People who recover from COVID-19 often report persistent symptoms or long COVID. According to the Centers for Disease Control and Prevention (CDC)Trusted Source, people can develop post-COVID conditions following SARS-CoV-2 infection even if they did not have COVID-19 symptoms. Long-term effects may include fatigueTrusted Source, cognitive symptomsTrusted Source, and respiratory symptoms.
Many adults report long COVID symptoms. However, there is conflicting data about the long-term impact of SARS-CoV-2 infection in children. Most children and young people (CYP) are either asymptomatic or have milder COVID-19 symptomsTrusted Source than adults, but some studiesTrusted Source report long COVID in childrenTrusted Source.
A group of U.K. researchers has completed a systematic analysis of the literature on long COVID in CYP. The study, which appears in the Journal of Infection, aimed to clarify whether persistent symptoms in young people are due to SARS-CoV-2 infection or the pressures of living in a pandemic.
Dr. Christopher Coleman, assistant professor of infection immunology at the University of Nottingham, U.K., told Medical News Today, “This is an important piece of research, as it attempts to pool all of the studies in this area — which should give a better conclusion than small studies.”
“Our findings suggest that persistent symptoms do occur in CYP after SARS-CoV-2 infection, but prevalence is much lower than originally suggested by many low-quality uncontrolled studies from early in the pandemic.”– Dr. Olivia Swann, corresponding author and clinical lecturer in Paediatric Infectious Disease at the University of Edinburgh, U.K.
101 reported symptoms
The researchers identified 3,357 studies, of which 22 met their criteria for analysis. Participants had to be 19 years or under, with confirmed or probable SARS-CoV-2 infection, and experience symptoms beyond the acute illness. The study analyzed data from 23,141 CYP in 12 countries, who were followed up for a median of 120 days.
The meta-analysisTrusted Source looked for evidence of many symptoms associated with long COVID. Across all studies, a total of 101 wide-ranging symptoms was reported, including cognitive difficulties, loss of smell, headache, sore throat, fatigue, insomnia, and diarrhea. The researchers assessed the prevalence, risk factors, type, and duration of long-term post-COVID symptoms.
“Most of these persistent symptoms were equally common in SARS-CoV-2 positive cases and SARS-CoV-2 negative controls.” – Dr. Olivia Swann
Testing positive linked to more symptoms
The studies in the analysis had some limitations. All symptoms were self-reported by the participants, so could not be clinically verified. Of the 22 studies, only five had a SARS-CoV-2 negative control group. The authors regarded these as higher-quality studies, stressing the importance of a control group for avoiding bias.
Dr. Swann commented, “It’s important to note that the quality of published studies has been highly variable: Earlier studies without a control group paint a very different picture to more recent case-control studies, which are more reassuring.”
Speaking to MNT, Dr. Danelle Fisher, MD, FAAP (Fellow of the American Academy of Pediatrics), chair of pediatrics at Providence Saint John’s Health Center in Santa Monica, California, agreed, “There are limitations to this study but it is important to try to track the longevity of the symptoms and if possible compare it to control subjects, which has not yet been done.”
Those who had tested positive for SARS-CoV-2 were more likely to have a few symptoms, such as cognitive difficulties, headache, loss of smell, sore throat, and sore eyes, than those who had not been infected.
“The meta-analysis showed a slight increase in children and young people who had symptoms after COVID-19 infection including cognitive difficulties, headaches, fatigue, and loss of smell. These symptoms are also found after other related viral illnesses that are similar to COVID-19.” – Dr. Danelle Fisher
Importance of clear messaging
The authors note that the higher-quality studies found a lower prevalence of all long-term symptoms.
One of the study authors, Dr. Shamez Ladhani, a pediatric infectious disease consultant at St. George’s Hospital, London, commented, “The vast majority of kids with COVID-19 will recover completely, but we do need better tools to identify (and resources to investigate and support) the small proportion of kids with persistent symptoms.”
