Study: Long COVID symptoms in children vary by age

(Press-News.org) Symptoms associated with Long COVID in children differ based on the child’s age, according to a nationwide, multi-site study. The research will be presented at the Pediatric Academic Societies (PAS) 2024 Meeting, held May 3-6 in Toronto. 

Experts say that the study findings allow clinicians to recognize and manage Long COVID in children more accurately based on common symptoms. The study characterized pediatric Long COVID symptoms and how they differ based on a child’s age. The study identifies symptoms in different age groups including young children, such as infants, toddlers, and preschool-age children (birth to five years); school-age children (six to 11 years); adolescents (12 to 17 years); and young adults (18 to 25 years). Researchers compared prolonged symptoms in participants with and without a history of a COVID-19 infection to identify symptoms mostly highly linked with Long COVID. 

According to the findings, school-age children, adolescents, and young adults with a history of a COVID-19 infection had many prolonged symptoms in common, including low energy; tiring after walking; headaches; body, muscle, and joint pains; lightheadedness or dizziness; trouble concentrating or focusing; and gastrointestinal symptoms, like nausea and vomiting.

Some symptoms varied by age with school-age children having more prolonged phobias or fears of specific things and school refusal, and adolescents having more fears of crowds or enclosed spaces and panic attacks compared to similarly aged children without a COVID-19 infection history. Research showed that change in smell or taste was more commonly described by adolescents and young adults, and chest pain and palpitations were more common in young adults, but not in the younger age groups.

The study found that young children between birth and five years old with a prior COVID-19 infection were more likely to have general symptoms, including poor appetite, trouble sleeping, and fussiness, and prolonged respiratory symptoms like stuffy nose and cough, compared to young children without a known prior COVID-19 infection.

“These findings underscore the importance of characterizing Long COVID in children while researchers are still discovering the long-term effects of COVID-19 infection in this age group,” said Rachel Gross, MD, MS, associate professor of pediatrics and population health at New York University Grossman School of Medicine and presenting author. “This research is important because clinicians can appropriately diagnose and treat Long COVID when they better understand how different age groups are affected by the condition.”

Researchers surveyed 7,229 caregivers and children enrolled in the National Institutes of Health’s Researching COVID to Enhance Recovery (RECOVER)-Pediatrics study, 75% of whom had reported having had a COVID-19 infection.

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EDITOR:

Dr. Rachel Gross will present “Spectrum of Clinical Symptoms Identified as Long COVID from Infancy Through Young Adulthood: First Look Results from the NIH-Funded RECOVER (Researching COVID to Enhance Recovery) Initiative” on Saturday, May 4 from 11:15-11:30 AM E.T.

Reporters interested in an interview with Dr. Gross should contact Amber Fraley at amber.fraley@pasmeeting.org.

The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information, please visit www.pas-meeting.org.

About the Pediatric Academic Societies Meeting

Pediatric Academic Societies (PAS) Meeting connects thousands of leading pediatric researchers, clinicians, and medical educators worldwide united by a common mission: Connecting the global academic pediatric community to advance scientific discovery and promote innovation in child and adolescent health. The PAS Meeting is produced through the partnership of four leading pediatric associations; the American Academy of Pediatrics (AAP), the Academic Pediatric Association (APA), the American Pediatric Society (APS), and the Society for Pediatric Research (SPR). For more information, please visit www.pas-meeting.org. Follow us on X @PASMeeting and like us on Facebook PASMeeting.

Abstract: Spectrum of Clinical Symptoms Identified as Long COVID from Infancy Through Young Adulthood: First Look Results from the NIH-Funded RECOVER (Researching COVID to Enhance Recovery) Initiative.

Presenting Author: Rachel Gross, MD, MS

Organization

New York University Grossman School of Medicine

Topic

General Pediatrics: All Areas

Background

The CDC considers Long COVID to be persistent, relapsing, or new symptoms occurring ≥4 weeks after a SARS-CoV-2 infection. The absence of a specific clinical phenotype challenges the ability to diagnosis, prevent, and treat Long COVID in children.

Objective

Characterize Long COVID in children in an inclusive national sample; and determine how symptoms vary across the early life course (infancy [0-2 years], preschool [3-5], school-age [6-11], adolescence [12-17], young adulthood [18-25]).

Design/Methods

RECOVER-Pediatrics is an NIH-funded, longitudinal, multi-site observational study of persons age 0-25 years, recruited from healthcare and community settings in >100 US sites. Participants with and without a history of SARS-CoV-2 infection were newly recruited into RECOVER and from the Adolescent Brain Cognitive Development (ABCD) cohort. Baseline surveys and blood collection for antiviral antibody levels were completed. Participants were screened for 95 symptoms across 9 body systems that lasted ≥4 weeks and started or worsened since the beginning of the pandemic. Uninfected participants without a negative antibody screen were excluded, as were those enrolled as infected if < 90 days had elapsed between their first SARS-CoV-2 infection and enrollment. The proportion experiencing each symptom was compared between infected and uninfected groups by calculating unadjusted risk differences and fitting logistic regression models adjusted for sex and race/ethnicity. Symptoms that were present in ≥5% of either infected or uninfected groups were examined. The top 15 symptoms with the largest unadjusted risk difference and adjusted odds ratio were considered to be most highly linked with Long COVID.

Results

Of the 5914 participants, 75% were infected; 51% female; 62% white; 11% Black; 24% Hispanic (Table 1). Median (IQR) time after SARS-CoV-2 infection that symptoms were measured was 15.6 months (9.8, 25.0). An excess symptom burden between infected and uninfected was detected across multiple body systems, even in infancy. Symptoms with the highest excess burden differed with age: infants exhibited primarily general and respiratory (e.g., cough) symptoms; preschoolers had those plus GI and ENT (e.g., stuffy nose) symptoms; school-age children mostly exhibited general and ENT symptoms; and adolescents/young adults had loss of taste/smell and pain (Table 2, Fig 1).

Conclusion(s)

In this large-scale study, an excess symptom burden after infection was seen across all age groups. A clear pattern of differences among age groups underscores the importance of characterizing Long COVID across the early life course.

Tables and Images

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