NBC News
Millions of American children are estimated to have suffered long-term effects from COVID-19, but less is known about their symptoms than about those of adults.
A large national study offers new insights into what the disease looks like after infection in children and teens, suggesting they experience a markedly different set of symptoms than adults. While COVID-19 has historically been milder in children, the findings indicate that many have debilitating long-term side effects that make it difficult to attend school, participate in extracurricular activities or spend time with family or friends.
“This is a public health crisis for children,” said Dr. Rachel Gross, senior author of the study and an associate professor of pediatrics at New York University’s Grossman School of Medicine.
“Having suffered from a chronic illness affects them as they grow up, and it impacts their health when they become adults,” he added.
The study is part of the RECOVER initiative, one of the world’s largest investigations into long COVID-19, which was funded by the National Institutes of Health.
Researchers in the new study, published Wednesday in the journal JAMA, interviewed caregivers of more than 3,800 children, asking them about symptoms their children experienced in the first 90 days after infection. They also surveyed caregivers of about 1,500 children with no history of COVID-19 and compared the responses.
The results showed that among children aged 6 to 11 years, headache, memory and concentration problems, sleep problems and stomach pain were the most commonly associated with long COVID-19.
Common symptoms of lTeenagers were more similar to adultswhich RECOVER’s previous findings showed included post-exertional malaise (worsening of symptoms after exercise), fatigue, brain fog, dizziness, gastrointestinal problems and palpitations. The new research showed that children aged 12 to 17 were more likely than younger people to experience daytime sleepiness or lack of energy, as well as body, muscle or joint aches.
Headaches and memory or concentration problems remained common in this age group. Changes or loss of taste or smell – another hallmark symptom of long-term COVID-19 in adults – were also common in adolescents, but not in children.
“We need to look for these differences,” Gross said. “Otherwise, we might be missing children who have long COVID-19.”
Overall, long COVID-19 appears to be less common in children than in adults, but a review published in February in the journal Pediatrics estimated that 10% to 20% of children who contracted the virus developed post-viral symptoms within six months.
According to the new study, the spectrum of symptoms in children and adolescents is broad. In total, 14 symptoms were more prevalent in children with a history of COVID-19 than in those who did not have them.
The study has some limitations, however. Because caregivers reported the children’s symptoms, it’s possible they missed some or overestimated others. Those caregivers also reported infections from the children that were confirmed by testing. However, the researchers did test to make sure the uninfected group did not have antibodies to the virus.
According to Dr. Amy Edwards, director of the pediatric COVID-19 recovery clinic at UH Rainbow Babies and Children’s Hospital, who was not involved in the new research, the results are consistent with what doctors have been seeing in COVID-19 clinics for some time.
Edwards said some children at her clinic “have dropped out of school, put all their extracurricular activities on hold and are barely functioning.” For others, she added, “it’s not so bad that they can’t go to school, but their grades are slipping. They may have been straight-A students or honor roll students before, and now they’re having a hard time passing.”
The new research validates these experiences, she explained, especially for some of her pediatric patients who faced skepticism from adults when they reported their symptoms.
“School nurses made fun of them for pretending”“They are teenagers and children, and people tell them to their face that nothing is wrong with them,” Edwards said.
Knowing that a symptom may be linked to long-term COVID-19 could help children find appropriate treatments, said Christine Koterba, a pediatric neuropsychologist at Nationwide Children’s Hospital, who was also not involved in the study.
There is no widely effective treatment for long COVID-19, but there are many clinical trials underway. In the meantime, Koterba said, doctors have turned to treatments for other long-term illnesses, such as post-concussion syndrome, which is similarly characterized by headaches and problems with memory or concentration.
“There are many things we can learn from other similar populations to help children get back to functioning,” she said.
Edwards said that for many children with long-term COVID-19, she recommends sleep and a healthy diet consisting of anti-inflammatory foods, as well as alleviating other conditions such as allergies that can further aggravate the immune system.
At least anecdotally, Young children tend to recover more quickly from long COVID-19 than teenagers or adults, he said.
“What we see in our school-aged children is almost 100% recovery within one to two years. That’s quite common, and for many of them, the time is even shorter,” Edwards said, adding: “Children’s immune systems are structured to deal with new viruses, because all viruses are new to a child.”
Most teens also recover over time, although it may take longer.
Gross said there isn’t enough research to support these assumptions yet, but RECOVER researchers plan to follow the children in their study to find out if their symptoms improve over time.
