Long COVID in Children and Adolescents Research
Researchers are investigating why some people experience lasting symptoms after recovering from COVID-19 – a condition called long COVID. It’s estimated that 65 million people in the world have long COVID, with more being diagnosed each day.
But most of this research has only studied adults. Do children and teenagers also get long COVID?
Unfortunately, the answer is yes — even young children can have lasting effects from COVID-19. A new study co-led by Mass General Brigham investigators found common patterns of lasting symptoms in school-age children and adolescents who previously were infected by SARS-CoV-2, the virus that causes COVID-19.
In JAMA, they report children and teens had prolonged long COVID symptoms in almost every organ system, and most had multiple symptoms affecting more than one system. The researchers also designed an index to identify children and adolescents who are most likely to have long COVID, finding that common symptoms were similar, yet slightly different between the two age groups. This index is intended for use in research studies, not clinical diagnosis.
“The symptom patterns we observed tell us we should study and evaluate long COVID differently depending on the child’s age,” says Andrea Foulkes, ScD, a Mass General Brigham biostatistician and co-senior author on the study. “The index used for this study is the first step toward a clinical tool that will help us diagnose, and eventually treat, long COVID in children and teenagers.”
Dr. Foulkes and Tanayott Thaweethai, PhD, a Mass General Brigham biostatistician and co-first author on the study, explain the index and their findings.
What is long COVID?
Long COVID, also known as postacute sequelae of SARS-CoV-2 infection (PASC), are signs, symptoms, and conditions that can occur over time in people who were infected by COVID-19. Those symptoms can develop after someone recovers from the initial infection. Or they may be symptoms that occurred during the infection that have since relapsed, or have continued to persist for weeks, months, or years afterward.
The effects of long COVID can be mild, but they can also severely impact a person’s daily life and ability to complete normal tasks. Long COVID symptoms in adults often include worsening of symptoms after physical or mental exertion (called post-exertional malaise), brain fog, intense fatigue, persistent coughing, and loss of smell or taste.
A research initiative funded by the National Institutes of Health (NIH), called RECOVER (Researching COVID to Enhance Recovery), seeks to understand the long-term effects of COVID-19 and identify strategies to prevent and treat long COVID. The RECOVER initiative has also identified a cohort of children aged 0 to 25 years old, called RECOVER-Pediatrics, to study the condition in children.
Studying long COVID in children and adolescents
Most long COVID research has only studied adults, so Dr. Foulkes, Dr. Thaweethai, and colleagues set out to understand if the condition affects young children and teenagers differently.
They analyzed data from the RECOVER-Pediatrics cohort, which included symptoms in children aged 6 to 17 that were reported by their caregivers. The researchers note that this was the first data-driven study of the differences in long COVID symptoms among school-age children (6-11 years old) and adolescents (12-17 years old).
Their study identified patients from across the United States, including 751 school-age children who had been infected by SARS-CoV-2 previously and 147 who were not, as well as 3,109 infected and 1,369 uninfected adolescents.
The researchers recorded prolonged symptoms that were present across all patients and narrowed the list down to only include those that were found in at least 5% of patients who had been infected with COVID-19. They then used statistical techniques to identify which of those symptoms were the most predictive of long COVID.
Common long COVID symptoms in children and teenagers
The researchers created a PASC index, or measurement tool, that included the symptoms most likely to predict long COVID in children and adolescents. They identified 10 symptoms in school-age children and 8 symptoms in teenagers, with some overlap between the two age groups.
These were the most predictive symptoms of long COVID found in both school-age children and adolescents:
For children aged 6-11, other unique predictive symptoms included:
- Stomach pain
- Phobias, or fear of specific things
- Refusing to go to school
- Itchy skin or rash
- Trouble sleeping
- Nausea or vomiting
For adolescents aged 12-17, other unique predictive symptoms were:
- Change in or loss of smell and/or taste
- Body, muscle, or joint pain
- Daytime tiredness, sleepiness, or low energy
- Tired after walking
While most patients in the analysis had multiple symptoms occurring at the same time, the authors acknowledge that even just one symptom could be enough to indicate long COVID.
The effects of long COVID in children
Using their PASC index, the researchers estimate that in the RECOVER-Pediatrics cohort, 20% of the school-age children who previously had COVID-19 and 14% of the previously infected teenagers most likely had long COVID. These results, along with similar findings from another study published in Pediatrics, indicate that more children may have long COVID than the Centers for Disease Control and Prevention (CDC) reported as of 2022.
Even more troubling, Dr. Thaweethai adds that, “The children and teenagers with the most symptoms and the most organ systems affected were associated with poorer overall health and quality of life. This attests to the significant impact long COVID can have on children’s lives.”
What should I do if my child or teenager might have long COVID?
If you think your child might have long COVID, talk to their pediatrician or primary care provider (PCP). While there isn’t a way for doctors to test for long COVID, they can help you and your child better understand what’s going on and help them cope with their symptoms.
The PASC index from this study can’t be used in clinical settings at this time, but it’s helpful for doctors to know that long COVID symptoms can be different between younger children and adolescents.
“A significant finding from this study was that common symptoms could be different between the two age groups,” says Dr. Thaweethai. “That tells us we should look at long COVID differently in school-age children versus adolescents.”
How can my family avoid long COVID?
If you reduce your chances of getting COVID-19, you reduce your chances of getting long COVID.
There are steps you can take to help reduce your chances of getting or spreading COVID-19 and other respiratory viruses, like the flu and respiratory syncytial virus (RSV). Here’s what you can do:
- Stay up to date with your vaccines, including the COVID vaccine and annual flu shot.
- Practice good hand hygiene.
- When you have a respiratory virus, take precautions to prevent spread. The CDC is a great resource for the latest guidance on respiratory viruses.
“Studies like this one show how important it is to study this complex condition across multiple age groups,” say Dr. Foulkes. “The PASC index can help us track long COVID persistence and recovery in children, so we can begin to treat it more effectively.”
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