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What is “Long COVID” in Children and Adolescents?

July 24, 2023

We hear a lot in the news about “long COVID,” but mostly in adults. What can we say about long COVID in children and adolescents? Does it even exist?

Authors from 4 institutions in Canada, China, the Netherlands, and Pakistan, led by Dr. Li Jiang and Xuan Li, conducted a systematic review of 31 studies and 15,000 patients to characterize symptoms lasting for at least 3 months after a COVID-19 infection in the pediatric population. This article, entitled “A Systematic Review of Persistent Clinical Features After SARS-CoV-2 in the Pediatric Population,” is being early released this week by Pediatrics (10.1542/peds.2022-060351).

First, it’s important to note that there is a lot of variability in how these 31 studies were done:

  • Some studies included only patients who were hospitalized and were diagnosed with COVID-19 infection; others also included patients who had not been hospitalized
  • Some studies got their information from in-person clinical encounters, while others did so from surveys or telephone interviews

None of the studies were population-based, so we cannot accurately estimate the proportion of children and teenagers who have prolonged symptoms after a COVID-19 infection.

Also, few of the studies had control groups, so we cannot say if some of the symptoms (for instance, mood disorders) were associated with the COVID-19 infection or with pandemic-associated events, such as school closures and absence of in-person get-togethers.

The authors found that more than 20 symptoms lasting for at least 3 months were documented.  The most commonly documented were sore throat, persistent fever, sleep disturbance, fatigue, and muscle weakness.

However, we do not get much more information than a listing of symptoms. While the analysis indicated that females were more likely to have sleep problems and headaches, we do not get any other descriptors, such as age, that give us a clue as to who might be at higher risk for having persistent symptoms. Some of the symptoms, such as difficulty with concentration – or mental fog, which have been described in many adults, were not commonly described in this pediatric population. I wonder if this is because many of these symptoms were parent-reported, and particularly in younger children, symptoms such as fever would be more easily noticed.

I’m sure that more will be published in the coming months and years about persistent symptoms after COVID-19 infection. This article is just a snapshot of what to expect. Even so, it may help to validate family concerns when a child has persistent symptoms.

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