New research raises concerns about long Covid in children

A major analysis appeared in the magazine on Wednesday Pediatrics underlines the long toll Covid can take on children, which in some cases can lead to neurological, gastrointestinal, cardiovascular and behavioral symptoms in the months following an acute infection.

“Long Covid-19 is a serious problem in the US, in adults and children,” said Dr. Ziyad Al-Aly, chief research and development officer at the VA St. Louis Health Care System and clinical epidemiologist at Washington University in St. Louis, which studies the condition but was not involved in the new report. He said the paper, which is based on numerous studies of long Covid-19 in children, is “important” and illustrates that the condition can affect multiple organ systems.

The new research found that 10 to 20 percent of children in the United States who had Covid developed Covid for a long time. Dr. However, Suchitra Rao, a pediatric infectious disease expert at Children's Hospital Colorado and co-author of the paper, acknowledged that there are “a lot of caveats” to the prevalence estimates used to arrive at that number. For example, some of the included studies only looked at the very small percentage of children admitted to hospital due to Covid. Like adults, children who have had more severe cases of Covid are at greater risk of persistent symptoms or new complications.

The Centers for Disease Control and Prevention is closing in on the prevalence of long Covid-19 1 percent of children who have had Covid. (The estimate in adults is 7 percent.)

In general, most parents don't have to worry about their children developing Covid for a long time, said Dr. Stephen Freedman, a professor of pediatrics and emergency medicine at the University of Calgary's Cumming School of Medicine. “I don't get many, if any, questions about 'Is my child now at risk of developing long Covid-19?' after we diagnose them as having an acute infection,” he said. “And I think that's right.”

What does long Covid look like in children?

Long Covid can be challenging to study in part because it is difficult to diagnose because the symptoms are so broad. Making a diagnosis may be even more difficult in children, because the symptoms may present differently than in adults. Young children also may not have the language to describe what they are feeling, so researchers advised parents to look for changes in behavior.

Fatigue, brain fog and headaches are among the most commonly reported symptoms of a long Covid-19 bout in children. Although these problems 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 act out, frustrated because they can no longer easily do what they used to do. Most symptoms improve within a year, experts say, but in some children they can last longer.

It's still not clear what the long-term impact these long-lasting symptoms may have on children's development, said Dr. Laura Malone, director of the Pediatric Post-Covid-19 Rehabilitation Clinic at the Kennedy Krieger Institute in Baltimore.

In severe cases, some children experience persistent respiratory and cardiovascular problems, including the heart condition myocarditis. Diabetes and other autoimmune diseases can also develop as a result of a Covid infection, although these are “much less common in children” than milder symptoms, Dr Al-Aly said.

Even children with mild infections can experience persistent and severe symptoms, says Dr. Sindhu Mohandas, an infectious disease specialist at Children's Hospital Los Angeles.

That was the case for Lucas Denault, whose first brush with Covid in 2021 went little further than a stuffy nose. Lucas, then 15, recovered and returned to school, athletic training and student council meetings. But months later, he began having trouble walking the halls of his high school in Littlestown, Pennsylvania. His head and chest ached. He felt dizzy and nauseous.

“It was such a quick demise,” said his mother, Karin Denault. Neither Lucas nor his mother thought his problems could be related to his brief bout with Covid. But on the recommendation of a relative, he went to the Kennedy Krieger Clinic in Baltimore for examination. There he was diagnosed with long-term Covid-19 and with postural orthostatic tachycardia syndrome, a cluster of symptoms that lead to extreme fatigue and occur in people with long Covid.

What treatments are available?

No drugs have been approved to treat long Covid-19, so doctors are focusing on managing symptoms and helping patients function day to day. Some doctors will prescribe medications to address problems such as headaches and muscle pain.

Dr. Mohandas, who was also involved in the research review, said much of the work she and other doctors do revolves around validating the experiences of these young patients. Many “were very healthy before, so often that everyone tends to doubt their symptoms,” she said.

Dr. Malone said schools should provide accommodations for children who are struggling, including breaks during the day and extra time for testing.

Small changes helped Lucas. For example, he had trouble pushing himself out of bed, so he started sleeping upright to make it easier. At his doctor's suggestion, he would sometimes dangle his feet off the bed and spell 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 visited colleges, his mother often had to push him in a wheelchair. Last weekend she came to campus to watch him play club basketball.