Symptoms of Long COVID can vary significantly in children compared to adults, and even between different age groups of children.
According to a new study published on August 21 in the journal JAMA, the symptoms of prolonged COVID in children may be different from those that appear in adults. This study is part of the US National Institutes of Health's RECOVER research initiative.
Dr. Rachel Gross, an associate professor of pediatrics at NYU Grossman School of Medicine and co-author of the study, points out that most of what we know about Long COVID comes from studies on adults. The new study includes one of the first and largest efforts to characterize prolonged symptoms in children and understand how they may differ between different age groups.
To reach these results, Gross and her colleagues interviewed caregivers of more than 5,000 children in the US—some of whom had experienced COVID-19 and some who had not—about health issues that emerged during the pandemic. They analyzed the children's responses and medical history data to identify symptoms that were most closely related to previous infections, identifying them as possible indicators of Long COVID in children.
In children ages 6 to 11, researchers identified 10 symptoms closely related to Long COVID:
- Problems with memory or concentration
- Back or neck pain
- Stomach ache
- Headache
- Phobias
- Refusal to go to school (which may be indicative of larger problems)
- Itching or rash on the skin
- Sleep problems
- Nausea or vomiting
- Dizziness
Meanwhile, in adolescents aged 12 to 17 years, 8 main symptoms emerged:
- Change or loss of smell or taste
- Body, muscle or joint pain
- Low energy or sleepiness during the day
- Fatigue after walking
- Back or neck pain
- Problems with memory or concentration
- Headache
- Dizziness
Identifying these symptoms is not enough to officially diagnose Long COVID, but they served as a guide to assess which children may have Long COVID. The researchers estimated that 20% of previously infected children and 14% of previously infected adolescents were at risk for Long COVID, especially those who were infected before the Omicron wave.
These percentages are higher than some previous estimates, including a recent CDC report that concluded that only about 1% of children in the U.S. had Long COVID by 2022. However, other studies have reached similar conclusions. similarly, estimating that somewhere between 10% and 20% of children who become infected with COVID-19 will develop long-term complications.
With so many unanswered questions about Long COVID in children, it's important for clinicians to know the symptoms to look for, Gross says. There is a "misconception" that "if children have Long COVID, it will look like Long COVID in adults," but this is not necessarily true. The study suggests that children can experience a wide range of complications after a case of COVID-19, reporting everything from sleep disturbances and behavioral problems to nasal congestion.
Certain symptoms of Long COVID, such as fatigue and cognitive issues, appear to be shared between age groups. But some of the pediatric symptoms identified in the new study—such as phobias and rashes—are not typically associated with Long COVID in adults and thus may be ignored or misinterpreted if clinicians look only for common adult symptoms.
At the moment, even an accurate diagnosis of Long COVID does not guarantee that a child will receive adequate treatment. Researchers are looking for therapies, but there is still no approved test or treatment proven effective against Long COVID.
The results of the new study should reframe how parents think about the risks the virus poses to their children, Gross says. It is true that children are less likely than adults to become seriously ill or die if they contract COVID-19. But long-term complications are possible for people of any age—even if they don't look the same at different stages of life.
