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How do I know if my child has 'long COVID'?
Thomas Wintle
More young people are experiencing long-term effects after catching COVID-19. Christopher Hopefitch/Getty Creative/CFP

More young people are experiencing long-term effects after catching COVID-19. Christopher Hopefitch/Getty Creative/CFP

 

As scientists try to understand why the Omicron variant appears to be impacting younger people more than previous strains of COVID-19, many parents are worried that post-acute coronavirus, more commonly known as 'long COVID,' could affect their children. 

But how exactly do you know if your child has long COVID? Until recently, the differing types, numbering, and duration of the condition's symptoms made it difficult for scientists to whittle down a catch-all diagnosis, leaving many parents in the dark as to whether their children were affected. 

Now top UK pediatricians have agreed on a formal definition for long COVID in children that they hope will reduce the dramatic variance in data on the condition's prevalence is in young people. 

 

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What happens when children have long COVID?

Although long COVID diagnoses are considered rare in children, it has become clear over the pandemic that a growing number of young people are experiencing coronavirus symptoms long after their initial infection.

Lasting anywhere from four weeks to many months, symptoms of long COVID in kids vary widely between age groups and can affect all ages, including babies.

They can range from the comparatively mild symptoms including a continuous cough, a sore throat, slight dizziness, aches and pains, and changes to smell or taste (more common in adolescents according to researchers) - to much more severe indicators such as chronic fatigue, recurring chest pains, labored breathing, and "brain fog," where children's thinking becomes sluggish and fuzzy. 

 

Symptoms among young people include chronic fatigue, recurring chest pains, labored breathing, and “brain fog”. /Mehmet Hilmi Barcin/Getty Creative/CFP

Symptoms among young people include chronic fatigue, recurring chest pains, labored breathing, and “brain fog”. /Mehmet Hilmi Barcin/Getty Creative/CFP

 

Mental health issues, particularly among adolescents, have also been reported, while rare diagnoses of Multisystem Inflammatory Syndrome in Children, a debilitating condition that attacks the organs, and increased risk of type 1 diabetes have also been linked to the virus in children. Essentially, from the lightest to the most extreme, all of these symptoms could effectively fall under the definition of long COVID

Add the complications that few children actually seek medical attention for long COVID, and it's easy to understand why the difference in the type and duration of symptoms has led to a slew of definitions for long COVID in younger people.

 

 

How can we define pediatric long COVID?

A group of British infectious disease experts has attempted to solve this issue by standardizing a definition, writing in the peer-reviewed Archives of Disease in Childhood, that to qualify as having long COVID, young people must show continued symptoms after catching the virus that has impacted their physical, mental or social wellbeing interfered with some aspect of daily living, and persisted for a minimum time of 12 weeks. 

 

 Definition of long COVID in children and young people

Long COVID in children and young people is a condition in which a child or young person has symptoms (at least one of which is a physical symptom) that:

1. Have continued or developed after a coronavirus diagnosis
2. Impact their physical, mental or social wellbeing
3. Interfere with aspects of daily living (eg, school, work, home or relationships) 
4. Persist for a period of 12 weeks after testing even if symptoms wax or wain

 

"This is the first research definition of long COVID in children and young people and complements the clinical case definition in adults proposed by WHO," the authors wrote, adding that the two definitions are "reassuringly similar."

And perhaps most importantly, the authors say that having a "consistently applied" definition of long COVID in children, it may help reduce the dramatic variance in figures on how many children actually have the condition.

 

 

How common is long COVID among children?

Even with a working research definition, recording the prevalence of long COVID among children has proven incredibly difficult for researchers.

One of the first studies on long COVID in children, an Italian report carried out in late 2020, said more than half of the infected children they studied had at least one coronavirus symptom lasting more than 15 weeks.

A more recent study from the University College London of a larger group of children put the figure much lower, with up to one in seven children - just 14 percent - still showing symptoms 15 weeks later. The study's lead author Terence Stephenson said on the data's release: "It is reassuring that the figures were lower than the worst-case scenarios predicted last December." 

But despite the study's strengths - the fact it was nationally representative, relied on PCR proven coronavirus status, and included a COVID-negative comparison control group, experts still say taking data on children continues to have serious limitations.

 

Scientists have only recently reached a general research definition for long COVID. /Visual China/CFP

Scientists have only recently reached a general research definition for long COVID. /Visual China/CFP

 

For example, one large study in the UK found that nearly all symptoms reported by children who tested positive were also reported by those who tested negative, while the researchers who formalized the definition for pediatric long COVID point out that the prevalence of symptoms can range from 1 to 51 percent.

For now, an National Institute for Health Research funded pediatric study into long COVID in the UK from August 2021 shows that 14 percent of children can go on to develop long COVID, meaning up to four children in each classroom could statistically develop the condition. 

Scientists will hopefully learn more as time progresses, but one of the underlying issues around the uncertainty around long COVID's prevalence in children is what actually causes the condition. 

 

What causes post-COVID symptoms in children?
 

While it is still unclear which children are most likely to be affected by long COVID, support group Long COVID Kids say that risks appear to be higher for those in the following groups: females; those who are young, fit, and healthy; people with Eczema, Asthma, Hayfever; those allergic to animals; people with previous post viral fatigue; and those with Ehlers-Danlos syndromes, Fibromyalgia, and Irritable Bowel Syndrome.

But in comparison, why might kids be more at risk from long COVID? One of the theories which remains unproven, is that certain inactivated viral proteins in the virus could be continually setting off inflammation, something which could affect children more than adults. 

Results indicate that generally, the virus is more likely to concentrate in a child’s gut than their respiratory system, making their symptoms more gastrointestinal than respiratory. Based on stool samples from children who have had coronavirus, some scientists believe it may take longer for it to exit a child's system than it does for an adult. Such long-term exposure to the viral antigens could lead to regular or intermittent inflammation, even if it is mild, a hypothesis dubbed "slow burn" theory. 

Another theory suggests that long COVID is a type of autoimmune process in which antibodies made against the virus attack the host even after it has left the body. But despite ever more data from a growing body of studies into the condition, scientists are yet to confirm its root causes in adults or in children. 

 

As a preventative measure, some specialists suggest vaccinating young people. /Panyawat Boontanom / EyeEm/Getty Creative/CFP

As a preventative measure, some specialists suggest vaccinating young people. /Panyawat Boontanom / EyeEm/Getty Creative/CFP

 

How can you treat long COVID in children and how long will it last?

Even if the risk of children experiencing long COVID is low, according to pediatric infectious disease specialists, the high incidence of infections amid the Omicron variant "means that large numbers of children might require treatment." 

As a preventative measure, they suggest vaccinating young people to help reduce "some of the indirect harms caused by repeat testing and isolation, lockdowns, school closures, and reduced social activities."

For those already experiencing long COVID, due to the variety of examples, there is no one way to treat long COVID in children, but pediatricians from Yale University say the best results tend to come from considering each symptom by itself. 

For example, a child with "brain fog" may be sent to a neurologist, while a young person suffering from exhaustion may go to see a specialist who works with people suffering from diseases linked to chronic fatigue like mononucleosis or 'mono.' It essentially depends which part of the body the virus attacks. 

As for the exact duration of long COVID, there is no definitive answer, but there is reassuring evidence that symptoms will get better over time in the majority of cases. Still, David Strain, chair of the British Medical Association board of science and a contributor to the new working definition of long COVID in children, stressed the importance of catching the condition quickly. 

"A three-month delay in offering support to a child or young person, at this vitally important period of their educational development could have lasting long term impacts," he said.

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