Long COVID impacts millions of children with symptoms that vary by age

Millions of children are suffering from long COVID, the lingering post-viral illness that follows SARS-CoV-2 infection and can last weeks, months or even years. But while a lot is known about post-infection effects in adults, children have been somewhat lost in the follow-up.
That has led some to conclude that it’s either rare in kids or similar to that in adults. Now a new study just published in JAMA said that’s an incorrect assumption that can lead health care providers to miss symptoms or misdiagnose cases in kids.
In truth, symptoms of long COVID in children are both similar and different than in adults — and it varies by the ages of the kids, too, with differences and overlap between schoolchildren ages 6 to 11 and adolescents ages 12 to 17.
The National Institutes of Health’s Researching COVID to Enhance Recovery (RECOVER) Initiative looked at children to understand the impact of lingering symptoms and offer some guidance to help recognize post-infection illness. It also teamed up with the Clinical Science Core at NYU Langone Health to develop an index to identify youths most apt to have long COVID.
The consequence of long COVID in children is consequential. Sometimes, the researchers wrote, the post-viral illness is debilitating, making it hard for grade-school children and adolescents to go to school, participate in extracurricular activities or enjoy time with family and friends.
What’s clear, the study found, is that lingering symptoms can impact any organ system in both age groups. And understanding the effect of long COVID on what’s believed to be nearly 6 million children matters, researchers said.
“Children aren’t just little adults,” Dr. Melissa Stockwell, the study’s co-author and division chief of child and adolescent health at Columbia University, told USA Today, which noted that the “more providers understand how long COVID impacts people at different ages, the easier it will be to diagnose children and provide prompt care.”
The research included 751 COVID-19 infected and 147 uninfected school-age children, along with 3,109 infected and 1,369 uninfected adolescents at more than 60 health care institutions across the United States. In the uninfected group, antibody testing was done to ensure participants had not had COVID-19, as some cases are asymptomatic.
Caregivers who reported on their children’s health pondered 74 prolonged symptoms. One of those, panic attacks, was assessed in adolescents, but not grade-school-age children. The analysis was age-stratified.
Forty-five percent of the infected and 33% of the uninfected school-age children had at least one prolonged symptom. For adolescents, the numbers were 39% of the infected and 27% of uninfected adolescents. A single symptom can indicate long COVID, the researchers said, though those with more symptoms and more serious symptoms have the hardest time.
They identified 26 symptoms in infected school-age children and 18 symptoms in infected adolescents that lasted in at least 5% of the young study participants after acute illness passed. Of those, 10 symptoms in the young group and eight among adolescents were most associated with infection history. In both groups, a higher post-viral-infection symptom score was correlated with poorer overall health, quality of life and physical health.
For the adolescents who had the lingering symptoms associated with long COVID, the most common were tiredness, sleepiness or low energy (80%), muscle or joint pain (60%), headaches (55%) and trouble with memory or focusing (47%).
Among school-age children, four symptom clusters were identified, while there were three in the adolescent group. The researchers said that suggested there may be different types of long COVID experience among children.
For the younger children, the first cluster had high rates of many symptoms. The second featured high rates of headache (95%), body/muscle/joint pain (60%) and daytime tiredness/sleepiness or low energy (52%). The third cluster included a lot of trouble sleeping (64%) and memory/focusing problems (62%). The fourth cluster was primarily stomach pain (100%) and nausea/vomiting (61%), per the report
Among adolescents, the first cluster was similar to that of the younger group, with high rates of many symptoms. The second included high rates of daytime tiredness/sleepiness or low energy (89%) and body/muscle/joint pain (87%). The third group experienced change or loss in smell or taste (100%), with relatively low rates of all other symptoms.
Across groups, trouble sleeping (47%), feeling anxious (47%) and feeling sad/depressed (38%) were most common, but because they were common among both those who’d had COVID-19 and those who had not, they were not considered post-viral symptoms.
The researchers found that even those with asymptomatic COVID-19 could have long COVID symptoms, though in smaller numbers. They also found quite a bit of overlap in symptoms between adolescents and adults, with less overlap between adults and the younger group of children.
According to NBC News, “The findings align with what doctors are observing in long COVID clinics, said Dr. Amy Edwards, director of the pediatric COVID recovery clinic at UH Rainbow Babies and Children’s Hospital, who wasn’t involved in the new research.”
Edwards recounted for NBC the story of children who’d “dropped out of school, dropped out of all their extracurricular activities and are barely functioning.” Others, she said, go to school but their grades are slipping and some who were successful students in the past are “really struggling to pass.”
Some of the children have faced adult skepticism, she added. “School nurses were mocking them for faking it. These are teenagers and kids and people are telling them to their face that there’s nothing wrong with them.”
The researchers emphasized that the index scoring system they created is not intended to be used in clinical practice to diagnose long-term COVID-19 symptoms — or to rule it out.
The researchers did note some study limitations. Similar symptoms could be related to other conditions. There’s no way to quantify population prevalence. Also, because a positive antibody test wasn’t required to be counted as having been infected with COVID-19, some folks may have been misclassified. And the study relied on caregivers’ memories, too, which might be accurate to differing degrees.