Long Covid describes lasting effects from COVID-19 infection. It refers to ongoing, relapsing, or new symptoms, or other health effects occurring after acute infection and persist for at least three months. For the full consensus definition, see here
Some children may have symptoms that do not go away after their COVID infection. Some children may start to feel better and then start having new symptoms. Long Covid can happen to any child, even if they had mild or no symptoms during their COVID infection.
The most predictive symptoms for Long Covid in school age children (5-11) are trouble with memory or focusing, back or neck pain, stomach pain, headache, fear about specific things (phobias), refusing to go to school, itchy skin or rash, trouble sleeping, nausea or vomiting, and feeling lightheaded or dizzy.
The most predictive symptoms for Long Covid in adolescents change or loss in smell or taste, body, muscle, or joint pain, daytime tiredness/sleepiness or low energy, tired after walking, back or neck pain.
Source: Characterizing Long COVID in Children and Adolescents, JAMA, 2024.
Post Exertional malaise (PEM) is the cardinal symptom of Myalgic encephalomyelitis/chronic fatigue syndrome or ME/CFS, and is a symptom that has been reported in children with Long Covid. PEM is a flare of symptoms and/or the appearance of new symptoms after exertion, often presenting 24 hours after the triggering event. Physical activity, cognitive overexertion, and sensory overload can all trigger PEM. Post Exertional malaise is a unique symptom, incongruent with experiences of fatigue after overexertion in healthy children. It is not the same as being more tired than normal after an activity, or second day muscle soreness after an activity.
Long Covid, often an invisible illness, relies heavily on patients describing their symptoms for proper recognition. This can be challenging for children, who may find it difficult to recognize and describe their symptoms. It’s crucial to understand that children may display Long Covid symptoms differently than adults. Recognizing these differences ensures they receive the necessary care and attention.
COVID-19 has been discovered to awaken dormant infections in individuals, leading to a resurgence of symptoms from conditions such as EpsteinBarr virus (EBV),
cytomegalovirus (CMV), human herpesvirus 6 (HHV6), and Lyme disease. Reactivation of infections post-COVID can worsen symptoms, emphasizing the need for comprehensive care due to immune system changes.
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