1. Beal, Judy A. DNSc, RN, FNAP, FAAN

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Acute flaccid myelitis (AFM) is a rare but devastating illness that predominantly affects children. Since 2014, the Centers for Disease Control and Prevention (CDC, 2019) has investigated more than 500 possible cases. According to the CDC, acute flaccid myelitis "is a rare disease that affects the spinal cord. Symptoms include acute weakness in the arms or legs along with loss of muscle tone and decreased or absent reflexes along with pain in some cases, facial weakness, drooping of the eyelids, and difficulty swallowing, speaking, or moving the eyes. The most serious complication of AFM is respiratory failure" (CDC, 2019). The CDC confirmed 186 cases of AFM across 38 states in the United States in 2018, mostly in individuals under 18 years of age.

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Acute flaccid myelitis is difficult to diagnose as symptoms often are confused with those of Guillain-Barre syndrome, acute disseminated encephalomyelitis, and transverse myelitis. The cause of most cases of AFM remains unknown. There is some speculation that symptoms of AFM develop after a viral infection; for example, poliovirus, West Nile virus, and adenovirus, but in most cases the etiology is unclear (CDC, 2019; Hopkins, 2017; Messacar et al., 2016). With recent press coverage on this increase in incidence of AFM, parents may express alarm. Pediatric nurses must be knowledgeable of the most current information on AFM. Although it is reassuring that this illness remains rare, there are steps that can be taken to prevent infections by currently speculated AFM infections. Specifically, pediatric nurses need to reinforce the importance of staying-up-to-date with polio vaccines and handwashing, as well as minimizing exposure to mosquitoes. Sharing information from the CDC on AFM at and immunizations with parents can be helpful.


Pediatric nurses must be aware and vigilant of presenting symptoms to ensure rapid referral and early intervention. There is no known effective treatment for AFM; however, physical and occupational therapies play an important role in recovery that varies in length from continued muscle weakness after 1 year to full recovery (Hopkins, 2017; Messacar et al., 2016). There are support and advocacy organizations available for patients and families affected by AFM. The Transverse Myelitis Association can be accessed at The AFM awareness and other polio-like virus side effect Facebook page can be accessed at


Although pediatric nurses need to be knowledgeable about and vigilant for AFM presentation, our most important role, until more research on AFM is conducted, is to educate parents about the rare occurrence of the disease and in prevention and advocacy.




Centers for Disease Control and Prevention. (2019). Acute flaccid myelitis. [Context Link]


Hopkins S. E. (2017). Acute flaccid myelitis: Etiologic challenges, diagnostic and management considerations. Current Treatment Options in Neurology, 19(12), 48.[Context Link]


Messacar K., Schreiner T. L., Van Haren K., Yang M., Glaser C. A., Tyler K. L., Dominguez S. R. (2016). Acute flaccid myelitis: A clinical review of US cases 2012-2015. Annals of Neurology, 80(3), 326-338.[Context Link]