Researchers worry about long Covid in children – 02/15/2024 – Health

A major analysis published last week in the journal Pediatrics highlights the impact that long Covid can have on children, in some cases leading to neurological, gastrointestinal, cardiovascular and behavioral symptoms in the months following the acute infection.

“Long Covid in adults and children in the United States is a serious problem,” says Ziyad Al-Aly, chief of research and development at the VA St. Louis Health Care System and a public health clinical researcher at Washington University in St. Louis , who studies the condition and was not involved in the new report.

He says the article, which was based on several studies on long Covid in children, is “important” and illustrates that the condition can affect multiple organs in the body.

The new review suggests that 10% to 20% of children in the US who had Covid developed long Covid. However, Suchitra Rao, a pediatric infectious disease specialist at Children’s Hospital Colorado and co-author of the paper, says there are “a lot of caveats” with the prevalence estimates used to arrive at this number.

Some of the studies included in the review, for example, only analyzed the small percentage of children who were hospitalized due to the disease. Just like adults, children who have had more severe cases have a higher risk of persistent symptoms or new complications.

Data from the Centers for Disease Control and Prevention suggests that the prevalence of long Covid in children is closer to 1% to 2% of those who have had the infection. Al-Aly says this number is likely in the single digits in adults as well.

Generally speaking, most parents shouldn’t worry about their children developing long Covid, says Stephen Freedman, professor of pediatrics and emergency medicine at the University of Calgary Cumming School of Medicine. “I don’t get asked much, if at all, ‘Is my child now at risk of developing long Covid?’ following a diagnosis of acute infection,” he says. “I think that’s appropriate.”

How does long Covid manifest in children?

Long Covid can be challenging to study, in part because it is difficult to diagnose since symptoms are so varied. Making a diagnosis is perhaps even more complicated in children, as symptoms may present differently than in adults. Young children may also lack the language to describe what they are feeling, so researchers advised parents to watch for changes in behavior.

Fatigue, mental confusion and headaches are among the most frequently reported symptoms of long Covid in children. Although these problems are sometimes mild, they can prevent children from fully participating in school or recreational activities. Young children may also act aggressively, frustrated that they cannot easily do what they used to do. Most symptoms improve within a year, experts say, but in some children they may persist for longer.

It’s not yet clear what impact these prolonged symptoms will have on children’s development long-term, says Laura Malone, director of the Pediatric Post-Covid Rehabilitation Clinic at the Kennedy Krieger Institute in Baltimore.

In severe cases, some children experience persistent respiratory and cardiovascular problems, including myocarditis. Diabetes and other autoimmune disorders can also arise after an infection, although they are “much, much less prevalent in children” than milder symptoms, says Al-Aly.

Persistent, severe symptoms can develop even in children with mild infections, says Sindhu Mohandas, an infectious disease specialist at Children’s Hospital Los Angeles.

That was the case for Lucas Denault, whose first brush with Covid in 2021 didn’t include much beyond a stuffy nose. Lucas, then 15, recovered and returned to school, track practice and student council meetings. But months later, he began having trouble walking the halls of his Littlestown, Pennsylvania, high school. His head and chest hurt. He felt dizzy and nauseous.

“It got worse so quickly,” says his mother, Karin Denault. Neither Lucas nor his mother had considered that their problems could be related to the brief Covid episode. But on the recommendation of a relative, he underwent an evaluation at the Kennedy Krieger clinic in Baltimore. There, he was diagnosed with long Covid and postural orthostatic tachycardia syndrome, a set of symptoms that leads to extreme fatigue and can occur in people with the condition.

What treatments are available?

There are no approved medications to treat long Covid, so doctors focus on managing symptoms and helping patients function in everyday life. Some doctors may prescribe medications to treat problems such as headaches and muscle pain. Mohandas, who was also involved in reviewing the research, said much of the work she and other clinicians do revolves around validating the experiences of these young patients. Many “were previously very healthy, so often everyone tends to doubt their symptoms,” she says.

Malone says schools must make accommodations for children who are experiencing the condition, including breaks during the day and extra time for testing.

Small changes helped Lucas. It was difficult for him to get out of bed, for example, so he started sleeping with a higher pillow to make it easier. His doctor’s suggestion was that he sometimes dangle his feet off the bed and spell his name with his toes to improve blood flow. His doctor also prescribed several medications, including one for blood pressure, to help manage symptoms such as fatigue and mental confusion.

Lucas is now a freshman at Princeton, and most of his symptoms have improved. When he was visiting colleges, his mother often had to push him in a wheelchair. Recently, she went to campus to watch him play club basketball.