Identifying the Most Common Symptoms of Long COVID in Children and Adolescents

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While the height of the COVID-19 pandemic is well behind us, its effects have been long-lasting. Postacute sequelae of SARS-CoV-2 infection (PASC), or long COVID, is a chronic condition that occurs following COVID-19. It includes a number of symptoms which can last up to years. According to a household survey conducted by the Centers for Disease Control, about 18% of all United States adults reported experiencing long COVID as of July 2024.¹

While there is much research on the effects of long COVID in adults, less is known about the condition in children and adolescents. A study published in JAMA sought to address this and identify key symptoms within a younger population.²

“Most research characterizing PASC has focused on adults, leading to misperception that pediatric PASC is rare or presents similarly to PASC in adults,” the study authors wrote. “This may lead clinicians to miss symptoms or misdiagnose children. Consistent with the life course framework in which developmental stage influences health outcomes, PASC may present in both similar and different ways compared with adults.”

The multicenter longitudinal observational cohort study aimed to compare symptoms between age groups of 6 to 11 and 12 to 17. Participants were recruited from over 60 US health care and community settings between March 2022 and December 2023 and included those with and without a COVID-19 diagnosis.

A total of 898 school-age children were included in the study—147 did not have a previous case of COVID-19. According to the results, 14 symptoms in both school-age children (ages 6 to 11) and adolescents (ages 12 to17) were more common in those with COVID-19 infection history compared with those without infection history, with 4 additional symptoms in school-age children only and 3 in adolescents only.

“These symptoms affected almost every organ system. Combinations of symptoms most associated with infection history were identified to form a PASC research index for each age group; these indices correlated with poorer overall health and quality of life,” the authors wrote of the findings. “The index emphasizes neurocognitive, pain, and gastrointestinal symptoms in school-age children but change or loss in smell or taste, pain, and fatigue/malaise–related symptoms in adolescents. Clustering analyses identified 4 PASC symptom phenotypes in school-age children and 3 in adolescents.”

Looking deeper into the results of the study, both age groups had a single cluster with high symptom burden and a cluster predominated by fatigue and pain symptoms. School-aged children had clusters with neuropsychological and sleep impacts as well as one with gastrointestinal predominance. Adolescents had a cluster that was primarily loss of taste and smell, which is similar to adults, but was not noted in the school-aged group.

“In this large-scale study, symptoms that characterized pediatric PASC differed by age group, and several distinct phenotypic PASC presentations were described,” the authors concluded. “The research indices developed here will help researchers identify children and adolescents with high likelihood of PASC. Although these indices will require further research and validation, this work provides an important step toward a clinically useful tool for diagnosis with the ultimate goal of supporting optimal care for youth with PASC.”

References

1. National Center for Health Statistics. U.S. Census Bureau, Household Pulse Survey, 2022–2024. Long COVID. Generated interactively: August 26, 2024 from https://www.cdc.gov/nchs/covid19/pulse/long-covid.htm

2. Gross RS, Thaweethai T, Kleinman LC, et al. Characterizing Long COVID in Children and Adolescents. JAMA. Published online August 21, 2024. doi:10.1001/jama.2024.12747. https://jamanetwork.com/journals/jama/article-abstract/2822770