People sometimes assume that young people don’t get Long Covid; or that if young people do, their symptoms are the same as those for adults. Emerging work from the RECOVER (Researching COVID to Enhance Recovery)–Pediatrics Initiative is now showing that Long Covid in children and teenagers is a grave public health crisis and is in some ways different from Long Covid in adults. Conservative estimates of the prevalence of Long Covid in children (2%–10%) correspond to millions of people; but this number may be much higher. Because trauma and illness can profoundly change the development of young people and have lasting effects, it is critical to accurately diagnose and treat young people with Long Covid. But diagnosing Long Covid in young people is challenging because symptoms of Long Covid may be misremembered by children; may be misinterpreted as symptoms of other illnesses common among children; or may change with a child’s age.
The RECOVER-Pediatrics group just presented an online seminar describing their initial results, which are now published in the Journal of the American Medical Association and which begin to answer important questions about how Long Covid affects young people (Box 1). The researchers found that although many symptoms of Long Covid for young people are like those for adults, some are different. Also, symptoms in young children (aged 6–11 years) can differ from those in teens (12–17 years).
For this study, the RECOVER-Pediatrics team recruited about 900 children and about 4,500 teenagers from over 100 sites across the country. Participants were as diverse as the national population, and about as many girls participated as boys. About a third of participants were from medically underserved areas. The researchers found that symptoms associated with Long Covid in the children and teens involved diverse parts of the body. These included the eyes, ears, nose, and throat; the cardiopulmonary system; skin; neurological system; psychiatric functioning; gastrointestinal and urinary systems; and muscular and skeletal systems. Many symptoms affecting children were the same as those affecting teens. These included aches and pains; depression and anxiety; fatigue; headache; lightheadedness; nausea; poor cognitive functioning; and poor sleep. However, itchy skin rash and palpitations during exercise were more common among younger children than among teens. The younger children were also more afraid about certain things and more often refused to go to school. In contrast, olfactory functions (smell or taste) was more diminished among teens. Teens also had panic attacks more often than did the younger children.
The researchers found 10 symptoms in children that most associate with a history of having Long Covid—poor memory and poor focus (most strongly); fear about certain things; headache; itchy skin; lightheadedness; nausea; pain in the back or neck; pain in the stomach; poor sleep; and refusing to go to school. And for teenagers, the researchers found eight symptoms most associated with Long Covid—changed or lost smell or taste (most strongly); fatigue after walking; headache; lightheadedness; pain in the back or neck; pain in the body, muscles, or joints; poor memory and poor focus; and sleepiness. By using these symptoms, the researchers set up an index score to figure out the chance of Long Covid in children; and another index score to determine the chance in teens. Indeed, participants with high index scores had poorer health than those with lower index scores. Although these index scores are not yet ready for clinical use, they’re still a big deal because future studies may use them to find which young people most probably have Long Covid. (One reason the index scores are not ready for diagnosing young people is that the scores are calculated by adding individual scores of prolonged symptoms; thus, young people with more symptoms have higher index scores. However, a young person may have Long Covid but may have only one or two symptoms, generating a misleadingly low index score.)
Another key result was that the children with Long Covid usually fell into one of four groups with distinct prominent symptoms; and teens with Long Covid, one of three groups (Box 2). Thus, Long Covid looks different in distinct groups of children and teens.
These findings are important because they show that serious symptoms of Long Covid can affect multiple organ systems of patients at these formative ages. These results also highlight that the symptoms of Long Covid for young people can differ from those of adults, and that symptoms can change as people grow. Distinct symptoms correlate best with Long Covid in children and in teens, and different types of Long Covid exist for people at these ages. In time, this ongoing study will yield more important insights into why some young people get Long Covid while others do not; how Long Covid affects health later on (as young people become adults); and how to best treat young patients of different ages and with different symptoms.
Although these were important first steps to understand how Long Covid affects young people, the researchers noted opportunities to do even better. For example, the researchers learned about symptoms through parents (or caregivers). This was a good approach because parents usually spend the most time with young people and can best perceive health changes. But the researchers eventually want to use more objective data, like clinical data they directly collected from the young patients. The researchers also want to study how Long Covid affects very young patients (those younger than five years). Until the end of this year, the researchers will continue to recruit young people to participate in this important study. To watch this presentation and to learn more about this study, please visit the RECOVER website (recovercovid.org).
