Ask the Pediatrician: Should parents be concerned about long-term COVID-19 effects in children? | Lifestyles
Q: My son had COVID-19 a few months ago and seems to have some lingering effects. Should I talk to his pediatrician?
A: Millions of American children and teens have tested positive for SARS-CoV-2, the virus that causes COVID-19. Fortunately, so far they are less likely than adults to get very sick.
But even if they had few or no symptoms, children can develop a number of other conditions after the COVID-19 infection. Some are small and may disappear on their own. Others are more serious and may need treatment.
After a COVID-19 diagnosis, talk to your child’s doctor about any persistent or new symptoms and what to do. Your pediatrician can also assist with your child’s safe return to activities, such as sports.
Here are some symptoms and conditions that can affect children after COVID-19 that you should discuss with the pediatrician:
— Respiratory problems: Because COVID-19 most commonly affects the lungs, persistent respiratory symptoms are not uncommon. These can include chest pain, coughing, and increased difficulty breathing during exercise. Some of these symptoms can last for three months or more. Children 6 years of age or older with persistent 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.
— Heart problems: Myocarditis, an inflammation of the heart muscle, can develop after COVID-19 (and in extremely rare cases receiving mRNA vaccines). A study of adult patients who recently recovered from COVID-19 suggested that 60% showed signs of myocarditis on cardiac 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 have had a COVID-19 infection in the past six months and have these symptoms should undergo a thorough examination, including heart testing, before returning to school or sports activities.
— Smell and taste: As many as 1 in 4 children and teens ages 10 to 19 who have had COVID-19 experience changes in their smell and taste. This can have a negative effect on their eating habits and mood. They may also notice dangerous odors.
These symptoms usually disappear within a few weeks. If not, your child’s doctor may recommend steps to test or retrain these senses.
— Developmental issues: Active COVID-19 disease can affect the brain and, in rare cases, lead to stroke or encephalitis (swelling of the brain). Severe brain inflammation can lead to marked problems in a child’s daily functioning, but children who have had mild or moderate COVID-19 infection can still experience subtle changes in attention, speech, schoolwork, movement and mood. Your pediatrician may refer you for follow-up with a neurological specialist, speech therapist, or physiotherapist or occupational therapist.
– Mental fatigue: “Brain fog” – unclear or “fuzzy” thinking, difficulty concentrating or memory problems – is a common complaint among adults who have had COVID-19. Children and teens may have similar symptoms. Your child may seem more forgetful or have trouble paying attention. They can read more slowly and need more repetition and pauses while learning. Make sure your child gets enough sleep and help them manage stress, which can make these symptoms worse. If mental fatigue after COVID-19 does not improve or interfere with daily activities, your child may benefit from a team-based assessment and recovery plan.
— Physical fatigue: After SARS-CoV-2 infection, children and teens may become fatigued more easily and have less physical stamina, even if they had no heart or lung symptoms from the virus. This usually improves over time. Your pediatrician may 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: Headaches are a common symptom during and after SARS-CoV-2 infection. Getting enough sleep, drinking plenty of water, eating regularly, and managing stress can help. If the headache is persistent and severe, your child’s doctor may recommend preventive medications.
— Mental and behavioral health: Having COVID-19 can affect a child’s mental health. For children with pre-existing mental/behavioural disorder, events surrounding COVID-19 (hospitalization, isolation, absence from school activities) can also exacerbate symptoms. Your pediatrician can monitor your child for signs of depression, anxiety, and other mental health problems, and advise when your child may need more support.
— Childhood Multisystem Inflammatory Syndrome (MIS-C): This is a rare complication that usually occurs 2 to 4 weeks after SARS-CoV-2 infection. Talk to your pediatrician if your child has symptoms such as a fever with no apparent cause after having had COVID-19 or being exposed to someone who has. MIS-C can worsen rapidly 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 specific lab test can distinguish “long-range COVID-19” from other conditions. If symptoms persist for more than three months, your child’s doctor may recommend additional testing and possible referral to a specialist, multidisciplinary post-COVID-19 clinic.
After a COVID-19 diagnosis, talk to your pediatrician about any concerns, how to address them, and ways to help your child return to normal activities safely.
ABOUT THE WRITER
dr. Sarah Risen is a pediatric neurologist in Houston, Texas, and a member of the American Academy of Pediatrics. For more information, visit HealthyChildren.org, the AAP’s parent website.
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