One of the few mercies of the coronavirus pandemic is that children are, by and large, spared the most serious outcomes. More than 4.7 million pediatric cases have been diagnosed in the United States so far, and under 2% have resulted in hospitalization.
But questions still remain about the long-term effects of COVID-19 on kids, especially its long-haul iteration. Here’s what parents need to know about the most common symptoms, and how to protect their children.
Symptom #1: Fatigue and shortness of breath
For the most part, the most common complaints of children grappling with long-haul COVID ― which the Centers for Disease Control and Prevention now often refers to as a “post-COVID condition” ― are pretty much the same as those of adults.
Difficulty breathing, shortness of breath, and tiredness or fatigue are right at the top of the list, but the severity of those symptoms runs the gamut. For example, Carey Lumeng, a pediatric pulmonologist with C. S. Mott Children’s Hospital who leads the Pediatric Post-COVID Syndrome Clinic, said that his team has treated several pediatric patients who are athletes and noticed they were unable to run and play in the same way they could pre-COVID.
Other kids experience levels of tiredness that are profound and relentless. Experts are exploring how long-haul COVID in children might overlap with serious conditions like chronic fatigue syndrome or postural orthostatic tachycardia syndrome, which can cause lightheadedness, exhaustion, and heart palpitations.
“I think it’s important for parents to know that in most children, thankfully, COVID is mild,” said Dr. Diane Arnaout, a Texas-based pediatrician who regularly posts COVID tips for families on her Facebook page. “But it doesn’t mean they can’t get severely or chronically sick.”
Symptom #2: Brain fog
Children with long-haul COVID also report dealing with “brain fog,” which is a broad (and non-clinical) term used to describe difficulty thinking or concentrating.
“In children and adolescents, this can look like they suddenly developed attention-deficit/hyperactivity disorder (ADHD) without the hyperactivity,” according to the American Academy of Pediatrics.
Other common symptoms: Loss of smell and taste, headaches, muscle pain, and more
While those are among the most common symptoms, they’re not the only ones. One study, which focused on adults, found that there may be 200 symptoms associated with long-haul COVID-19.
“I have one poor teenager who, months out from her COVID infection, smells feces anytime she’s near meat of any kind,” said Arnaout. “That seems mild, but it can really do a number to one’s appetite and mental wellbeing.”
Long-haul COVID is not easy to diagnose or define.
Long-haul COVID is a syndrome — a group of symptoms that often occur together — so it’s not something that can be diagnosed with a test.
“Long-haul COVID in kids can look like a lot of things,” Arnaout said.
Furthermore, children can develop long-term symptoms even if they initially had no symptoms, or just very mild symptoms. They might not even have been tested for COVID-19, or could have inconsistent results on subsequent antibody tests.
“There is no one diagnostic test for [long-haul COVID]. In addition, there’s no one single treatment for it,” said Lumeng, who added that in the clinic he oversees, treatments tend to be based on symptoms. So if a child has asthma-like symptoms, they deal with those the same way they’d treat a child with asthma. An ear nose and throat specialist might help with loss of smell or taste.
But to further complicate matters, there is not a universal definition for what “long-haul” means, though many experts consider the starting point to be three months after the onset of symptoms.
“The definition of ‘long COVID’ is still being decided. We definitely know children can have symptoms for as long as four weeks, and that’s actually fairly normal,” Lumeng said, though he noted he was not dismissing how challenging it can be on kids and parents when a child is unwell for weeks on end.
“Many children can have symptoms that are prolonged as long as two to three months that eventually resolve. Certainly, that’s distressing to the family. They don’t know what’s going on. But there is actually a kind of drop-off at about three months when things do get better,” he added.
Talk to your child’s pediatrician if you’re at all concerned that they’re dealing with long-haul COVID.
Long COVID in kids is less common than doctors once feared.
Early on in the pandemic, there was some research suggesting that the prevalence of long-haul COVID symptoms in children may be as high as 60%, Lumeng said.
But subsequent research has been much more reassuring. One study found that about 4% of children had symptoms about one month after their initial infection, and two months out, less than 2% of children did. However, research published this week — which has not been subject to peer review — found that somewhere between 2 and 14% of kids have symptoms several months after the fact.
By contrast, studies suggest that one in four adults may develop long-haul symptoms, even if their initial infection was relatively mild.
“Thankfully it seems to happen more rarely in kids than adults,” said Arnaout.
Delta could change things for kids.
While doctors are heartened by the fact that long-haul COVID in children is a lot less common than they once feared, pediatric cases are surging right now as a result of the more-contagious delta variant. The variant could change the scope and nature of the pandemic for children, so it is more important than ever that parents help keep their children safe by wearing masks, maintaining distance, and making sure that family members who are eligible get vaccinated as soon as possible.
Many parents are already doing what doctors and public health guidelines suggest, like moving birthday parties outdoors, Arnaout said. Postpone family gatherings, she urged, and open windows in schools. It’s critical that parents take this variant seriously, particularly as kids go back to school. While long-haul COVID in children is relatively rare, the odds increase when more kids are infected in the first place.
“Delta is a whole new ballgame, and we’re seeing more severe disease in kids. I’m nervous, and am encouraging folks to listen to the medical community to know what to do,” Arnaout said. “We’re drowning, but we’re trying to build the boat as we float in it.”
Experts are still learning about COVID-19. The information in this story is what was known or available as of publication, but guidance can change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.