An extensive analysis published Wednesday in the journal
Pediatrics
highlights the long-term toll that Covid can take on children, in some cases causing
neurological, gastrointestinal, cardiovascular and behavioral symptoms
in the months following an acute infection.
“Long Covid in the US, in adults and children, is a serious problem,” said Dr. Ziyad Al-Aly, chief of research and development at the VA St. Louis Healthcare System and clinical health researcher. public at the University of Washington.
in St. Louis, which studies the condition but was not involved in the new report.
He said the paper, which was based on numerous studies of
long Covid in children
, is “important” and illustrates that the condition can affect multiple organ systems.
The new review suggested that between 10% and 20% of children in the United States who had coronavirus developed long Covid.
However, Dr. Suchitra Rao, a pediatric infectious diseases expert at Children's Hospital Colorado and co-author of the paper, acknowledged that there are "many caveats" with the prevalence estimates used to arrive at that figure.
For example, some of the included studies looked at only the very small percentage of children who were hospitalized for the virus.
Like adults, children who have had more severe cases of the disease are at higher risk for persistent symptoms or new complications.
The Centers for Disease Control and Prevention (CDC) places the
prevalence of long Covid closer to 1% of children
who have had the virus.
(The estimate in adults is 7%).
Generally speaking, most parents should not worry about their children developing long Covid, said Dr. Stephen Freedman, professor of pediatrics and emergency medicine at the University of Calgary Cumming School of Medicine.
"I don't get asked much, if anything, about, 'Is my child now at risk of developing long Covid?'
after we diagnosed him with an acute infection,” he said.
“And I think that's appropriate.”
What does long Covid look like in children?
Long Covid can be a challenge to study in part because
it is difficult to diagnose, as the symptoms are so varied
.
Making a diagnosis may be even more complicated in children because symptoms may present differently than they do in adults.
Young children may also not have the language to describe what they are feeling, so researchers advised parents to look for
changes in behavior
.
Fatigue, mental confusion and headaches are among the most common symptoms of long Covid in children.
While these problems are sometimes on the mild end of the spectrum, they can prevent children from fully participating in school or recreational activities.
Young children may also act out, frustrated that they cannot easily do what they used to do.
Most symptoms improve within a year, experts said, but in some children they can persist longer.
It's still unclear what the long-term impact of these prolonged symptoms may be on children's development, said Dr. Laura Malone, director of the Post-Covid-19 Pediatric Rehabilitation Clinic at the Kennedy Krieger Institute in Baltimore.
Medical monitoring is essential to control the symptoms of long Covid.
In severe cases, some children experience
persistent respiratory and cardiovascular problems, including myocarditis
, a heart disease.
Diabetes and other autoimmune disorders can also arise immediately after a Covid infection, although “they tend to be much, much less prevalent in children” than milder symptoms, Al-Aly said.
Persistent and severe symptoms can arise even in children with mild infections, said Dr. Sindhu Mohandas, an infectious disease specialist at Children's Hospital Los Angeles.
That was the case for Lucas Denault, whose initial brush with Covid in 2021 didn't include much more than a stuffy nose.
Lucas, then 15, recovered and returned to school, athletic practices and student council meetings.
But months later, he began having
difficulty walking
through the halls of his high school in Littlestown, Pennsylvania.
His head and chest hurt.
He felt dizzy and nauseous.
“It was a very quick fall,” said his mother, Karin Denault.
Neither Lucas nor his mother had considered that his problems could be related to his brief attack of Covid.
But on the recommendation of a family member, he went for an evaluation at the Kennedy Krieger clinic in Baltimore.
There, he was diagnosed with long Covid and postural orthostatic tachycardia syndrome, a set of symptoms that cause extreme fatigue and can occur among people with long Covid.
What treatments are available?
There are no approved medications to treat long Covid, so doctors focus on managing symptoms and helping patients function day to day.
Some doctors will prescribe medications to treat problems such as headaches and muscle aches.
Mohandas, who also participated in reviewing the research, said much of the work she and other doctors do revolves around validating the experiences of these young patients.
Many “had previously been very healthy, so often everyone tends to doubt their symptoms,” she said.
Malone said schools should make accommodations for children who are struggling, including breaks during the day and extra time for tests.
Small changes helped Lucas.
He found it difficult to get out of bed, for example, so he started
sleeping upright
to make it easier.
At the suggestion of his doctor, he sometimes hung the foot of the bed and spelled his name with his fingers to improve blood flow.
His doctor also prescribed several medications, including a blood pressure medication, to help manage symptoms such as fatigue and brain fog.
Lucas is now a freshman at Princeton and most of his symptoms have improved.
When he toured colleges, his mother often had to push him in a wheelchair.
Last weekend, he came to campus to watch him play club basketball.
The New York Times. Special
Translation: Patricia Sar
MG