Ask the Pediatrician: Should parents be concerned about long-term COVID-19 effects in children?

Dr. Sarah Risen American Academy of Pediatrics

A: Millions of U.S. children and teens have tested positive for SARSCoV-2, the virus that causes COVID-19. Fortunately, they have been less likely than adults, so far, to become very ill.

However, even if they had few or no symptoms, kids can develop a number of other conditions after the COVID-19 infection. Some are minor and may go away on their own. Others are more serious and may need treatment.

After a COVID-19 diagnosis, talk with your child’s doctor about lingering or new symptoms, and what to do. Your pediatrician also can help guide your child’s safe return to activities, such as sports.

Here are some symptoms and conditions that can aff ect children after COVID-19 that you should discuss with the pediatrician:  Breathing problems: Because COVID-19 most often aff ects the lungs, lingering respiratory symptoms are not uncommon. Th ese may include chest pain, cough and more trouble breathing during exercise. Some of these symptoms can last for three months or longer. Children 6 years or older with ongoing symptoms may need lung function tests. Children with exercise-induced breathing problems that don’t go away may also need heart tests to rule out complications such as blood clots or abnormal heart function.  Cardiac issues: Myocarditis, an infl ammation of the heart muscle, can develop after COVID-19 (and in extremely rare cases, receiving mRNA vaccines). One study of adult patients who recently recovered from COVID-19 suggested that 60% had signs of myocarditis on heart imaging, regardless of how severe their symptoms were during the infection. Symptoms of myocarditis may include chest pain, shortness of breath, irregular heartbeat, and fatigue. Children and teens who had COVID-19 infection and these symptoms within the last six months need an thorough exam, including heart tests, before returning to school or sports activities.  Smell and taste: As many as 1 out of 4 children and teens ages 10 to 19 who have had COVID-19 experience changes to their smell and taste. Th is can have a negative eff ect on their eating habits and mood. It can also prevent them from noticing dangerous odors.

Th ese symptoms typically go away in several weeks. If they don’t, your child’s doctor may recommend steps to test or help retrain these senses.  Developmental issues: Active COVID-19 illness can aff ect the brain and, in rare cases, lead to stroke or encephalitis (brain swelling). Serious infl ammation of the brain can lead to obvious diffi culties in a child’s daily function, but children who have had mild or moderate COVID-19 infection may still experience subtle changes in attention, speech, schoolwork, movement and mood. Your pediatrician may refer you for follow-up with a neurodevelopmental specialist, a speech language pathologist or physical or occupational therapists.  Mental fatigue: “Brain fog” — unclear or “fuzzy” thinking, diffi culties with concentration, or memory problems — is a frequent complaint among adults who’ve had COVID-19. Children and teens may have similar symptoms. Your child may seem more forgetful or have trouble paying attention. Th ey may be slower at reading and need more repetition and breaks while learning. Make sure your child gets enough sleep and help them manage stress, which can worsen these symptoms. If post-COVID-19 mental fatigue doesn’t improve or interferes with daily activities, your child may benefi t from a team-based evaluation and recovery plan.  Physical fatigue: After SARS-CoV-2 infection, children and teens may tire more easily and have less physical endurance, even if they had no heart or lung symptoms from the virus. Th is usually improves over time. Your pediatrician can advise a gradual increase in physical activity. If this doesn’t improve symptoms, they may recommend a visit to a physical therapist or other specialist.  Headaches: Headache is a common symptom during and following SARS-CoV-2 infection. Getting enough sleep, drinking plenty of water, eating regular meals and managing stress can help. If the headaches are persistent and severe, your child’s doctor may recommend preventive medicines.  Mental and behavioral health: Having had COVID-19 can aff ect a child’s mental health. For children with existing mental/behavioral illness, events surrounding COVID-19 (hospitalization, isolation, absence from school activities) may also make symptoms worse. Your pediatrician can check your child for signs of depression, anxiety and other mental health concerns, and advise when your child may need more support.  Multisystem infl ammatory syndrome in children (MIS-C): Th is is a rare complication that typically happens 2 to 4 weeks after SARSCoV-2 infection. Talk with your pediatrician if your child has symptoms such as fever without an obvious cause after having COVID-19 or being exposed to someone who did. MIS-C can get worse quickly, and children who develop this condition should be cared for in a pediatric/cardiac intensive care unit whenever possible.

Long-haul COVID-19 is a general term that covers physical and mental health symptoms that some patients experience four or more weeks after SARS-CoV-2 infection. No specifi c lab test can tell “longhaul COVID-19” apart from other conditions. If symptoms last beyond three months, your child’s doctor may recommend additional tests and possible referral to a specialized, multidisciplinary post-COVID-19 clinic.

After a COVID-19 diagnosis, talk with your pediatrician about any concerns, how to address them, and ways to help your child return safely to normal activities.

Dr. Sarah Risen is a pediatric neurologist in Houston, Texas, and a member of the American Academy of Pediatrics. For more information, go to HealthyChildren. org, the website for parents from the AAP.