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Interdisciplinary Pediatric Long-COVID Care: A Descriptive Study of Interventions and Health-Related Quality of Life
David W Miller1,2,3, Samuel N Rodgers-Melnick1,2, Nada Tharwat Deraz2,3
1Connor Whole Health, University Hospitals of Cleveland, Cleveland, Ohio, USA.
Insights
Pediatric long-COVID patients experience significant fatigue, headache, and anxiety. Integrative care clinics offer interventions like diet changes and pacing, but symptom severity remains high compared to national norms.
Area of Science:
- Pediatric Medicine
- Infectious Diseases
- Integrative Health
Background:
- Limited data exists on pediatric long-COVID, particularly regarding integrative care and patient-reported quality of life.
- Existing studies primarily focus on symptom prevalence and incidence, lacking comprehensive clinical descriptions.
Purpose of the Study:
- To describe the demographic, clinical, symptom severity, and intervention characteristics of pediatric long-COVID patients.
- To evaluate patient-reported outcomes (PROs) including wellbeing, fatigue, sleep, depression, and anxiety.
- To highlight the collaborative approach between infectious disease and integrative medicine in managing pediatric long-COVID.
Main Methods:
- Retrospective analysis of electronic health records for 214 pediatric patients (ages 4-25) with long-COVID.
- Utilized validated PRO measures (PedsQL, PROMIS) for a subset of patients to assess wellbeing and symptom burden.
- Documented common conditions, interventions, and compared PRO scores to national and chronic disease cohort norms.
Main Results:
- Common symptoms included fatigue (85%), headache (75.2%), dizziness (64.5%), anxiety (62.1%), and nausea (59.3%).
- Interventions focused on diet changes (81.8%), pacing (65.9%), sleep hygiene (61.2%), and self-care techniques.
- Patients reported significantly elevated PROMIS scores for sleep disturbance, sleep-related impairment, anxiety, and depression, alongside severe PedsQL fatigue scores, exceeding national norms.
Conclusions:
- Pediatric long-COVID is associated with a substantial symptom burden affecting quality of life.
- Integrative care models show promise in addressing complex pediatric long-COVID cases.
- Further research with diverse populations is crucial to validate the effectiveness of integrative care strategies for pediatric long-COVID.
Objectives:
Data on pediatric long-COVID is limited to descriptive reports of symptom prevalence and incidence, with few studies describing integrative care or including patient-reported quality of life. This study describes demographic, clinical, symptom severity, and intervention characteristics within a pediatric long-COVID clinic involving collaboration between infectious disease and integrative medicine physicians.
Methods:
Clinical data were extracted from the electronic health records for patients aged 4-25 with long-COVID seen within this clinic. A subset of patients completed validated PROs of wellbeing, fatigue, sleep-related impairment and disturbance, depression, and anxiety.
Results:
A cohort of 214 patients (mean age 14.7, 61% female, 83% White) were seen between March 2021 and June 2023, with 39.7% providing Pediatric Quality of Life Inventory (PedsQL) and 30.3% providing Patient-Reported Outcomes Measurement Information System (PROMIS) measures. Common documented conditions included fatigue (85%), headache (75.2%), dizziness (64.5%), anxiety (62.1%), and nausea (59.3%). Common interventions included diet changes (81.8%), pacing (65.9%), sleep hygiene (61.2%), and other self-care techniques (46.7%). The long-COVID cohort reported elevated PROMIS sleep disturbance (61.79), sleep-related impairment (63.9), anxiety (58.1), and depression (58.1) as well as PedsQL total fatigue (40.19). These scores were more severe than national norms as well as compared with other pediatric chronic disease cohorts (eg, chronic pain, cancer, sickle cell disease, autism).
Conclusions:
Pediatric patients with long-COVID report high symptom burden. This study describes patient characteristics, care delivered and provides a novel description of symptom severity. Future research among more diverse populations is needed to evaluate outcomes of this integrative care.
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