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Dec 08, 2023

What Long COVID Looks Like in Kids

Long COVID — an umbrella term for symptoms that linger or develop after someone

Long COVID — an umbrella term for symptoms that linger or develop after someone recovers from COVID-19 — is one of the biggest mysteries currently facing the healthcare industry.

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Doctors and researchers are still trying to figure out why some people experience fatigue or breathlessness, or more serious conditions like heart issues, for weeks or months after having COVID-19.

"We really don't know where long COVID comes from," says pediatrician Kimberly Giuliano, MD, adding that doctors are working on different theories to explain it.

"It might be the amount of virus that somebody had in their system, their overall health, underlying genetics or health habits," she says. "Long COVID is probably a combination of all of those factors, which is why it's a little bit hard to pinpoint exactly what the cause is or preventing it. We can't change our genes."

Kids can also experience long COVID symptoms. Dr. Giuliano says the most common ones seen in children include:

But one of the most challenging factors for parents and caregivers is that symptoms like these could signal something else is wrong that has nothing to do with COVID-19.

"For example, a cough could be from COVID or it could be from a new illness," says Dr. Giuliano. "Or it could be from another symptom or problem in its entirety.

"It's the same thing with mood disturbances or difficulty concentrating," she continues. "These are really common challenges that children who have — and haven't — had COVID can experience at any point in their life."

Dr. Giuliano says the above symptoms associated with long COVID are reported in "roughly about 25% of children who have had COVID," although she notes that studies "really vary in the number and frequency of the symptoms" they’ve found.

"Some children will have long COVID symptoms for several weeks or several months," says Dr. Giuliano. "And then there are children that do appear to be having symptoms for much longer than that. The exact frequency is difficult to estimate. We just don't have a lot of data around all of that."

Both children and adults can experience long COVID symptoms or conditions, although researchers are still trying to determine how these symptoms differ across different age groups.

The U.S. Centers for Disease Control and Prevention (CDC) publishes and updates a lengthy list of long COVID symptoms of conditions in adults. They’re also posting studies and up-to-date research around children's long COVID symptoms as well. For example, an August 2022 report published by the CDC found that kids who had COVID-19 were "significantly more likely" to have symptoms such as "smell and taste disturbances, circulatory signs and symptoms, malaise and fatigue, and musculoskeletal pain."

However, this study was conducted between 2020 and early 2022, before kids could get vaccinated against COVID-19. "There is data that shows that people who have been vaccinated are less likely to have symptoms of long COVID than people who have not been vaccinated," notes Dr. Giuliano. "And that holds true for children as well as adults."

In kids, lingering respiratory symptoms after COVID-19 can include a cough that won't go away or being short of breath after exercise or physical activity.

So, when should kids see a doctor about treatment for suspected long COVID? Dr. Giuliano says an evaluation makes sense if kids have a symptom (or symptoms) after COVID that are:

She adds that a child's symptoms will dictate treatment. "Something like a long-term cough is going to be treated very differently than someone who is having trouble concentrating."

"Children who are struggling with long-term coughs sometimes respond to similar inhalers that we use to treat asthma — medications like albuterol, or inhaled steroids," explains Dr. Giuliano. "If there are other symptoms that we think could that be contributing to post-nasal drip, antihistamines or nasal steroids might be another option to look into."

As far as concentrating difficulties go, Dr. Giuliano says doctors usually spend a "significant amount of time" discussing things like:

"There's a lot of little nuances there that really help us dive into the best treatment options for kids because they can depend on some of the potential triggers or modifying factors," she notes.

When putting together a long COVID treatment plan, each kid is different. "Your child's pediatrician or family practice provider will spend some time trying to understand the timeline related to COVID and the onset of symptoms," says Dr. Giuliano. "They’ll also look at how common these symptoms were for the child before the infection even started. Then, they’ll put all of those pieces together to determine the best treatment option."

One of the most important things a kid can do is get the COVID-19 vaccine, and then boosters when eligible. "In the context of COVID, we’re often talking about preventing severe disease. And when we say severe disease, people think about hospitalizations and death," says Dr. Giuliano. "But long COVID is another reason to get vaccinated.

"Somebody who's gone through this experience of dealing with these symptoms for months on end would say that this is not a mild illness," she adds. "Even if you didn't end up in the hospital, these symptoms really can have a significant impact on a kid and their family."

Unfortunately, we can't prevent long COVID — or determine who’ll experience it. But Dr. Giuliano stresses that right now is a good time for parents and kids to do a health audit and make sure everything is on the right track.

"This is an opportunity to really take a comprehensive look at your child's health," she affirms. "This includes making sure that they’re getting the nutrition that they need, that they’re well rested, and that they’re exercising. We have control over our exercise habits, our sleep habits, our food choices, and nutritional status, as well as choosing to get vaccinated."