Long COVID in children is a condition affecting young individuals after a SARS-CoV-2 infection. Symptoms persist for weeks or months, even if the initial illness was mild or asymptomatic. While many children recover fully, some experience lingering health issues that can impact their daily lives. Research continues to investigate this condition in pediatric populations.
Symptoms and Common Presentations
Children with Long COVID can experience various symptoms, which may be persistent or fluctuate. Physical symptoms frequently include severe fatigue that does not improve with rest and worsens with exertion. Headaches are commonly reported, varying in intensity and frequency. Many children also experience shortness of breath, chest pain, and muscle or joint pain. Gastrointestinal issues, such as stomach cramps, diarrhea, nausea, and vomiting, can also occur.
Beyond physical complaints, cognitive and neurological symptoms are a concern. “Brain fog” is a term often used to describe difficulty concentrating, impaired memory, and slower processing of information. Children may struggle with schoolwork, finding it hard to focus or retain new information. Sleep disturbances, including insomnia or unrefreshing sleep, can further compound fatigue. Dizziness or lightheadedness, impacting balance and coordination, are also reported.
Emotional and psychological changes can also manifest. New or worsened anxiety, depression, mood swings, and irritability have been observed. These challenges are often exacerbated by the prolonged illness and disruption to routines, social interactions, or hobbies. These symptoms collectively impact a child’s well-being, making daily functioning challenging.
Underlying Causes and Risk Factors
The exact reasons why Long COVID develops in some children are not yet fully understood, and research is ongoing. One theory involves viral persistence, where fragments of the SARS-CoV-2 virus may remain in the body, continuing to stimulate an immune response. This prolonged presence could contribute to ongoing inflammation and dysfunction in various organ systems.
Another mechanism is immune system dysregulation or an overactive immune response. The immune system may continue to react, potentially leading to widespread inflammation that affects different tissues and organs, including the brain and heart. Autonomic nervous system dysfunction, which controls involuntary bodily functions like heart rate and digestion, is also being explored. Mitochondrial impairment, affecting cellular energy production, is another area of study that could explain severe fatigue.
Regarding risk factors, the severity of the initial COVID-19 infection does not always predict whether a child will develop Long COVID. While some studies suggest a higher risk in children who experienced more acute symptoms or required hospitalization, Long COVID can also occur in those with mild or even asymptomatic initial infections. Factors under investigation include older age in children (with some studies noting a higher prevalence in adolescents) and the presence of pre-existing health conditions such as asthma, obesity, or certain neurological disorders. Any child can develop Long COVID.
Diagnosis and Medical Evaluation
Diagnosing Long COVID in children can be complex, as no single definitive laboratory test is available. Instead, the diagnosis is typically one of exclusion, meaning healthcare providers first rule out other potential medical conditions that could be causing the child’s symptoms. This process involves a thorough evaluation to ensure the symptoms are not attributable to another illness.
The medical evaluation usually begins with a comprehensive review of the child’s medical history, including details about their initial COVID-19 infection and the onset and progression of their current symptoms. A physical examination is performed to assess various bodily systems. Depending on the symptoms, doctors may order a range of tests, such as routine blood tests (to check for inflammation or organ function), chest X-rays (to assess lung health), or electrocardiograms (ECGs) (to evaluate heart activity). In some cases, specialized imaging (e.g., an MRI of the head) or referrals to specialists (e.g., cardiologists, neurologists, or pulmonologists) may be necessary to investigate specific concerns. Parents can assist this diagnostic process by keeping a detailed journal of their child’s symptoms, noting their nature, duration, and any factors that seem to worsen or improve them.
Managing Long COVID and Supporting Recovery
Managing Long COVID in children involves a multidisciplinary approach, focusing on symptom relief and supporting the child’s gradual return to their previous level of functioning. Since there is no specific cure, treatments are tailored to address the individual symptoms a child experiences. For instance, pain relievers may be used for headaches, and physical therapy can help address fatigue or muscle weakness. Occupational therapy may be beneficial for cognitive challenges, helping children manage “brain fog” and improve concentration.
A strategy for managing persistent fatigue and post-exertional malaise (PEM), which is a worsening of symptoms after exertion, is pacing and energy conservation. This involves teaching children and their families to recognize and respect the child’s physical and cognitive limits, avoiding the urge to “push through” symptoms that can lead to a crash. Gradually increasing activity levels while monitoring symptoms is central to this approach.
School support is also important for children with Long COVID. Federal policies in some regions recognize Long COVID as a disability, which can provide access to accommodations such as a 504 plan or an Individualized Education Program (IEP). These plans can include modified school schedules, extended time for assignments or tests, frequent breaks, or alternative assignments to reduce academic burden. Open communication with teachers and administrators ensures the child receives the necessary support.
Addressing the mental health impact of Long COVID is also an important part of recovery. Living with a chronic illness can be isolating and frustrating for children and families. Psychological support (e.g., therapy or counseling) can help children cope with anxiety, depression, and mood changes, providing strategies to manage emotional challenges and improve well-being. This support helps children and families navigate Long COVID and work towards recovery.