VIDEO: How long COVID presents in children

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First I'd like to say thank you for calling attention to this issue. Long COVID overall has been a challenging, new clinical entity in the era of the pandemic, but in particular in the pediatric space, has been largely under reported and sort of under appreciated. In the pediatric population, we estimate that anywhere between two to 25% of children that have acute COVID, most likely around 10%, do have some ongoing symptoms that would rise to the definition of pediatric long COVID.

The definition that I use, which is developed by the WHO, is symptoms that have started within two months of an acute COVID infection that have persisted for at least three months. They may fluctuate or relapse and remit, however are significant enough to cause an impact on daily life. So would be that, you know, prevent participation full in-person school or participation in sports activities or activities of daily living, such as walking and dressing oneself. So all of those things, any symptoms that prevent that that fit that category would qualify as long COVID.

As you can see, that's a very heterogeneous condition. That being said, there are some core symptoms that most kids with long COVID present with, and they're similar to what we see in adults. So far and away, fatigue is the most common symptom that children present with, and that can be very mild to something that, you know, peak athletes notice they're not accomplishing their, you know, typical abilities, or it can be devastating to point of being bed bound. And we see the whole, the whole gamut, the whole spectrum. Sometimes that evolves over time.

But really almost everyone that comes to our clinic has fatigue. The other sort of major symptom that goes similar with that but is separate is a degree of exercise intolerance or something called post exertional malaise or post exertional symptom exacerbation. So this is something where after either a physical, mental, academic, social, emotional taxing event, the fatigue that accompanies that or the worsening of symptoms is delayed and much more severe than would be expected in a quote-unquote normal individual. So for example, someone going for a short walk with post exertional malaise, the next two days they would be unable to get out of bed. So that is really challenging part of this diagnosis is in terms of management. But again, something we see in probably about half of our individuals, even more so in those that are really affected, you know, going on two years or even three years at this point.

Other common symptoms include headache, abdominal pain, things like chronic nausea are very common in pediatric population, and more so than we've seen or has been reported in adults with long COVID, which is interesting. And then, you know, understandably, a lot of these patients have developed anxiety as a result of their symptoms or have exacerbation of underlying anxiety. Underlying with ADHD mood symptoms is often seen with this presentation as well.