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Long COVID in pediatrics-epidemiology, diagnosis, and management
Nicole Toepfner1, Folke Brinkmann2, Silvia Augustin3
1Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. Nicole.Toepfner@ukdd.de.
Insights
Post-acute sequelae of COVID-19 (PASC), or Long COVID, affects children and adolescents, causing activity limitations. Management requires an individualized, interdisciplinary approach to address diverse symptoms and needs.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Post-acute sequelae of COVID-19 (PASC), also known as Long COVID, presents a spectrum of unspecific symptoms beyond four weeks post-infection in children and adolescents.
- These symptoms can significantly impact daily activities and quality of life, even following mild acute COVID-19 infections.
Purpose of the Study:
- To review current knowledge on PASC and post-COVID-19 condition (PCC) in pediatric populations.
- To synthesize information on diagnosis, clinical manifestations, and management strategies for pediatric PASC/PCC.
Main Methods:
- A comprehensive literature review was conducted, synthesizing data from clinical studies, expert opinions, and established guidelines.
- Information was gathered on symptom presentation, diagnostic challenges, and therapeutic interventions for PASC in children and adolescents.
Main Results:
- Pediatric PASC/PCC often manifests after mild COVID-19, with common symptoms including fatigue and exertion intolerance, and can lead to conditions like postural tachycardia syndrome (PoTS) or ME/CFS.
- While many cases resolve within months, symptoms can persist for over a year, causing significant disability; diagnostic markers and causal treatments are currently unavailable.
- The World Health Organization (WHO) established a case definition for PCC in children and adolescents in February 2023, emphasizing symptom duration and impact on daily activities.
Conclusions:
- PASC in pediatric populations is characterized by heterogeneous severity and duration, necessitating a stepped, interdisciplinary, and individualized clinical management approach.
- Adaptation of current healthcare structures and expanded research are crucial to meet the medical and psychosocial needs of young individuals affected by PASC/PCC.
- Interdisciplinary collaborations are vital for developing harmonized, multimodal approaches to the diagnosis and management of PASC/PCC in children and adolescents worldwide.
Abstract:
This review summarizes current knowledge on post-acute sequelae of COVID-19 (PASC) and post-COVID-19 condition (PCC) in children and adolescents. A literature review was performed to synthesize information from clinical studies, expert opinions, and guidelines. PASC also termed Long COVID - at any age comprise a plethora of unspecific symptoms present later than 4 weeks after confirmed or probable infection with severe respiratory syndrome corona virus type 2 (SARS-CoV-2), without another medical explanation. PCC in children and adolescents was defined by the WHO as PASC occurring within 3 months of acute coronavirus disease 2019 (COVID-19), lasting at least 2 months, and limiting daily activities. Pediatric PASC mostly manifest after mild courses of COVID-19 and in the majority of cases remit after few months. However, symptoms can last for more than 1 year and may result in significant disability. Frequent symptoms include fatigue, exertion intolerance, and anxiety. Some patients present with postural tachycardia syndrome (PoTS), and a small number of cases fulfill the clinical criteria of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). To date, no diagnostic marker has been established, and differential diagnostics remains challenging. Therapeutic approaches include appropriate self-management as well as the palliation of symptoms by non-pharmaceutical and pharmaceutical strategies. Conclusion: PASC in pediatrics present with heterogenous severity and duration. A stepped, interdisciplinary, and individualized approach is essential for appropriate clinical management. Current health care structures have to be adapted, and research was extended to meet the medical and psychosocial needs of young people with PASC or similar conditions. What is Known: • Post-acute sequelae of coronavirus 2019 (COVID-19) (PASC) - also termed Long COVID - in children and adolescents can lead to activity limitation and reduced quality of life. • PASC belongs to a large group of similar post-acute infection syndromes (PAIS). Specific biomarkers and causal treatment options are not yet available. What is New: • In February 2023, a case definition for post COVID-19 condition (PCC) in children and adolescents was provided by the World Health Organization (WHO), indicating PASC with duration of at least 2 months and limitation of daily activities. PCC can present as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). • Interdisciplinary collaborations are necessary and have been established worldwide to offer harmonized, multimodal approaches to diagnosis and management of PASC/PCC in children and adolescents.
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