A large analysis published Wednesday in the journal Pediatrics highlights the long-term impact of Covid on children, in some cases leading to neurological, gastrointestinal, cardiovascular and behavioral symptoms in the months following an acute infection.
“Long-term Covid in the US, in adults and children, is a serious problem,” said Dr. Ziyad Al-Aly, head of research and development at the VA Health System St. Louis and a clinical epidemiologist at Washington University in St. Louis, who studies the condition but was not involved in the new report. He said the work, which was based on numerous studies of long-term Covid in children, was “significant” and showed that the condition can affect multiple organ systems.
The new review suggested that 10 to 20 percent of children in the United States who had Covid experienced prolonged Covid. However, Dr. Suchitra Rao, a pediatric infectious disease specialist at Children’s Hospital Colorado and a co-author on the paper, acknowledged that there are “many caveats” with the prevalence estimates used to arrive at that number. For example, some of the included studies only looked at the very small proportion of children who were hospitalized for Covid. Like adults, children who have had more severe cases of Covid are at greater risk of developing prolonged symptoms or new complications.
The Centers for Disease Control and Prevention puts the prevalence of long-term Covid closer to 1 percent of children who have had Covid. (The estimate in adults is 7 percent.)
In general, most parents shouldn’t worry that their children will develop long-term Covid, said Dr. Stephen Freedman, professor of pediatrics and emergency medicine at the University of Calgary Cumming School of Medicine. “I don’t get asked many, if any, questions about ‘Is my child now at risk of long-term Covid?’ after we diagnose them with an acute infection,” he said. “And I think it’s appropriate.”
What does long Covid look like in children?
Long-term Covid can be difficult to study in part because it is difficult to diagnose because the symptoms are so widespread. Diagnosis may be even more difficult in children because symptoms may appear differently than they do in adults. Young children may also lack the language to describe what they’re feeling, so the researchers advised parents to look for changes in their behavior.
Fatigue, brain fog and headaches are among the most commonly reported symptoms of long-term Covid in children. While these issues are sometimes on the mild end of the spectrum, they can prevent children from fully participating in school or recreational activities. Young children may also play, frustrated that they cannot easily do what they used to. Most symptoms improve within a year, experts said, but for some children they may persist longer.
It’s not yet clear what the long-term impact of these lingering symptoms might be on children’s development, said Dr. Laura Malone, director of Pediatric Clinical Post-Covid-19 Recovery at the Kennedy Krieger Institute in Baltimore.
In severe cases, some children develop prolonged respiratory and cardiovascular problems, including the heart condition myocarditis. Diabetes and other autoimmune disorders can also occur after a Covid infection, although these “tend to be much, much less prevalent in children” than milder symptoms, Dr Al-Aly said.
Persistent and severe symptoms can occur even in children with mild infections, said Dr. Sindhu Mohandas, an infectious disease specialist at Children’s Hospital Los Angeles.
That was the case for Lucas Denault, whose initial brush with Covid in 2021 involved little more than a stuffy nose. Lucas, then 15, recovered and returned to school, track practice and student council meetings. But months later, he began struggling to walk the halls of his high school in Littlestown, Pa. His head and chest hurt. He felt dizzy and nauseous.
“It was such a quick decline,” said his mother, Karin Denault. Neither Lucas nor his mother had considered that his problems could be linked to the short period of Covid. But at the recommendation of a relative, he went for an evaluation at the Kennedy Krieger Clinic in Baltimore. There, he was diagnosed with long Covid and with orthostatic tachycardia syndrome, a symptom cluster that leads to extreme fatigue and can occur in people with long Covid.
What treatments are available?
There are no approved drugs to treat long-term Covid, so doctors focus on managing symptoms and helping patients function every day. Some doctors will prescribe medication to treat problems such as headaches and muscle pain.
Dr. Mohandas, who also participated in the research review, said much of her and other clinicians’ work revolves around validating the experiences of these young patients. Many “were previously very healthy, so often, everyone tends to question their symptoms,” he said.
Dr Malone said schools should make accommodations for children who struggle, including breaks during the day and extra time for exams.
Small changes helped Lucas. He found it hard to push himself out of bed, for example, so he started sleeping standing up to make it easier. At his doctor’s suggestion, he would sometimes swing his legs out of bed and write his name with his toes to improve blood flow. His doctor also prescribed several medications, including a blood pressure medication, to help manage symptoms such as fatigue and brain fog.
Lucas is now a freshman at Princeton and most of his symptoms have improved. When he toured colleges, his mother often had to push him in a wheelchair. Last weekend, she came to campus to watch him play basketball.
