Although COVID-19 in children has generally been milder than in adults, there are concerns that long COVID could be a major consequence of the pandemic for children and young people.
Long COVID, also known as the “post-COVID condition,” is an umbrella term for a range of symptoms that can persist for months after the initial acute phase of COVID. Long COVID can include fatigue, post-exercise malaise, sleep disturbances, cognitive difficulties, pain, anxiety and depression. These symptoms can affect people of all ages, including children.
Recognition and support from healthcare professionals is important in recovering from long COVID. Identifying it early and implementing management strategies can prevent symptoms from becoming entrenched and prevent larger problems in the future.
What does long COVID look like in children?
Defining long COVID has been difficult due to varied symptoms and time frames that make consistent characterization and comparison of the disease difficult.
A review of extensive research on COVID in children found that mood symptoms, fatigue and trouble sleeping were the most commonly reported symptoms. In total, more than 40 symptoms were included, ranging from mental health symptoms to gastrointestinal, cardiac and respiratory symptoms.
However, many studies of long COVID did not have a control group (i.e., comparisons with children who did not have COVID), making it difficult to distinguish between symptoms of long COVID. Long COVID and the indirect impacts of the pandemic on children.
For example, high rates of depression and anxiety have been observed in children, likely linked to the effects of lockdowns, school closures and social isolation. These conditions share many characteristics with long COVID and complicate the interpretation of research on this disease.
More recent studies including a control group identified only a very small increase in long COVID symptoms after mild COVID infection, compared to those who tested negative. This potentially means that long COVID in children is quite rare.
What we see in our children’s COVID clinic
Our COVID follow-up clinic at the Royal Children’s Hospital Melbourne operated from mid-2020 to mid-2023. We have seen over 600 children throughout this period.
In our experience, most children make a full recovery from COVID, similar to other viruses.
A small proportion experience prolonged symptoms, including fatigue, post-exercise malaise, difficulty concentrating and pain. These symptoms are similar to other post-viral syndromes such as chronic fatigue syndrome (also known as myalgic encephalitis), of which viruses are a common precursor. Some patients we saw met the criteria for chronic fatigue syndrome following their COVID infection.
Another group of children in our clinic developed physical symptoms, such as headaches and chest pain. But most of these children had normal test results, which is reassuring. However, symptoms can still impact daily functioning, such as participation in school and other activities.
How long does it last?
Recognition and support for children with prolonged COVID symptoms is often delayed. Children and families report feeling unheard or misunderstood by others, including health care providers.
It’s difficult to live with the uncertainty of not knowing how long symptoms will last.
In our experience with long COVID, most children experience a full recovery or significant improvement three to six months after infection.
The impact on operation is generally minimal. However, there have been rare serious cases, with more debilitating fatigue impacting school attendance and activities. These patients are usually diagnosed with chronic fatigue syndrome and managed accordingly.
How is long-term COVID-19 in children managed?
Children and families feel frustrated because there is no specific treatment or cure.
Although trials are underway in adults, there are no drugs or cures available for long COVID.
The Australian Government has announced $50 million for long COVID research, which will open up new avenues of support and treatment.
The currently recommended approach to managing long COVID in children is based on the recognized management of chronic fatigue syndrome.
This approach may involve a range of healthcare professionals, including GPs, pediatricians, physiotherapists, exercise physiologists and psychologists, depending on the needs of the child. They help the patient get used to managing daily tasks such as going to school, exercising or participating in activities, taking into account the amount of energy they have at each stage to avoid Professional exhaustion.
Symptoms such as sleep disturbances, dizziness and cognitive difficulties can be managed with lifestyle modifications such as sleep hygiene practices (going to bed at the same time, no screens before bed) or medications.
It is important that activities continue, at a level appropriate to the patient’s stage of recovery. This includes school and social outings.
While there is no cure for long COVID yet, self-management and trying to minimize secondary impacts such as missing school are key to preventing mental health issues and physical deconditioning (the body’s getting used to doing less).
I think my child has long COVID, what should I do?
It is important to see a doctor if COVID-related symptoms, such as fatigue, persist for more than four weeks. A check-up with your GP or pediatrician is a good place to start if you have concerns for your child.
Shidan Tosif is Honorary Clinical Associate Professor at the University of Melbourne. This piece first appeared on The conversation.
This article was co-authored by Colette Reveley and Eva Sudbury, pediatricians in the Department of Adolescent and General Medicine at the Royal Children’s Hospital, Melbourne.