Kids don’t get serious illness from a COVID-19 infection as often as adults, but they can still face complications. Some people who develop a COVID-19 infection can experience long-term effects, or long COVID. Anyone who has had a COVID-19 infection is at risk for this condition — even children.
What is long COVID?
Long COVID is when you develop new, recurrent, or chronic health problems after an initial illness with COVID-19. The timeline of these symptoms is important. That’s because COVID-19 symptoms typically resolve a few days to weeks after the illness. In general, someone will get a diagnosis of long COVID when symptoms continue at least 4 weeks after the original infection.
How common is long COVID in kids?
Among children who have had COVID-19, it’s likely that up to 10% may experience long COVID. But the reports on how often long COVID occurs among kids vary quite a bit. That’s likely because the illness includes a lot of symptoms. Plus, it’s difficult to accurately track because some kids have the symptoms of long COVID but have not had a known COVID-19 infection.
Long COVID is less common in children and adolescents than adults. This may be because COVID-19 infection itself is less common in this age group.
What are the symptoms of long COVID in kids?
Just as symptoms of COVID-19 infection can vary widely, so can symptoms of long COVID. Experts believe it affects multiple areas of the body. There are over 60 recognized symptoms of long COVID. Here are a few common areas long COVID can affect.
Lungs
Respiratory issues are the most common symptoms of an acute COVID-19 infection. They’re also some of the most common, long-lasting symptoms.
Symptoms can last for up to 3 months or longer. Common respiratory symptoms include:
Chest pain
Cough
Heart
COVID-19 infection can affect the heart in different ways, although the issue is usually myocarditis. Myocarditis is inflammation of the heart muscle. It can occur as part of the initial illness or with long COVID.
Myocarditis may also occur after one of the mRNA COVID-19 vaccines. This is more common in adolescent males and young men, although the risk is very low. And myocarditis is more likely to occur due to COVID-19 infection than vaccination.
Symptoms of myocarditis can include:
Chest pain
Shortness of breath
Arrhythmias
Fatigue
In more severe cases, myocarditis can lead to:
Heart failure
Sudden cardiac arrest
Nervous system
Children with long COVID can also experience developmental delays. They may also have cognitive delays that affect academics, behavior, or speech and language. This is likely due to injury to the nervous system from inflammation.
“Brain fog” is a common complaint after COVID-19 infection in adults. But it can also affect children and adolescents. Brain fog is a generic term referring to symptoms of:
Unclear thinking
Problems paying attention
Trouble with concentration or memory
In one study, brain fog occured in about 10% of kids with long COVID.
Headache is also a common symptom during and after COVID-19 infection.
Mental health
Researchers have found many mental health effects in long COVID. Psychological symptoms include:
Mood changes
Anxiety
Depression
Thoughts of suicide
Insomnia
Mental health symptoms are common after COVID-19 infection and are likely due to many factors. It’s difficult to separate symptoms from the virus and those from the social effect of the pandemic.
Emotional and behavioral effects from the pandemic include:
Social isolation
Family stress
Increased sedentary (inactive) lifestyle
Fear of risks
Adjustment disorders
You don’t need a diagnosis of COVID-19 to experience the emotional effects of the pandemic. Anyone with signs of depression or anxiety should seek help and support from a healthcare provider.
Smell and taste
Among kids 10 to 19 years old, up to 1 out of 4 may have an altered sense of smell. Loss of smell and taste can last months in adults. In children, it typically resolves in several weeks.
After COVID-19 illness, there are a few other common symptoms. Children and adolescents may often report feeling tired. And they may have decreased endurance. These symptoms can occur even when there aren’t signs of effects to the heart or lungs. There are also reports of muscle and joint pain in kids with long COVID.
What are the long-term health effects of COVID-19 in children?
Compared to adults, kids with COVID-19 often have no symptoms. Or they may have a mild infection. Fortunately, life-threatening complications from COVID-19 are rare in kids. That means COVID-19 infection carries a relatively low risk in the short term. But, sometimes, infection in children brings long-term effects. These include long COVID and multisystem inflammatory syndrome in children (MIS-C).
