When we believed that children weren’t susceptible to long COVID, it was Rutgers University pediatrician and professor Lawrence C. Kleinman, M.D. that corrected us. In fact, children can be vulnerable to a serious COVID complication known as multisystem inflammatory syndrome (MIS-C), which usually arises a few weeks after infection and can suffer the same long- COVID symptoms as adults (extreme fatigue, brain fog, etc.). 

Believing long COVID in children is underreported and could impair their development in unknown ways, Kleinman is now co-leading a national study to learn more about long COVID’s physical and mental impact on the very young. Several thousand children and young adults with confirmed COVID-19 are involved in the $30 million study, funded by the National Institutes of Health, including those with long COVID and MIS-C—collectively called post-acute sequelae of COVID (PASC).

In an interview, Kleinman discussed the team’s latest findings, what they hope to achieve, and Kleinman’s separate study on predicting children at high risk for serious complications.

‘How Often Do Children Develop Long-Term Symptoms?’

Kleinman says estimates of long COVID in children range from 5%-10% to more than 40% of those infected. He goes on to explain that these symptoms should be viewed in terms of the child’s stage of development and the life trajectory they’re on. Will visible or still invisible symptoms disrupt their learning? For example, there may be readily observable clinical changes now and changes that occur over time due to certain stressors or a child’s natural development.

‘What about the Subset of Kids with the Inflammatory Syndrome?’

One study showed 316 children with MIS-C out of one million COVID-19 cases, but the condition was higher among racial minorities. Moreover, Centers for Disease Control and Prevention data only count cases of severe disease requiring hospitalization.

Fever is common in children and young adults with MIS-C, as is the involvement of two organ systems that usually include the gastrointestinal tract. Cardiovascular conditions like myocarditis and heart failure are also common in MIS-C.

Kleinman explains there is usually about a one-month period between COVID onset and MIS-C. Many children end up in intensive care. Thankfully most recover, but some have ongoing symptoms.

‘What Do You Hope to Learn about Kids with Long COVID?’

The research team wants to learn more about the condition’s impact on child development. “If that’s altered, that would be unique in kids,” said Kleinman. For instance, brain fog and lack of stamina during exercise and daily activities are seen in children, but any effect of long COVID on childhood development isn’t yet known. 

• He says there’s also another kind of long COVID: the economic and psychological trauma from family loss.
• He asks whether anti-inflammatory drugs may be effective against long COVID should inflammation play a role in the disease.

The team hopes to identify patterns of symptoms that can serve as a basis for understanding the underlying disease mechanics and identifying effective therapies.

‘Tell Us about Your Other Study to Determine Which Children are at Risk’

Kleinman’s research in this area is ongoing. He’s looking at factors including community, social determinants of health, different bodily stressors, genetics, and any existing illnesses.

‘Are There Ways to Prevent Long COVID?’

Kleinman names a handful of effective measures:

• Avoiding infection
• Vaccination
• Masking
• Social distancing

‘How Might the Omicron Variant Change the Equation?’

“Each of these new variants poses a risk,” Kleinman explains. It remains to be seen how these new variants affect long COVID prevalence and whether a mild infection means a lower likelihood of long COVID. ”We don’t know these things. Some of them we’ll never know. We’ll at least be able to study them on average.”

*Avril, T. (2021, December 21). Long COVID in kids is a unique challenge, and a Rutgers team is part of a national effort to study it. The Press of Atlantic City. https://pressofatlanticcity.com/news/state-and-regional/long-covid-in-kids-is-a-unique-challenge-and-a-rutgers-team-is-part-of/article_e8b2e806-61cb-11ec-a6c5-3b6c24308302.html