Italian intersociety consensus on management of long covid in children

Abstract

Background Two sequelae of pediatric COVID-19 have been identified, the multisystem inflammatory syndrome in children (MIS-C) and the long COVID. Long COVID is much less precisely defined and includes all the persistent or new clinical manifestations evidenced in subjects previously infected by SARS-CoV-2 beyond the period of the acute infection and that cannot be explained by an alternative diagnosis. In this Intersociety Consensus, present knowledge on pediatric long COVID as well as how to identify and manage children with long COVID are discussed. Main findings Although the true prevalence of long COVID in pediatrics is not exactly determined, it seems appropriate to recommend evaluating the presence of symptoms suggestive of long COVID near the end of the acute phase of the disease, between 4 and 12 weeks from this. Long COVID in children and adolescents should be suspected in presence of persistent headache and fatigue, sleep disturbance, difficulty in concentrating, abdominal pain, myalgia or arthralgia. Persistent chest pain, stomach pain, diarrhea, heart palpitations, and skin lesions should be considered as possible symptoms of long COVID. It is recommended that the primary care pediatrician visits all subjects with a suspected or a proven diagnosis of SARS-CoV-2 infection after 4 weeks to check for the presence of symptoms of previously unknown disease. In any case, a further check-up by the primary care pediatrician should be scheduled 3 months after the diagnosis of SARS-CoV-2 infection to confirm normality or to address emerging problems. The subjects who present symptoms of any organic problem must undergo a thorough evaluation of the same, with a possible request for clinical, laboratory and / or radiological in-depth analysis in case of need. Children and adolescents with clear symptoms of mental stress will need to be followed up by existing local services for problems of this type. Conclusions Pediatric long COVID is a relevant problem that involve a considerable proportion of children and adolescents. Prognosis of these cases is generally good as in most of them symptoms disappear spontaneously. The few children with significant medical problems should be early identified after the acute phase of the infection and adequately managed to assure complete resolution. A relevant psychological support for all the children during COVID-19 pandemic must be organized by health authorities and government that have to treat this as a public health issue.

Cognitive Difficulties, Psychological Symptoms, and Long Lasting Somatic Complaints in Adolescents with Previous SARS-CoV-2 Infection: A Telehealth Cross-Sectional Pilot Study

“…These findings are consistent with the recent literature, showing the persistence of at least one complaint, even after 120 days from the initial diagnosis, regardless of the clinical features of the illness. According to previous findings, the most common somatic complaints described in our sample were headache and numbness/weakness, while subjective attention difficulty was the most reported cognitive symptom [ 20 , 21 , 22 ].…”

“…Increasing research has explored the prevalence and impact of long-COVID on health and quality of life in pediatric age [ 10 , 11 , 19 , 20 , 21 ]. The most commonly reported symptoms resemble those described in the adult populations, with a prevalence of headache ranging from 3 to 80%, fatigue ranging from 3 to 87%, and concentration difficulties ranging from 2 to 81% [ 22 , 23 ].…”

‘Long COVID’: Symptom persistence in children hospitalised for COVID‐19

“… 18 Therefore, it is plausible to assume that symptoms compatible with long‐COVID may persist for an extended period of time in some patients. 19 , 20 Any persistent medical problems in children and adolescents, who are suffering from long‐COVID, should be identified after the acute phase of the infection and adequately managed to assure complete resolution. 19 …”

COVID-19-related headache and innate immune response — a narrative review

“…Headache is a common symptom of post-COVID-19 syndrome included in some diagnostic guidelines [84]. A study assessing data from 905 subjects with COVID-19-related headache showed that 31.1% of patients still had headache after one month, 16.8% after three months, and 16% after nine months [2].…”