#72: Kids & Long-Haul Symptoms after Covid: What you Need to Know

January 27, 2022

Post-Covid Symptoms in Kids/Teens: What you Need to Know

In the beginning of the pandemic pediatricians and parents held their breath as we watched Covid-19 infect people all over the world. I, like you, watched the news and heard about the increase in hospitalizations and deaths, primarily of older people and those with preexisting medical conditions. . It seemed that for some reason, in this pandemic, kids would be for the most part spared from the more severe aspects of Covid. Parents reported mostly mild symptoms in kids. In the back of my mind though, and probably in the back of yours too, I wondered what this virus is really doing that we still don’t know or understand yet.

Fast forward now and we are 2 years into the pandemic, and while there is a lot we know there is also a lot we don’t know. In the office older kids and teens began to report signs of chest pain, shortness of breath, fatigue, and headaches after having Covid. I started to wonder if maybe smaller kids were feeling this too but couldn’t explain it. Maybe they just seemed more cranky and parents didn’t even think of a possible connection to Covid. New studies are coming out that are confirming that sadly this is true.

How Many Kids are Having Long Haul Symptoms?

No one actually knows how many kids who have had symptomatic or asymptomatic Covid go on to be long-haulers. In one study, close to half of teens and young adults between 16- 30 years report symptoms that are persisting 6 months after having Covid. The question is what about the little kids? Sometimes it is difficult for younger kids to express how they feel. It may be a long time before we have a full grasp on the effects of Covid in children. Close to 15% of kids who have had Covid are reporting symptoms consistent with long-haul Covid. The number is probably much higher since it is hard to sometimes connect the symptoms with having had a Covid infection at all. The severity of the disease does not predict the appearance of long-haul Covid symptoms.

What are the symptoms?

The long-haul symptoms are often vague, different for everyone and are often showing up weeks after a mild or even asymptomatic case. In this last wave of Omicron we saw many children become infected with Covid and it’s important that you’re aware of what the chronic symptoms may look like and when to seek help.

First, we consider symptoms that persist or begin after 30 days from the start of a Covid infection, long haul or PASC (post acute sequela of Covid) In adults, about 10% of patients go on to experience long haul symptoms. Here are some of the more common ones:

Anosmia or Panosmia – For some reason, a mechanism that is not entirely clear, some people develop anosmia (loss of smell) after having a Covid infection. Thankfully for most people it improves after a few weeks but for others, the symptoms can persist while others go on to have panosmia (altered sense of smell). This means that things smell different than they used to. For example coffee may smell like rotten eggs, or your favorite food may taste like smelly fish or cigarettes. While this may seem unimportant to you, our sense of smell is extremely important. It is a way for us to recognize potentially dangerous things, like smoke or burning. Smell is also intrinsically tied to our sense of taste so it can definitely alter the taste of things that perhaps you used to enjoy. Anosmia is not a new thing and can develop after brain injuries and/or other infections. It can cause anxiety, weight loss and depression in those who develop this long term. We should be hypervigilant to look for this in children who perhaps reject certain foods that they once loved or don’t respond to a strong smell when presented with it. Thus far, the results from some studies have shown a benefit to using inhaled steroids in the first weeks of the loss of smell but it is not 100%. Others have shown equal improvements with smell therapy (when you smell different smells for 20 seconds at least 3 at a time for a few days and then repeat and change the smells.
Brain Fog and Fatigue – Again, for reasons poorly understood, many patients with long term effects of Covid go on to develop “brain fog” and fatigue. In children this can present as having difficulty concentrating in school, excessive tiredness and/or misbehavior.
Dizziness/ Palpitations and Tachycardia – As scary as it sounds, even patients that have mild forms of Covid 19 can develop myocarditis and/or other cardiac symptoms. This is especially concerning in student athletes competing at high levels. Oftentimes these athletes are pushed to compete and perform despite their physical limitations. It is extremely important that if you see any signs of early fatigue, complaints of chest pain or even your child telling you that their heart is beating faster than normal, pay attention. Seek the guidance of a cardiologist. The earlier the better. When having sports physicals, consider asking for a screening EKG if available where you live. Although this will not pick up all cardiac problems, it is a good place to start. Listening to your kids, though, is the most important thing.
Shortness of Breath/ Chest Pain – It’s no secret that Covid 19 can cause respiratory problems, as we saw early on in the pandemic. I think it’s safe to say that most of us now have a pulse oximeter at home when maybe that thought had never crossed our minds! Suddenly all of us wanted to know our oxygen levels as it was an important way to measure our oxygen levels at home and determine our need to go to the ER. (personally this made my telemedicine visits much better when assessing respiratory status on a screen) ** A note on this below since it does have to be used correctly and does come in different sizes for children and infants. Not using it properly can cause undue anxiety.
Headaches – This symptom can often be a frustrating one since headaches can result from many different things. The bottom line is pay attention to your kids. If they complain of recurrent headaches, begin a log and jot down when they complain so that you can see patterns, increase in severity and frequency, or conversely a decrease as well. Pay attention to when in the day your child is having headaches. In general headaches that are waking a child from sleep, worse in the morning and/or increasing in severity and frequency should be evaluated.
Anxiety and Depression – Patients with long haul symptoms ranked anxiety and depression on the top of their list of concerns.