Dr. Swann noted that the few symptoms found more frequently in CYP “can help us identify children who are persistently affected after SARS-CoV-2 and support their recovery.”
“Let’s stop the scaremongering and get the public messaging right.” – Dr. Shamez Ladhani.
Long COVID and children: The unseen casualties of COVID-19
Since children appear to be less at risk of severe COVID-19 than adults, those who do develop the disease may not receive as much attention from researchers and the media. Yet some of these children have become “long haulers” who experience symptoms months after they first contracted SARS-CoV-2.
All data and statistics are based on publicly available data at the time of publication. Some information may be out of date. Visit our coronavirus hub and follow our live updates page for the most recent information on the COVID-19 pandemic.
Some studies have argued that children have a lower riskTrusted Source of developing severe COVID-19 — the disease caused by SARS-CoV-2 — than adults.
Reports indicate that, in most cases, children who contract the new coronavirus develop mild-to-moderate symptomsTrusted Source or remain asymptomatic.
However, in some extreme cases, they may develop multisystem inflammatory syndrome in children (MIS-C)Trusted Source or pediatric inflammatory multisystem syndrome (PIMS), as some experts refer to it.
Stay informed with live updates on the current COVID-19 outbreak and visit our coronavirus hub for more advice on prevention and treatment.
According to existing data, MIS-C/PIMS can become apparent at 2–6 weeks after a SARS-CoV-2 infection, and some of the symptoms that can accompany it include:
rashes or pink eye (conjunctivitis)
In most cases of COVID-19 in children, symptoms should typically improve and then disappear altogether after a couple of weeks from symptom onset. Yet some children experience ongoing symptoms weeks or even months after their initial illness — a phenomenon commonly referred to as “long COVID.”
How do ongoing symptoms of COVID-19 actually impact the day-to-day lives and well-being of the children and adolescents who experience them?
To answer this and many other questions, Medical News Today spoke to the parents of children and teens with long COVID.*
In this Special Feature, we present, at length, the stories of four parents whose children still experience debilitating symptoms. These parents spoke to us about the difficult journey towards securing an accurate diagnosis, and the often fruitless search for formal support.
For an informed medical perspective on long COVID, MNT sought the expertise of Dr. Amanda Morrow, rehabilitation physician, and Dr. Laura Malone, neurologist — both from the Kennedy Krieger Institute, a Johns Hopkins affiliate in Baltimore, MD.
Dr. Morrow is an assistant professor of physical medicine and rehabilitation at the Johns Hopkins School of Medicine. Dr. Malone is also an assistant professor of Neurology and Physical Medicine and Rehabilitation at the Johns Hopkins University School of Medicine.
Drs. Morrow and Malone offered MNT joint comments about long COVID in children.
How many children are long haulers?
There are limited comprehensive data about children with long-lasting symptoms of COVID-19, so it can be difficult to say just how common this phenomenon is among the under 18s.
The most detailed sets of data, for the time being, have been collected by the Office for National Statistics (ONS) in the United Kingdom.
According to updated experimental estimates published by the ONS in January 2021, around 12.9% of children aged 2–11 years, 14.5% of those aged 12–16 years, and 17.1% of teenagers and young adults aged 17–24 years still had COVID-19 symptoms at 5 weeks after the initial onset.
A study headed by researchers from the Department of Woman and Child Health and Public Health at the Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome, Italy, also suggests that long COVID may be more common in children than public health experts had expected.
The study — as yet unpublished and not peer reviewed, shared on the preprint platform medRxiv — analyzed the health data of a cohort of 129 children diagnosed with COVID-19 between March and November 2020 in Italy.
Of these, 52.7% reported experiencing at least one symptom of COVID-19 at 120 days (approximately 4 months) or more after the initial diagnosis.
In a recent webinar for The BMJ, Dr. Elizabeth Whittaker — senior clinical lecturer in pediatric infectious diseases and immunology at Imperial College London in the U.K. — outlines the wide array of symptoms children with long COVID can experience.
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