According to a recent estimate, about 25% of children who test positive for COVID-19 later develop Long COVID symptoms. Because Long COVID can manifest differently in certain ways in children, however, special treatment guidelines are needed. Recognizing this, the American Academy of Physical Medicine and Rehabilitation (AAPM&R) has issued clinical instructions expressly for physicians treating children with Long COVID.*

What does Long COVID in kids look like?

While there is some overlap in physical symptoms in children and adults, some children are also negatively affected by social isolation, interruption of their school routine, and the loss of family members and friends. Children with developmental delays or disabilities may struggle to describe their symptoms and adjust to rapidly-changing habits or schedules. On the other hand, children are less likely to have many of the underlying chronic medical issues that adults have, so some tests may not be necessary.

In the new guidance published in the AAPM&R’s official journal, PM&R, healthcare quality consultant Sarah Sampsel, MPH, and her colleagues list an array of signs and symptoms to look for in children, including, among others:

• Fatigue, low exercise capacity, and post-exertional malaise with extracurricular activities
• Problems sleeping
• Mood disturbances, anxiety, and depression
• Slipping academic performance
• Regression in social development
• Difficulty paying attention, concentrating or remembering
• Lingering fever and headaches
• Paresthesias (pins and needles sensation) or numbness

Guidelines co-author Amanda Morrow, M.D. of the Kennedy Krieger Institute said that identifying and understanding these symptoms is “vital to treating and diagnosing Long COVID in children.”

New PASC treatment guidance for children

The new pediatric Long COVID guidance is the latest disease advice in a series from the PASC (post-acute sequelae of SARS-CoV-2) Collaborative. Morrow said the new guidance is meant to provide clinicians with diagnostic and treatment recommendations from a “multidisciplinary PASC Collaborative Pediatric Workgroup.” 

Once other conditions have been ruled out, clinicians are advised to focus on relieving children’s Long COVID symptoms and having them engage in comprehensive rehabilitation that allows for improved age-appropriate growth. Accommodations are also suggested to help children struggling with debilitating Long COVID symptoms, particularly bodily fatigue, post-exertional malaise, and cognitive dysfunction. For instance, schools could allow for:

• More time between classes,
• Use of elevators,
• Extra test-taking time, or
• Limited homework.

Such measures may be hard to coordinate, Morrow acknowledged. Comprehensive care may be especially difficult to implement in communities that lack Long COVID clinics, where physicians, physical therapists, and psychologists are all working in unison. 

That said, Morrow believes it’s possible for a patchwork of specialists to be knitted together in such communities through referral by primary care doctors.

Ultimate goal

Morrow says the ultimate goal is to give providers the understanding and tools they need to devise solutions to the mounting challenges they face treating evolving symptoms and the overwhelming numbers of people affected. The guidelines were developed to help patients, caregivers, and providers collectively address these struggles.

*DePeau-Wilson, M. (2022, September 29). New Guidance Focuses on Long COVID in Kids. MedPage Today. https://www.medpagetoday.com/special-reports/exclusives/100954