Scientists exploring long COVID in young people have discovered both similar and distinct patterns between children in the school-age group (ages 6-11) and adolescents (ages 12-17). They mapped out the most frequently reported symptoms.
Research supported by the National Institutes of Health (NIH) and published in JAMA examined this issue as part of the NIH’s Researching COVID to Enhance Recovery (RECOVER) Initiative. This ambitious project aims to understand, diagnose, treat, and prevent long COVID, a condition characterized by ongoing symptoms that occur after infection with SARS-CoV-2, the virus responsible for COVID-19.
Both children and adolescents were found to suffer from lingering symptoms affecting almost every organ system following a SARS-CoV-2 infection, with many experiencing symptoms in multiple systems.
“Most studies that describe long COVID symptoms tend to focus on adults, which can create the false impression that long COVID is uncommon in children or that their symptoms mirror those of adults,” explained David Goff, M.D., Ph.D., division director for the Division of Cardiovascular Sciences at the NIH’s National Heart, Lung, and Blood Institute. “Symptoms can differ from one child to another or appear in various patterns; without accurately detailing symptoms across different ages, it’s challenging to determine how to best support affected children and adolescents.”
The observational study assessed 3,860 children and adolescents with a history of SARS-CoV-2 infection at more than 60 locations in the United States from March 2022 to December 2023. Additionally, a control group of 1,516 children and adolescents without a prior SARS-CoV-2 infection was included to discern whether the extended symptoms in those who had COVID-19 were linked directly to SARS-CoV-2 or related to broader pandemic impacts.
Caregivers filled out a detailed symptom questionnaire covering 75 persistent symptoms across all major body systems, which occurred at least 90 days post-initial SARS-CoV-2 infection and lasted for a minimum of one month. They also provided insights into their child’s overall health, physical condition, and quality of life. Using a well-established statistical method, researchers distinguished which symptoms effectively differentiated participants with and without a SARS-CoV-2 infection history. They established specific symptom combinations for each age group that contributed to a long COVID research index, indicating a likely case of long COVID.
Researchers identified 18 prolonged symptoms that were particularly prevalent in school-age children, including headaches (57%), memory or focus issues (44%), sleep troubles (44%), and stomach pain (43%). Other frequent symptoms in this group, not part of the research index, included pain in the body, muscles, and joints; daytime fatigue or low energy; and feelings of anxiety.
In the adolescent group, 17 symptoms were commonly reported, including daytime fatigue or low energy (80%), pain in the body, muscles, or joints (60%), headaches (55%), and memory or focus difficulties (47%). Feelings of anxiety and sleep problems were also frequently noted but not included in the research index.
“The symptoms listed in the research index are not the only ones a child may experience, nor are they necessarily the most severe, but they are the best indicators of who might have long COVID,” stated Rachel Gross, M.D., an associate professor in pediatrics and population health at New York University Grossman School of Medicine and the primary author of the study.
Fourteen symptoms were found to overlap between the two age groups. Comparing this study with previous research on adults, it was noted that adults and adolescents shared more similar symptoms, such as alterations in smell or taste. Conversely, there was less overlap between adults and school-age children, highlighting the need for ongoing age-specific long COVID research.
The study developed distinct research indexes for school-age kids and adolescents along with shared, yet unique symptom patterns within each age group. Among the 751 school-age children who had COVID-19, 20% met the criteria for the long COVID research index. For the 3,109 adolescents with a SARS-CoV-2 infection history, 14% met the research index criteria, but the researchers cautioned that these figures shouldn’t be viewed as overall incidence rates, as their study may have included more children with long COVID than the general population.
Researchers point out that the research index is primarily a framework for identifying common symptoms for research purposes rather than a clinical care guide and will likely be refined as further studies are conducted involving children with and without long COVID.
“Our next goal is to examine children aged 5 years and younger to deepen our understanding of long COVID in very young patients,” said Gross.
In line with NIH’s Data Sharing and Management Policy, a dataset containing RECOVER Pediatric Observational Cohort Study data collected until June 15, 2024 — which includes the data used for this publication — will be made available on NHLBI BioData Catalyst® this fall.
This research was supported by NIH under award numbers OT2HL161841, OT2HL161847, and OT2HL156812, with additional assistance from grant R01 HL162373. The content reflects the views of the authors and does not necessarily represent the official stance of the NIH. For more information about RECOVER, visit https://recovercovid.org