What is multisystem inflammatory syndrome in children (MIS-C) after COVID-19?
Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious complication of COVID-19. It can occur 2 to 4 weeks after an active infection. Widespread inflammation can cause multiple organ systems to fail. And it can lead to death.
Your healthcare provider can make the diagnosis of MIS-C based on the history of the child’s illness and a clinical exam. Diagnostic testing for MIS-C may include:
Vital signs
Blood work
Chest X-ray
Electrocardiogram (EKG)
Signs of MIS-C include fever that won’t go away, abnormal laboratory test results, and evidence of organ dysfunction or shock.
There is no specific treatment for MIS-C. Supportive care is the mainstay of therapy. Steroid treatment and medications that modify the immune system may help with the effects of inflammation.
It’s best to identify and treat MIS-C early. Contact your healthcare provider if your child has a fever (100.4°F or higher) for 24 hours and any of the following:
Skin rash
Red eyes
Stomach pain
Diarrhea
Dizziness or lightheadedness
Vomiting
How do providers diagnose long COVID in kids?
No specific lab test can diagnose long COVID. There is also no definitive way to say whether symptoms are from long COVID or something else. There is a wide range of symptoms of long COVID. So you need close follow-up and discussion with a provider to watch ongoing symptoms and explore any new ones that develop.
There are different definitions of long COVID, which makes diagnosis somewhat challenging. The World Health Organization (WHO) describes long COVID as symptoms that fluctuate or persist and affect daily life. And no other diagnosis can explain it. In other words, long COVID is a diagnosis of exclusion. This means your provider will rule out all other possible causes of your symptoms before diagnosing long COVID.
Experts have also created several questionnaires to assess people who’ve had a recent COVID-19 infection. They help to check for ongoing symptoms that could indicate long COVID.
What is the treatment for long COVID in kids?
Unfortunately, there is no treatment that cures long COVID. Instead, treatment aims to help with managing specific symptoms and supporting kids while they recover.
Depending on the type and severity of symptoms, management may require a team approach. This may include services like:
Mental health support
School support
Physical therapy
Rehabilitation services
Specialty care
How long does it take children to recover from long COVID?
Each child with long COVID has a different recovery time depending on their symptoms. There’s also a big range in terms of when symptoms of long COVID start and how long they last.
For some people, it can last from weeks to months. Others may still have long COVID symptoms more than 1 year after a COVID-19 infection. And some people don’t develop symptoms of long COVID for many months after an initial COVID-19 infection. Research is ongoing to learn more about long COVID and its effects.
The bottom line
Long COVID is an uncommon complication of COVID-19 infection in children. But the effects can be serious and long-lasting. So make sure to contact your healthcare provider if your child has had a known or suspected COVID-19 infection and has lingering symptoms.
Diagnosis can be challenging, but your provider can assess your child and figure out if the symptoms are in line with long COVID. Making the diagnosis is important. That’s because there are many supportive services that can assist you and your child during the recovery process.
References
Aiyegbusi, O. L., et al. (2021). Symptoms, complications and management of long COVID: A review. Journal of the Royal Society of Medicine.American Academy of Pediatrics. (2022). Multisystem inflammatory syndrome in children (MIS-C) interim guide.
American Academy of Pediatrics. (2022). Post-covid-19 conditions in children and adolescents.
American Heart Association News. (2022). COVID-19 infection poses higher risk for myocarditis than vaccines.
Berg, S. K., et al. (2022). Long COVID symptoms in SARS-CoV-2-positive children aged 0–14 years and matched controls in Denmark (LongCOVIDKidsDK): A national, cross-sectional study. The Lancet.
Fainardi, V., et al. (2022). Long COVID in children and adolescents. Life.
Gurdasani, D., et al. (2022). Long COVID in children. The Lancet.
Izquierdo-Pujol, J., et al. (2022). Post COVID-19 condition in children and adolescents: An emerging problem. Frontiers in Pediatrics.
Myocarditis Foundation. (n.d.). Discover myocarditis causes, symptoms, diagnosis and treatment.
Zimmermann, P., et al. (2022). The challenge of studying long COVID: An updated review. The Pediatric Infectious Disease Journal.
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