Identifying the Most Common Long COVID Symptoms in Children and Adolescents

Long COVID, a condition characterized by persistent symptoms following a COVID-19 infection, is becoming increasingly recognized in children and adolescents. A new study, part of the NIH’s RECOVER Initiative and published in the Journal of the American Medical Association, sheds light on what long COVID looks like in young people, offering new insights that could improve diagnosis and treatment.

Led by researchers from Columbia University and other institutions, the study involved over 5,300 school-age children and adolescents. The researchers identified the most common symptoms of long COVID in these groups and developed indices—eight for children aged six to 11 and ten for adolescents aged 12 to 17—that can help guide further research.

The indices are not yet intended for clinical use but serve as a valuable tool for researchers aiming to better understand and address long COVID in young populations. "Many pediatric and adolescent patients with long COVID are really suffering," said Melissa Stockwell, MD, a senior author of the study and Chief of the Division of Child and Adolescent Health at Columbia University. "Knowing which symptoms are likely to indicate long COVID in children and teens will hopefully help us develop strategies to support their recovery."

According to the study, millions of children in the United States are believed to be living with long COVID, experiencing symptoms that can linger, reoccur, or develop weeks or months after their initial COVID infection. However, research on long COVID in children has been limited, often focusing on single symptoms or using adult data, which can lead to misdiagnoses or underestimation of the condition in the pediatric population.

This study marks the first data-driven approach to identifying symptom patterns specific to children and adolescents with long COVID. "This work provides a clearer picture of how long COVID manifests in young people, distinct from adults," explained Tanayott Thaweethai, MD, co-first author of the study and an instructor in medicine at Harvard Medical School.

The research revealed distinct differences in how long COVID affects children versus adolescents. For teens, symptoms such as fatigue, pain, and changes in taste and smell were prominent. In contrast, younger children more commonly experienced difficulty focusing, sleep problems, and stomach issues.

These findings highlight the complexity of long COVID, which often impacts multiple organ systems in affected youths. The study also noted a decrease in the prevalence of long COVID symptoms among children and teens following the emergence of the Omicron variants in late 2021, though the reasons for this trend are not yet fully understood.

The indices developed from this research will likely evolve as more data becomes available. "The research index is a starting point for further studies and is not intended for clinical use at this time," said Rachel Gross, MD, co-first author and associate professor at NYU Langone. "However, it lays the groundwork for future research that could eventually lead to more accurate diagnostics for children and adolescents with long COVID."

The researchers said they are continuing to refine these indices and are now focusing on developing similar tools for even younger children. The goal, they explained, is to build a comprehensive understanding of long COVID across all pediatric age groups, ultimately leading to more effective diagnostics and treatments.