A large analysis published Wednesday in the journal Pediatrics underscores the toll long Covid can take on children, in some cases leading to neurological, gastrointestinal, cardiovascular and behavioral symptoms in the months after an acute infection.
“Long Covid in the U.S., in adults and in kids, is a serious problem,” said Dr. Ziyad Al-Aly, chief of research and development at the V.A. St. Louis Health Care System and a clinical epidemiologist at Washington University in St. Louis, who studies the condition but was not involved in the new report. He said that the paper, which drew on numerous studies of long Covid in children, is “important” and illustrates that the condition can affect multiple organ systems.
The new review suggested that 10 to 20 percent of children in the United States who had Covid developed long Covid. However, Dr. Suchitra Rao, a pediatric infectious disease expert at Children’s Hospital Colorado and co-author on the paper, acknowledged that there are “lots of caveats” with the prevalence estimates used to arrive at that number. For example, some of the studies included looked only at the very small percentage of children who were hospitalized for Covid. Like adults, children who had more severe cases of Covid have a greater risk of lingering symptoms or new complications.
The Centers for Disease Control and Prevention puts the prevalence of long Covid closer to 1 percent of children who have had Covid. (The estimate in adults is 7 percent.)
Generally speaking, most parents should not be worried that their children will develop long Covid, said Dr. Stephen Freedman, a professor of pediatrics and emergency medicine at the University of Calgary Cumming School of Medicine. “I don’t get asked a lot, if at all, about ‘Is my child now at risk of developing long Covid?’ after we diagnose them with an acute infection,” he said. “And I think that’s appropriate.”
What does long Covid look like in kids?
Long Covid can be challenging to study in part because it is difficult to diagnose, as the symptoms are so wide-ranging. Making a diagnosis is perhaps even trickier in children because symptoms may present differently from how they appear in adults. Young children also may not have the language to describe what they’re feeling, so researchers advised parents to look for changes in behavior.
Fatigue, brain fog and headaches are among the most frequently reported symptoms of long Covid in children. While these issues are sometimes on the mild end of the spectrum, they can prevent kids from participating fully in school or recreational activities. Young children may also act out, frustrated that they can’t easily do what they used to. Most symptoms improve within a year, experts said, but for some children they can persist for longer.
It’s still not clear what the long-term impact of these prolonged symptoms may be 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 lingering respiratory and cardiovascular problems, including the heart condition myocarditis. Diabetes and other autoimmune disorders can also emerge on the heels of a Covid infection, though these “tend to be much, much less prevalent in kids” than more mild symptoms, Dr. Al-Aly said.
Persistent and severe symptoms can emerge even in children with mild infections, said Dr. Sindhu Mohandas, an infectious disease specialist at Children’s Hospital Los Angeles.
That was the case for Lucas Denault, whose initial brush with Covid in 2021 didn’t include much beyond a stuffy nose. Lucas, then 15, recovered and went back to school, track practice and student council meetings. But months later, he started struggling to walk down the halls of his high school in Littlestown, Pa. His head and chest ached. He felt dizzy and nauseated.
“It was just such a quick downfall,” said his mother, Karin Denault. Neither Lucas nor his mother had considered that his issues could be linked to his brief bout of Covid. But at the recommendation of a relative, he went for an evaluation at the Kennedy Krieger clinic in Baltimore. There, he was diagnosed with long Covid and with postural orthostatic tachycardia syndrome, a cluster of symptoms that lead to extreme fatigue and can occur among people with long Covid.
What treatments are available?
There are no drugs approved to treat long Covid, so doctors focus on managing symptoms and helping patients function day to day. Some doctors will prescribe medications to address issues like headaches and muscle pain.
Dr. Mohandas, who was also involved in the research review, said that much of the work she and other clinicians do revolves around validating the experiences of these young patients. Many “had previously been very healthy, so frequently, everyone tends to doubt their symptoms,” she said.
Dr. Malone said that schools should make accommodations for children who are struggling, including breaks during the day and extra time for tests.
Small changes helped Lucas. It was difficult for him to push himself out of bed, for example, so he started sleeping upright to make it easier. At his doctor’s suggestion, he sometimes dangled his feet off the bed and spelled his name with his toes to improve blood flow. His doctor also prescribed several medications, including a blood pressure drug, to help manage symptoms like fatigue and brain fog.
Lucas is now a freshman at Princeton, and most of his symptoms have improved. When he was touring colleges, his mother often had to push him in a wheelchair. Last weekend, she came to campus to watch him play club basketball.