Q&A: What to know about long COVID in children
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Key takeaways:
- Almost 6 million children are estimated to have had long COVID.
- Fatigue, headaches and pain are among the most common symptoms.
An estimated 5.8 million children in the United States have had long COVID, which may occur in up to 20% of children infected with SARS-CoV-2, according to the authors of a new state-of-the-art narrative review published in Pediatrics.
Subject matter experts from nearly a dozen specialties — including pediatrics, infectious diseases, neurology, pulmonology, rheumatology and cardiology — reviewed close to 100 studies to provide a summary of long COVID in children.
We spoke with Suchitra Rao, MD, an infectious diseases physician at Children’s Hospital Colorado, about what the review found and the questions that remain about pediatric long COVID.
Healio: What are some of the risk factors for pediatric long COVID besides SARS-CoV-2 infection?
Rao: Some of the risk factors for pediatric long COVID include older age (adolescents), being female, a history of allergic disease, multiple medical conditions, having severe COVID-19 infection, a first SARS-COV-2 infection before the omicron period, obesity, having repeat COVID infections, and the number of organ systems that were involved during the acute infection.
Healio: Has anything besides vaccination been shown to reduce the risk for long COVID?
Rao: We don’t currently have additional treatments or preventive measures besides vaccination to reduce the risk of long COVID. There are trials underway exploring whether longer courses of antiviral treatments during the acute phase of infection may decrease the risk of long COVID, but they are not recommended at this time.
Healio: What symptoms should pediatricians be aware of?
Rao: Long COVID can present in many different ways in children and can be related to the symptoms of acute COVID or could be new symptoms developing that are unrelated to the acute SARS-CoV-2 infection. In children, fatigue and malaise, headaches, shortness of breath, persistent cough and generalized pain are some of the more common manifestations. It can be more challenging to identify long COVID in younger children, who may not self-report many of these symptoms. Long COVID can affect virtually any organ system in the body.
Healio: How should a clinician approach caring for or referring a patient who they suspect has long COVID?
Rao: When a patient presents with long COVID symptoms, it is important to do a comprehensive evaluation to determine their symptoms and the impact on everyday functioning, assess what additional detailed evaluations may be helpful, identify “red flag” symptoms that warrant urgent further testing, consider which specialists to refer to and try to differentiate long COVID from pre-existing or new conditions that require a different therapeutic approach. Part of this assessment includes a full physical exam, including a thorough neuromuscular exam and provocative musculoskeletal tests specific to any areas of pain, and orthostatic vital signs/standing test if the patient is experiencing lightheadedness/dizziness.
The clinician should consider formal testing of physical functioning and endurance (for example, the 6-minute walk test) and an initial screening lab evaluation to rule out other conditions, including complete blood count, comprehensive metabolic panel, thyroid-stimulating hormone/free T4, iron panel, ferritin, vitamin D.
The next step is to conduct more targeted evaluations based on the symptoms. For example, if fatigue or exercise intolerance is associated with additional cardiopulmonary symptoms, consider a B-type natriuretic peptide, electrocardiogram, echocardiogram, pulmonary function tests and a chest X-ray.
Healio: What remaining questions are there about pediatric long COVID?
Rao: There is still a lot to be learned about why some patients experience long COVID symptoms but not others, to understand underlying mechanisms for their varied presentations. It is also important to learn how symptoms re-emerge over time during periods of physiological and/or psychological stress and reinfection. We also need studies evaluating the effectiveness of treatments for long COVID in children.
The NIH has responded to several of these research gaps by funding the Researching COVID to Enhance Recovery (RECOVER) Initiative, which is one of the largest and most diverse cohorts of patients with long COVID in the world, including children and adults. The pediatric branch of RECOVER consists of clinical cohorts from over 100 study sites throughout the U.S., which are following children and young adults from birth through 25 years of age for up to 4 years.
References:
Children’s Hospital Los Angeles RECOVER Study collaborators publish comprehensive report on long COVID symptoms in children. https://www.eurekalert.org/news-releases/1034084. Published Feb. 12, 2024. Accessed Feb. 14, 2024.
Rao S, et al. Pediatrics. 2024;doi:10.1542/peds.2023-062570.
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