There is increasing evidence that adult patients diagnosed with acute COVID-19 suffer from Long COVID. A recent large cohort of 1,733 patients from Wuhan found persistent symptoms in 76% of patients 6 months after initial diagnosis. To date, data on Long COVID in children are lacking. We assessed persistent symptoms in pediatric patients previously diagnosed with COVID-19.
A cross-sectional study, in collaboration with prof. Piero Valentini, dr. Angelo Carfi, Dario Sinatti, Cristina De Rose, Antonia Ricchiuto and FIMP-Roma, included all children ≤18 years old diagnosed with microbiologically-confirmed COVID-19 in Fondazione Policlinico Universitario “A. Gemelli” IRCCS (Rome, Italy). Patients > 18 years old or with severe disability were excluded. Caregivers were interviewed about their child’s health using a questionnaire (supplementary material) developed by the Long Covid ISARIC study group, for evaluation of persistent symptoms.
Participants were interviewed by two pediatricians, either online or in the outpatient department, from September 1st to January 1st. Participants were categorized into groups according to symptoms status during the acute phase (symptomatic/asymptomatic), need for hospitalization and time from COVID-19 diagnosis to follow-up evaluation (< 60, 60-120, > 120 days).
129 children diagnosed with COVID-19 between March and November 2020 were enrolled (mean age of 11 ± 4.4 years; 62 female, corresponding to 48.1% of the group). Subsequently, three developed Multisystem Inflammatory Syndrome (2.3%) and two myocarditis (1.6%). Patients were assessed on average 162.5 ± 113.7 days after COVID-19 microbiological diagnosis. 41.8% completely recovered, 35.7% had 1 or 2 symptoms and 22.5% had 3 or more. 52.7% had at least one symptom 120 days or more after diagnosis.
Insomnia (18.6%), respiratory symptoms ‒ including pain and chest tightness (14.7%), nasal congestion (12.4%), fatigue (10.8%), muscle (10.1%) and joint pain (6.9%), and concentration difficulties (10.1), were the most frequently reported symptoms. Although they were more common in symptomatic or hospitalized children, they were also described in those individuals who were asymptomatic during acute phase. 29 out of the 68 (42.6%) children assessed ≥120 days from diagnosis were still distressed by these symptoms.
Children have been mostly overlooked during this pandemic, since the clinical course of COVID-19 in this group is much milder than in adults (4). However, there is an increasing evidence that restrictive measures aimed at limiting the pandemic are having a significant impact on child’s mental health (5). Childhood is a delicate and fundamental period of life, critical for acquisition of social, behavioral and educational development.
The evidence that COVID-19 can have long-term impact on children as well, including those with asymptomatic/paucisymptomatic COVID-19, highlights the need for pediatricians, mental health experts and policy makers of implementing measures to reduce impact of the pandemic on child’s health.