Long Covid, here’s how it manifests itself in children and adolescents: from headaches to tiredness, all the symptoms
Long Covid affects both young children and adolescents, but with different typical symptoms. THE small childrenfor example, are more likely to report headaches, while teenagers tend to experience low energy and fatigue. These, in a nutshell, are the conclusions of a study conducted through the Researching COVID to Enhance Recovery (RECOVER) initiative and funded by the National Institutes of Health (NIH). The results were published in the journal Jama. RECOVER aims to understand, diagnose, treat and prevent Long Covid. “Most of the research characterizing the symptoms of Long Covid focuses on adults, which can lead to the misperception that Long Covid in children is rare or that their symptoms are like those of adults,” says David Goff, MD, director of the Division of Cardiovascular Sciences at the NIH’s National Heart, Lung, and Blood Institute. “Because symptoms can vary from child to child or present in different patterns, without proper characterization of symptoms across the lifespan, it is difficult to know how to optimize care for affected children and adolescents,” he adds.
The observational study included 3,860 children and adolescents with a history of SARS-CoV-2 infection at more than 60 sites in the United States between March 2022 and December 2023.. A comparison group of 1,516 children and adolescents with no history of SARS-CoV-2 infection was also included to determine whether the prolonged symptoms of those who had COVID-19 were related to SARS-CoV-2 itself or more broadly related to the effects of the pandemic. Caregivers completed a comprehensive survey that asked about 75 symptoms involving all major body systems that occurred at least 90 days after an initial SARS-CoV-2 infection and that lasted at least a month. They also completed a survey asking about their perceptions of the child’s general health, physical health, and quality of life.
The researchers then used a commonly used statistical technique to identify which symptoms were best suited to differentiate participants who had and did not have a history of Sars-CoV-2 infection. Well, the researchers identified distinct combinations of symptoms for each age group that together generated a research index for Long Covid, which indicates the likely presence of the post-infection syndrome. Researchers identified 18 prolonged symptoms that were more common in school-age childrenincluding headaches (57%), followed by memory or concentration problems (44%), difficulty sleeping (44%), and stomach aches (43%). Other common symptoms in school-age childrenand not included in the search index included body, muscle and joint pain; daytime tiredness/sleepiness or low energy; and feeling anxious. In adolescents17 symptoms were most common, including daytime tiredness/sleepiness or low energy (80%); body, muscle, or joint pain (60%); headache (55%); and memory or concentration problems (47%). Feeling anxious and having trouble sleeping were other commonly reported symptoms that were not included in the research index. “The symptoms that make up the research index are not the only symptoms a child can have and they are not the most severe, but they are the most predictive in determining who might have long Covid,” said Rachel Gross, associate professor in the departments of pediatrics and population health at New York University Grossman School of Medicine and the study’s lead author. Fourteen symptoms overlapped across age groups. Comparing previous research on Long Covid in adults, the new study found that adults and adolescents had greater overlap in symptoms, such as loss or change in smell or taste. The researchers found less overlap between adults and school-age children, underscoring the importance of age-based Long Covid research.
The study identified separate research indices for school-age children and adolescents along with overlapping but distinguishable symptom patterns in each group. Of the 751 school-age children who had COVID-19, 20% met the research index threshold for long COVID. Of the 3,109 adolescent children with a history of SARS-CoV-2 infection, 14% met the research index threshold, although the researchers noted that these numbers should not be used as measures of incidence in the general population, as their study may have included more children with long COVID than the overall population. The scientists stress that the research index provides a framework for examining common symptoms for research purposes, not necessarily to guide clinical care, and will likely be refined as researchers study more children with and without long COVID. “Our next step will be to study children aged 5 and younger, so we can better understand long COVID in younger children,” Gross said.
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