teens, and about 50 percent of adults. Common symptoms, which can come on quickly and may be severe, include:

• Dark, foamy, or bloody urine
• Frequent urination, especially at night
• Swollen eyelids, legs, or feet

Lupus nephritis may also occur alongside a flare-up of other lupus symptoms, such as joint pain and the butterfly rash.

4. Neurological Symptoms

Lupus can affect the brain, spinal cord, and nerves — together called the nervous system. Research suggests that children with lupus may be more likely than adults to develop serious or lasting brain-related symptoms, especially in the first couple of years after diagnosis. Some common neurological symptoms of lupus in children include:

• Headaches (the most common)
• Changes in mood, such as depression or anxiety
• Seizures
• Confusion or trouble thinking clearly
• Cognitive dysfunction (problems with memory, focus, or learning)
• Movement disorders, such as shaky hands or unusual muscle movements

5. General Lupus Symptoms

Lupus can also cause general symptoms that affect your child’s overall energy and well-being. These may include:

• Fatigue (extreme tiredness that doesn’t improve with rest)
• Joint pain, with or without swelling
• Fevers that come and go
• Weight loss or low appetite
• Swollen lymph nodes
• Raynaud’s phenomenon (a condition that causes white or blue fingertips when cold or stressed)

Seek a Pediatric Rheumatologist for an Accurate Diagnosis

Lupus can be hard to diagnose because it shares symptoms with many other health conditions, including:

• Fibromyalgia — A condition that causes widespread muscle pain, fatigue, and sleep problems
• Rheumatoid arthritis — An autoimmune disease that causes painful, swollen joints
• Rosacea — A skin condition that causes facial discoloration and visible blood vessels, sometimes mistaken for a lupus rash
• Chronic fatigue syndrome — A disorder marked by extreme tiredness that doesn’t improve with rest
• Celiac disease — An autoimmune condition in which eating gluten damages the small intestine
• Sjögren’s disease — An autoimmune disease that causes dry eyes and mouth
• Thyroid disorders — Conditions that affect how the thyroid gland controls metabolism, which can lead to tiredness, weight changes, or mood shifts

Getting an accurate diagnosis is essential. Children with lupus need regular checkups to monitor for organ damage and to start treatments that can help manage symptoms and prevent complications. Your child’s primary healthcare provider or your insurance provider may be able to help you find a pediatric rheumatologist — a doctor who specializes in diagnosing and treating autoimmune conditions like lupus in children and teens.

What To Expect

At the first visit, the pediatric rheumatologist will ask about your child’s health history and any ongoing symptoms. They’ll also order lab tests, such as blood tests to look for signs of an overactive immune system and urine tests to look for signs of kidney problems. They may also order imaging, like an X-ray, or request a biopsy (a small sample of tissue) from an organ to look for inflammation or organ damage.

Lupus can be challenging to diagnose, but early detection can lead to the right treatment and help protect your child’s health.

Talk With Others Who Understand

On MyLupusTeam, the social network for people with lupus and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with lupus.

Which lupus symptoms affect your child the most? Did you have any difficulty getting an accurate diagnosis? Share your experience in the comments below, or start a conversation by posting on your Activities page.