Long COVID + Children

Mar 16, 2022

Although children often have less severe COVID-19 infections and Long COVID appears to be less common in children, Long COVID can affect any person infected with COVID-19, regardless of age. Long COVID research studying the impact in children and adolescents is still limited. We previously posted an article summarizing research about Long COVID among children. This article provides an update of recent literature on the topic.

What are symptoms of Long COVID in children?

A recent review found that children with Long COVID often displayed common symptoms such as fatigue, headache, and sleep disturbances. Studies also found a wide range of symptoms including otolaryngologic (i.e., anosmia), cardiovascular (i.e., palpitations and chest tightness), pulmonary (i.e., cough), gastrointestinal (i.e., nausea, abdominal pain), neurologic and psychiatric. One report from the UK found that among primary school students, having at least one probable mental disorder was more likely among students with Long COVID than those without. However, the relationship was not significant among secondary school students.

Are some children more likely to be affected by Long COVID?

There is not yet a clear understanding of why some children may be more affected by Long COVID and presently no known pathophysiologic reasons to explain why some children may be at increased risk. Recent studies suggest that females may be at higher risk of Long COVID. One study in Denmark of adolescents, including 6,000 that tested positive for COVID-19 and over 21,000 matched controls, found that more female than male participants had symptoms lasting more than two months in both the case and control groups. Another study of household exposures, which has not been peer reviewed, found that infected adolescent girls had more moderate or severe persistent symptoms than the exposed, uninfected female adolescents. However, there was no difference in persistent symptoms one year later between infected and exposed male adolescents and no difference between infected and exposed children under 14 years of age, suggesting that male adolescents and younger children may be less impacted. The study also found an association between prolonged symptoms in individuals and prolonged symptoms in other household members and found that the risk for an individual experiencing an additional moderate or persistent symptom increased for every moderate or severe persistent symptom among household members. Therefore, the authors suggest that family-level approaches to Long COVID may be considered.

What are other effects of Long COVID on children?

In addition to the physical symptoms of Long COVID, children affected by persistent symptoms may also have difficulties returning to school and adjusting to their routines prior to their illness. The study out of Denmark found that the case group of those infected with COVID-19 had more sick days and days of school absence than the control group. Children who develop Long COVID may find that their symptoms pose challenges when they return to school and may need accommodations such as extra time on assignments or flexible schedules. Interestingly, the same study above also found that while the case group had more long-lasting symptoms, the control group had more short-lasting symptoms and reported worse quality of life than the case group. While the authors comment that the differences in quality of life may not be clinically relevant as only small, clinically significant effect sizes were found for emotional and social outcomes, it suggests potential effects of the pandemic on all children, regardless of infection status, possibly due to daily restrictions and fear of infection.

The pediatric population has not been a major focus of research since infections tend to be less severe in this age group; however, more research is needed on the impact of Long COVID in children. With a large portion of children still unable to be vaccinated, new waves of infection result in increases in cases in unvaccinated individuals, including children. Therefore, it is important to understand the potential long-term effects in the pediatric population, including on physical and mental health as well as school and daily activity functioning.

For inquiries related to the Long COVID Initiative, please contact long_covid_initiative@brown.edu