While there’s been a lot of attention paid to long COVID-19 in adults, many parents don’t realize that this condition can also impact younger patients. About 4 percent of children under the age of 14 experience symptoms of long COVID about a year after their initial infection, a June 2022 study published in The Lancet found.
“While that might not seem like a lot, it’s important to remember that almost 15 million children have tested positive for COVID-19 since the start of the pandemic,” says Amy Edwards, M.D., medical director of the pediatric COVID recovery clinic at UH Rainbow Babies and Children’s Hospital in Cleveland, Ohio. “That means that potentially hundreds of thousands of kids have long COVID.”
Here’s what parents need to know about the long-term effects of COVID, including why some kids get it and the symptoms to watch for.
What is long COVID?
Most people — both adults and kids — who get COVID-19 recover completely within three to four weeks. But sometimes, patients experience symptoms beyond that, even if they test negative for the virus. This is known as long COVID, or post-COVID conditions.
Since long COVID is such a new condition, doctors still don’t know much about it. They’re also working hard to understand why some children who get COVID-19 bounce back quickly, while others go on to develop long COVID that can last for months, if not longer.
One theory behind long COVID is that COVID itself causes an auto-immune response where the body goes into overdrive and attacks itself. Another is that there’s lingering virus in the body.
Long COVID is also different from multisystem inflammatory syndrome in children (MIS-C), a rare inflammatory condition that affects some children two to six weeks after an initial COVID-19 infection.
Long COVID symptoms in kids
Long COVID symptoms in kids include:
- GI symptoms, including loss of appetite, constipation, diarrhea and nausea, affect upwards to 70 to 80 percent of kids with long COVID, Dr. Edwards says. This is similar to what doctors see in MIS-C, she notes, most likely due to the viral persistence of COVID-19 in the digestive tract.
- Excessive fatigue, called post-exertional malaise, can cause kids to crash if they push themselves too hard, either physically or emotionally.
- Brain fog, which is trouble thinking and concentrating.
- Weight loss, usually due to a persistent loss of smell or taste that can make toddlers become especially picky eaters.
- Anxiety, which may stem from having symptoms of long COVID or be unexplained.
- Shortness of breath
- Inability to tolerate strenuous exercise
- Chest tightness
- Unexplained fevers
- Hair loss
Common symptoms also vary by age, according to a June 2022 study published in The Lancet Child & Adolescent Health. The study found that infants and toddlers mainly experienced mood swings, rashes and stomach aches, while older children experienced memory and concentration problems as well as mood swings and fatigue.
But these symptoms may still be present in younger children who aren’t able to verbalize them, says Dr. Edwards. That’s why it’s important to look for more subtle cues, like your toddler getting frustrated with an activity they usually enjoy, like building with blocks.
Diagnosing long COVID can be challenging in kids, since some may have been asymptomatic when they contracted the virus and were never diagnosed. Doctors sometimes have to look closely at a child’s family history to see whether there were any known virus exposures.
Antibody tests can indicate a past COVID infection, too. (There are tests that distinguish between antibodies from the COVID-19 vaccine and antibodies from actual exposure to the virus.)
If you suspect long COVID, it’s a good idea to get your child evaluated at a long COVID clinic, as they can run various tests to rule out other medical conditions that can cause similar symptoms, advises Dr. Edwards.
Why do some kids get long COVID?
There’s no rhyme or reason as to why some kids get long COVID and others don’t. But a July 2022 study published in the journal JAMA Network Open reveals some clues. The researchers found that nearly 6 percent of children who showed up at the ER with COVID-19 reported symptoms of long COVID about three months later. Patients were more likely to develop long COVID if they had one of the following:
- Hospitalization for at least 48 hours
- Four or more symptoms at their ER visit
- Age 14 or older
- Being female
- Having severe COVID-19
- Being overweight or obese
- Having allergies
Although research suggests teens are more likely to get long COVID than younger kids, that doesn’t mean babies and toddlers are invulnerable, stresses Dr. Edwards.
“They may be experiencing symptoms of long COVID, but don’t have the language yet to express how they feel,” she explains.
Kids are also more likely to develop long COVID after a second infection, Dr. Edwards adds. “Oftentimes, the child will have had COVID, recover and then a few weeks later get sick again with another virus or strep,” she explains. “It seems like it’s that second insult that pushes them over the edge.”
How common is long COVID in kids?
New research suggests that it’s as common in kids as it is in adults. Kids and teens with COVID were 30 percent more likely to experience long COVID symptoms three months or more after their infection compared to those who didn’t get COVID — similar to what’s seen in adults, a November 2022 study published in PLOS Medicine found.
Long COVID is probably more common than both doctors and parents realize, says Gina Posner, M.D., a board-certified pediatrician practicing at MemorialCare Medical Group in Fountain Valley, California, and a What to Expect Medical Review Board member.
“Unfortunately, I have a lot of kids in my practice who come in with complaints of feeling winded walking upstairs, or are exhausted, or have constant headaches after having had COVID-19 two to three months earlier,” she explains. “In my mind, it’s no coincidence that these symptoms started up a few weeks after they recovered from COVID, especially if we run a bunch of tests that come back normal. But parents often find it hard to believe because their child initially barely had any symptoms with COVID-19.”
Long COVID treatment
There’s no cure for long COVID since doctors aren’t exactly sure what causes it. But there are treatments available to help with different symptoms. After your child is evaluated at a long COVID clinic, you’ll likely be referred to different specialists. These may include:
These doctors can all work with you and your child to come up with a treatment plan. For example, if your little one becomes short of breath when they are active, a cardiologist may do a heart workup, and a pulmonologist may do breathing tests to check oxygen levels. If both are normal, then the doctors may recommend physical therapy and/or a home exercise program to get your child back up to speed.
You may wonder how long post-COVID conditions last in kids. The good news is most kids with long COVID tend to get better and usually make a full recovery, reassures Rajeev Fernando, M.D., an infectious diseases specialist and a What to Expect Medical Review Board member. “We don’t see the damage to organs like the heart, liver and lungs that we see in adults,” he explains.
If you do suspect that your little one has long COVID, it’s important to listen to your instincts and if your pediatrician dismisses your concerns, find a long COVID clinic near you.
Remember, also, the best way to protect kids against long COVID is to make sure they are fully vaccinated against the virus, including getting the updated COVID booster. Vaccination itself was found to reduce the risk of developing long COVID, according to an August 2022 review published in The Lancet.
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