Long COVID syndrome in children and adolescents

Posted on by Jesse Santiano, M.D.

This article is about the meta-analysis that included 80,071 children and adolescents that shows how many children and teenagers have the Long COVID syndrome and their most common symptoms.

The study is eye-opening because it shows that Long COVID symptoms in children are different from those of adults.

The World Health Organization defines Long COVID syndrome in individuals with probable or confirmed SARS-CoV-2 infection history. The symptoms usually start three months from the onset of COVID-19, last for at least two months, and cannot be explained by an alternative diagnosis.[1]

Symptoms may persist from the initial illness or may happen following initial recovery from an acute COVID19. The symptoms could fluctuate or go away but return over time.

Prevalence of Long COVID in children and teenagers

The pediatric meta-analysis showed that 25.24% of children and teenagers who recovered from COVID-19 have Long COVID. Long COVID is the presence of one or more symptoms following a SARS-CoV-2 infection.[2]

The most common clinical manifestations of Long COVID in children and teenagers were:

  1. Mood symptoms (e.g., sadness, tension, anger, depression, and anxiety) – (16.50%)
  2. Fatigue (9.66%)
  3. Sleep disorders (e.g., insomnia, hypersomnia, and poor sleep quality) (8.42%)
  4. Headache (7.84%)
  5. Respiratory symptoms (7.62%)
  6. Sputum production or nasal congestion (7.53%)
  7. Cognitive symptoms (e.g., less concentration, learning difficulties, confusion, and memory loss) (6.27%)
  8. Loss of appetite (6.07%)
  9. Exercise intolerance (5.73%)
  10. Altered smell (e.g., hyposmia, anosmia, hyperosmia, parosmia, and phantom smell) (5.60%)

Children infected by SARS-CoV-2 had a higher risk of persistent shortness of breath, loss of smell (anosmia), or taste (ageusia), and fever than those who did not have COVID-19.[2]

The figure below shows the most common Long COVID symptoms in children and teenagers.

From: Long-COVID in children and adolescents: a systematic review and meta-analyses

The most frequent Long COVID symptoms in adults were fatigue, shortness of breath, and cognitive dysfunction.[1]

Risk factors for Long COVID

The pediatric population’s risk factors associated with long-COVID:

  1. Older age
  2. Female gender
  3. Severe COVID-19
  4. Overweight/obesity
  5. Comorbid allergic diseases
  6. Other long-term comorbidities]

The most significant risk factor that is modifiable is being overweight. Here are some tips from the National Institute of Health if your child is overweight.

Protective factors against Long COVID

The protective factors leading to milder severity and duration of COVID-19, and possibly also long-COVID in children, include:

  1. Fewer comorbidities
  2. Strong innate immune responses – Harvard’s Boosting your child’s immune system
  3. Reduced expression of angiotensin-converting enzyme-2 (ACE2) receptors – younger children have fewer ACE2 receptors because their sinuses are less developed. I talked about that in my piece, Children 0-11 Years Old get mild COVID-19 and have a low risk of dying.
  4. Active thymic function – leads to the increased presence and decreased depletion of T cells. The thymus gland is in front of the thyroid and produces the T cells. As the child grows, the thymus gets smaller.
  5. Vaccination history
  6. Past infections
  7. Adequate nutrition – Mayo Clinic Guidelines for a healthy diet
  8. A healthy gut microbiome – How to Boost Your Child’s Microbiome

Parting thoughts

If your child develops new symptoms after COVID, ask their pediatrician if Long COVID may be possible. Yale and the Children’s Hospital of Los Angeles have specialized Long COVID care for children.

Your local hospital may already have one.

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Related:

  1. SARS-CoV-2 variants and Long COVID syndrome
  2. SARS-CoV-2 brings out an endogenous retrovirus protein to cause severe COVID-19 and Long COVID syndrome
  3. Persistent inflammation explains Long COVID syndrome
  4. The I-RECOVER Management Protocol for Long Haul COVID-19 Syndrome
  5. Asymptomatic or mild symptomatic COVID-19 elicits effective and long-lasting antibody responses in children and adolescents
  6. USA study: Adults and children with the Omicron variant have milder COVID-19
  7. COVID-19 infections among infants: Symptoms and who gets hospitalized
  8. USA study: Adults and children with the Omicron variant have milder COVID-19
  9. COVID-19 in children 0-17 years old has low risk of death and hospitalization
  10. Children 5-11 Years Old have Mild COVID-19

Reference:

  1. A clinical case definition of the post-COVID-19 condition by a Delphi consensus, October 6, 2021
  2. Lopez-Leon, S., Wegman-Ostrosky, T., Ayuzo del Valle, N.C. et al. Long-COVID in children and adolescents: a systematic review and meta-analyses. Sci Rep 12, 9950 (2022). https://doi.org/10.1038/s41598-022-13495-5

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