AAP issues guidance on caring for children after COVID-19

The AAP issued interim guidance on pediatric follow-up care for children who have had COVID-19, including recommendations for children with long COVID, a syndrome that is less common among kids than adults.

The guidance recommends that all children and adolescents who test positive for COVID-19 have at least one follow-up visit with their primary care provider. Follow-up visits should occur after the recommended quarantine period and before a return to any physical activity, the AAP said.

Sarah Resin, MD, FAAP, a pediatric neurologist at Texas Children’s Hospital and co-author of the new guidance, said pediatricians are vital to the care of children and adolescents who have been infected with SARS-CoV-2.

“A follow-up visit allows doctors to assess if there are any lingering or new symptoms or complications from the infection and gives pediatricians the chance to discuss the COVID-19 vaccination,” Resin said in a statement. “Importantly, pediatricians are able to check for mental health and cognitive/learning issues and recommend the appropriate supports for children returning to daily life as seamlessly as possible.”

According to the AAP, if concerns about long COVID persist after 12 weeks, additional diagnostic testing and/or referral to a multidisciplinary post-COVID-19 clinic may be appropriate.

During the follow-up visit, providers should take note of ongoing or residual issues, including:

• Respiratory: Because the lungs are the most commonly affected organ in COVID-19 cases, persistent respiratory symptoms are common. Symptoms include chest pain, cough and exercise-induced labored breathing.
• Cardiac: The risk for heart problems, including myocarditis, is a concern. Symptoms of myocarditis can include chest pain, shortness of breath, arrhythmias and fatigue.
• Cognitive fogginess or fatigue: “Brain fog” (a generic term that refers to unclear or “fuzzy” thinking, inattention, difficulty with concentration or memory) is a frequent neurologic complaint in adults after COVID-19 infection. School aged-children and adolescents may have similar complaints.
• Physical fatigue: Children and adolescents may complain of fatigue and poor endurance, even without known cardiac or respiratory symptoms. Assuming both cardiac and respiratory function are clinically normal, post-viral fatigue typically improves over time.
• Mental/behavioral health: Clinicians should be aware of the impact of stress and adjustment disorders when diagnosing and managing new symptoms in children who have had COVID-19.

“It’s important for pediatricians to carefully consider other conditions, including multisystem inflammatory syndrome in children and myocarditis,” Risen said. “Patients and families also should be instructed about signs and symptoms that require further evaluation.”

References:

AAP. Post-COVID conditions in children and adolescents. Post-COVID-19 Conditions in Children and Adolescents (aap.org). Accessed August 2, 2021.