So What Can we do?

VACCINATE: First if your child is vaccine eligible, vaccinate.

We are seeing that patients who are vaccinated are less likely to develop long-haul symptoms of Covid than those who are vaccinated. This is so important! Kids have a long (hopefully healthy) life ahead of them so the fact that the vaccines are showing to decrease the chances of developing long haul symptoms by upto half if they have a breakthrough infection, is very significant!
Not only were they less likely to develop the symptoms, but their symptoms were milder as well. About a third as likely to report any severe symptoms.
The vaccinated were also 70% less likely to require hospitalization.

DON’T PANIC : Not everything is due to Covid. There are still common illnesses and reasons for children to have symptoms like the ones explained above. If you are concerned, try to keep a log of your child’s complaints, changes in mood/behavior, sleep patterns, school performance and discuss any concerns with your pediatrician.
Early Intervention:

Most adults that are suffering from long haul symptoms improve gradually with early intervention not only for their physical symptoms but their psychological symptoms as well.
Cognitive Behavioral Therapy has shown promising results. So if you are seeing signs of anxiety and/or depression in your children, seek help, speak with your doctor and believe your child. When someone is feeling anxious and/or depressed the worst feeling is to feel like no one is listening. So if you don’t know what to say or what to do, just listen, believe them and find them some help.

What Has Helped Patients with Long Haul Symptoms?

There is still so much that we do not know or understand about the long term effects of Covid infections and it will probably be a while. In the United States, there have been numerous clinics opening up to address the long-haul symptoms of adults but very few are for children. Also, in the clinics available for children, the patients seeking care are from literate families that have the means to research and seek this specialized care.

I worry that there is a large patient population, specifically minorities like blacks and hispanics that are not aware of this possibility and of the resources available to help their children.

What Have they Learned From Adults with Long-Haul Symptoms?

The good news is that although many adults report symptoms 6 months after infection, many of them improve significantly with time. Early intervention in both physical and mental health support helps to haste their improvement. This is not surprising as our minds have a lot to do with our overall health. Addressing one without the other does not make sense.

The other good news is that going back to the essentials also helps patients recover more quickly. We all need 4 things in our life and this has nothing to do with Covid. We all need:

healthy nutritious foods
sleep (check table below for how much your child needs)
exercise (anything!)
lots and lots of water.

So before you panic with any of the above symptoms, make sure your child checks off all these boxes and see if the symptoms improve.

If symptoms persist, worsen or just don’t make sense to you, make an appointment with your doctor and see a specialist if warranted. Hopefully, and I have faith that we will, in a few years we will understand this virus more and more and will have the right tools in place to treat, prevent and resolve these frustrating effects of Covid 19.

What is the Medical Community doing to Help Patients with Long Haul Symptoms?

There are clinics around the country opening up addressing these symptoms in adults and many focusing on children as well.

Three notable ones are at:

The University of Michigan:

https://www.mottchildren.org/conditions-treatments/ped-respiratory-care/post-COVID-clinic

In Baltimore at Kennedy Krieger https://www.kennedykrieger.org/patient-care/centers-and-programs/pediatric-post-covid-19-rehabilitation-clinic and in Washington, D.C. at https://childrensnational.org/departments/post-covid-program.

While now many of them have long wait lists, I am hoping that other academic centers will also begin to open up to help their communities.

There are also countless scientists studying the effects of Covid and I provided some of these resources below in case you are interested in being a part of these studies or following along.

I worry that what began as a virus that appeared to be targeting only the eldery and chronically ill has in reality been silently affecting people, including children, in ways that we do not understand. I just want to make sure that you are aware of this and will share this information with loved ones and friends. We will all need to work together to ensure that our children fully recover both physically and mentally from this pandemic.