By: Peter Rowe, MD, FAAP
Most kids and teens who test positive for COVID-19 have mild, or even no, symptoms. But it's becoming clear that some are experiencing symptoms more than a month after being infected with SARS-CoV-2, the virus that causes COVID-19. This condition is often referred to as "long-haul COVID" or "long COVID." Research on this condition continues.
Who gets long-haul COVID?
No one knows exactly how many people who've had COVID-19 end up being long haulers. One study suggests that as many as 52% of teens and young adults between ages 16 and 30 may experience lingering symptoms 6 months after having COVID. And the United Kingdom Office for National Statisics reports that that nearly 13% of children age 2 to 11 years old and 14.5% of children age 12 to 16 still experienced symptoms after 5 weeks.
What we do know is that long-haul COVID can happen even in people who had mild or no symptoms of COVID-19. The symptoms they experienced during the acute infection may not go away, even long after their infection is gone. Sometimes, long-haul COVID symptoms start after a person is feeling better. Or, if they were asymptomatic (didn't have COVID symptoms), they may experience them weeks later. Any of these symptoms can be new and different, or they may be the same as the ones your child or teen had during the COVID infection.
What are the symptoms?
The most common symptoms of long-haul COVID include:
There are a variety of chronic symptoms your child can experience after having COVID-19. The specific symptoms your child has could depend on how severe their COVID infection was. For instance, if your child was in the intensive care unit (ICU) on a ventilator, they might have fatigue and weak muscles, as well as a fast heart rate and brain fog. These are common effects in people who have spent time in the ICU.
How is long-haul COVID diagnosed?
There's no specific test to diagnose long-haul COVID, so it's diagnosed based on symptoms. Your pediatrician may run other tests or refer you to a pediatric sub-specialist, especially if symptoms continue for more than 3 months. This is be certain there's nothing else causing your child's symptoms.
How long does it last?
That's still unknown. More studies need to be done to understand what's going on.
What causes it?
Researchers are still trying to figure out what causes some people to experience long-haul COVID. It will probably take some years before we know much more.
How is it treated?
Treatment depends on what symptoms your child is having. Your pediatrician will treat individual symptoms, such as headaches, lightheadedness, or problems sleeping.
Long-haul COVID-19 symptoms may be similar to or overlap with those of some other conditions, including:
Myalgic encephalomyelitis/chronic fatigue syndrome
Your child might be one of the people who weren't hospitalized that have reported the same symptoms as those found in a condition called
myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). (This used to be referred to as simply
chronic fatigue syndrome.)
They may have severe fatigue, lightheadedness, not feel rested after sleeping, and experience something known as
post-exertional malaise (PEM). Symptoms of PEM happen after you do more physical or mental activity than normal, or stand for a long time. Afterward, this can result in days of increased symptoms such as worse fatigue, headaches, and light and sound sensitivity. This is similar to what you'd experience after a concussion.
Brain fog is another extremely common symptom of both ME/CFS and long-haul COVID. In children and adolescents, this can look like they suddenly developed attention-deficit/hyperactivity disorder (ADHD) without the hyperactivity.
Many people with long-haul COVID, especially kids and teens, also may experience
intolerance. This makes you feel lightheaded, dizzy, weak, or faint when you sit or stand for more than a few minutes. It's caused by reduced blood flow to the brain and it's also seen in ME/CFS too. Experts think that having orthostatic intolerance influences how tireda person feels and how severe their PEM may be.
Kids who experience orthostatic intolerance may not have the energy to go out and do much. They may have to sit down in the shower or lie down afterwards because they get so tired from the combination of standing up and the heat. Basically, they have obvious difficulty doing the activities they used to do before they got sick.
Reports have come out showing that many adult long-haul COVID patients have a condition known as
postural orthostatic tachycardia syndrome POTS, a form of dysautonomia that involves problems with the nervous system functions such as heart rate. This may also be important causes of symptoms including lightheadedness and fatigue.
What about multisystem inflammatory syndrome in children (MIS-C)?
You may have heard of
multisystem inflammatory syndrome in children (MIS-C), a serious condition that may be related to COVID-19. However, doctors don't know for sure yet what causes MIS-C. They just know that many kids who have had it either had COVID-19 or were around someone else who did. Also, keep in mind that MIS-C is rare.
When to Seek Help
Be sure to see your pediatrician if you think your child may have long-haul COVID. Many medical centers in the United States are creating post-COVID care clinics so they can treat long-haul COVID more effectively. Your pediatrician can help you find a subspecialist or clinic if your child needs one.
About Dr. Rowe
Peter Rowe, MD, FAAP, is a Professor of Pediatrics at the Johns Hopkins University School of Medicine and serves as the Director of the Chronic Fatigue Clinic at Johns Hopkins Children's Center. He is a member of the American Academy of Pediatrics Maryland Chapter.