How can GPs best spot long COVID cases in children?

New research has shed light on the varying symptoms children with long COVID may experience in comparison to adults, finding the number of young people with the illness could be significantly underestimated.
 
The American study aimed to identify the most common prolonged symptoms experienced by children aged 6–17 years following a COVID-19 infection, with the researchers saying this cohort had been widely overlooked post-pandemic.
 
Study co-author Dr Melissa Stockwell says the work shows the ‘significant impact long COVID has on children and adolescents’.
 
The researchers found four distinct symptom clusters in school-age children and three in adolescents, suggesting there may be different types of long COVID that children experience.
 
They found significant differences in symptoms for children with long COVID and noted that symptoms ‘affected almost every organ system’.
 
‘The index emphasises neurocognitive, pain, and gastrointestinal symptoms in school-age children but change or loss in smell or taste, pain, and fatigue/malaise-related symptoms in adolescents,’ the research states.
 
The study, which is part of the Researching COVID to Enhance Recovery (RECOVER) Initiative, included 751 COVID-19 infected and 147 uninfected school-age children, along with 3109 infected and 1369 uninfected adolescents at more than 60 health care institutions across the United States.
 
Chair of RACGP Specific Interests Child and Young Person’s Health, Dr James Best, thinks the results reflect ‘just how little we know’ about long COVID.
‘It’s a very difficult area of research, but probably suggests that we should be doing more of it,’ he told newsGP.
 
‘We need to think of long COVID in children, which may not have been front of mind up until now.’
 
But some presenting symptoms used in the research are quite broad, Dr Best says.
 
‘It’s very hard to figure out what is what here, because what are being classified as potential long COVID symptoms are very non-specific,’ he said.
 
Although previous studies have suggested just 1% of paediatric COVID-19 cases will develop into long COVID or lead to long-term complications, this study estimates that figure could be as high as 20%.
 
Dr Best says that figure is unexpected, when compared to previous research, and that more work needs to be done.
 
‘Some of the issues that were being flagged were very significant for the children that were involved,’ he said.
 
‘We have to see this replicated in other studies, just so we get a better feel for it because it is a surprisingly high figure.’
 
Earlier this month, Australian researchers expanded the popular COVID-19 Risk Calculator’s (CoRiCal) to include long COVID, allowing GPs to undertake a personalised assessment of a patients risk of developing the condition six months after infection.
 
Similarly in the US, the research team is now developing an index to help identify long COVID in younger patients, but that tool is not yet ready for clinical use.
 
Researcher and study author Associate Professor Rachel Gross says this tool is a ‘first step’ to identifying long COVID in a ‘widely understudied group’.
 
‘While this provisional measurement tool may be used for ongoing research, we recognise that any one symptom, including those not in the index, may be sufficient to indicate the presence of long COVID in any given child,’ she said.
 
‘It will likely change and expand as we learn more.’
 
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children’s health COVID COVID-19 long COVID paediatrics