VIDEO: Challenges of diagnosing long COVID in children

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As I mentioned, this is a very heterogeneous and complicated condition that spans multiple different organ systems, has multiple degrees of severity of presentation, and frankly, isn't owned by one single specialty. One of the most challenging things about diagnosing pediatric long COVID is, aside from just developing a definition to work on, is recognizing it. So a lot of, especially for younger children, the findings may be a little bit more subtle. They, it may not be as obvious that they're, you know, taking an extra nap a day compared to say, you know, a 18-year-old who was previously running marathons who can now barely walk. But they're certainly still impacted and they're not developing and doing activities the same degree as they should be at that age.

So that recognition for some of the less overt symptoms is a challenge. Even to this day, recognition in the community by pediatricians, and even by a lot of other subspecialists is not as robust as many would hope. Some of this is due to the complexity, and I think unfortunately a lot of it is due to sort of this just discomfort with this diagnosis that we, you know, don't know exactly what to do with, and which is challenging to medical providers who are here to help patients and cure patients. So a little bit of it is, you know, lack of knowledge, some of it is psychological stress on the providers.

There are also barriers in terms of med access to knowledgeable medical care. So as mentioned, not all pediatricians are aware of this, and even if they are, most community pediatricians don't really have time to delve into something this complex, and they get 15 minutes for a well child visit or 20 minutes for a sick visit. These are much more complicated issues. Even if they, you know, are able to get to a provider, it's hard to find specialists. There are probably 12, if that, pediatric-focused long COVID clinics in the country. There are issues with the distribution regionally, so a lot more of those are on the East Coast or kind of the Northeast. They're not in rural areas, they're in major academic medical centers. And so for the people crossing state lines that might have state-run insurance like Medicaid, they may have challenges accessing that care. Telemedicine capabilities are still, you know- Briefly in the pandemic, they kinda got rid of state line regulations for emergency purposes, but that's no longer the case for a lot of states.

And so there are barriers to either telemedicine visits or follow-up for those that are from out of state. And then lack of specialized sort of pediatric care providers and ancillary support. The mainstays of diagnosis and treatment for these kids with long COVID are addressed, you know, specifically for their fatigue and sort of helping them manage that. And you know, knowledgeable physical therapists that handle the sort of post-malaise, the sort of autonomic issues that these kids have are few and far between. And that's coming from a small pool of already, you know, few pediatric physical therapists as well as psychologists that are pediatric-specific.

And neuropsychology is really been a challenge. And a lot of these kids have bad cognitive dysfunction or brain fog, quote, unquote, that really should be evaluated from a neuropsychological perspective to help them know which areas of support that that's need in their educational endeavors.