Long COVID in Children: A Multidisciplinary Review

Abstract

Long COVID syndrome has emerged as a long-lasting consequence of acute SARS-CoV-2 infection in adults. In addition, children may be affected by Long COVID, with potential clinical issues in different fields, including problems in school performance and daily activities. Yet, the pathophysiologic bases of Long COVID in children are largely unknown, and it is difficult to predict who will develop the syndrome. In this multidisciplinary clinical review, we summarise the latest scientific data regarding Long COVID and its impact on children. Special attention is given to diagnostic tests, in order to help the physicians to find potential disease markers and quantify impairment. Specifically, we assess the respiratory, upper airways, cardiac, neurologic and motor and psychological aspects. Finally, we also propose a multidisciplinary clinical approach.

Lung function assessment in children with Long‐Covid syndrome

“…In the absence of permanent functional abnormalities, symptoms such as fatigue and exercise intolerance might be explained by muscle deconditioning, and behavioral changes induced by lockdown and social isolation. 36 In a prospective cohort study, including 518 Russian children aged 10 years with previous SARS-CoV-2 infection, 5% of the parents reported emotional and behavioral changes of their children, such as changes in eating habits, emotional wellbeing and physical activities. 37 Indeed, 10% of the children were spending more time on social-media and virtual platforms for educational and recreational purposes, avoiding face-to-face communication with their peers.…”

“…40,41 Specifically, Cameli et al 40 COVID-19 at 3-6 months from the recovery. 36 Nitric oxide has an antimicrobial action versus bacteria, fungi, parasites and selected viral species, and its production increases during viral infections. 43 Hence, we speculated that lower levels of FeNO might have favored the viral persistence in the respiratory airways even months after the acute infection, inducing low levels of the immune activation.…”

“…However,, the authors observed increased CaNO levels in the severe/critical disease group compared to the mild disease one. Contrarily, Lindahl et al 42 found normal FeNO and CaNO levels in adult patients previously hospitalized for severe COVID‐19 at 3‐6 months from the recovery 36 . Nitric oxide has an antimicrobial action versus bacteria, fungi, parasites and selected viral species, and its production increases during viral infections 43 .…”

“…Similarly, Rinaldo et al 35 studied a cohort of 91 adult COVID‐19 survivors by cardiopulmonary exercise testing, with the most frequently observed abnormality consisting in early anaerobic threshold likely induced by muscle deconditioning. In the absence of permanent functional abnormalities, symptoms such as fatigue and exercise intolerance might be explained by muscle deconditioning, and behavioral changes induced by lockdown and social isolation 36 . In a prospective cohort study, including 518 Russian children aged 10 years with previous SARS‐CoV‐2 infection, 5% of the parents reported emotional and behavioral changes of their children, such as changes in eating habits, emotional wellbeing and physical activities 37 .…”

Long COVID in Children, Adults, and Vulnerable Populations: A Comprehensive Overview for an Integrated Approach

“…Fatigue and chronic fatigue syndrome (CFS) are common symptoms in children affected by long COVID [66,67]. In an English CLoCK study, fatigue, in addition to concentration problems and headaches, was the most frequent symptom in the case group [28].…”