Long covid causes very different symptoms in children versus teenagers

Long covid symptoms appear to differ substantially between younger children and adolescents. A better understanding of how the condition can present could aid diagnoses.

To date, most long covid research has focused on adults. That is partly due to a “misperception that children don’t get long covid”, says Rachel Gross at New York University.

Now, Gross and her colleagues have tracked 751 children aged 6 to 11 and 3109 aged 12 to 17, who had previously had an infection with the SARS-CoV-2 virus, according to their caregivers.

The researchers defined long covid as having at least one symptom that lasted for more than one month, started or became worse during the covid-19 pandemic and was present at the time of the study.

Among the younger children, these symptoms mainly included sleep problems, trouble focusing and abdominal issues, such as pain, nausea, vomiting and constipation.

These symptoms were much less common among nearly 150 children of the same age who hadn’t previously been infected, verified by them having no antibodies against the virus in their blood samples.

In contrast, the teenagers’ long covid symptoms generally included pain, fatigue and a loss of smell or taste, compared with 1300 of their uninfected counterparts.

Why these different symptoms occur between the age groups is unclear, but it could be down to variations in their hormonal and immune systems, says Gross. Alternatively, teenagers may simply be better able to vocalise their symptoms than younger children, says Danilo Buonsenso at the Gemelli University Hospital in Rome, Italy. For example, a teenager may complain of fatigue, while caregivers may only notice that a younger child has prolonged symptoms when they vomit.

Off the back of this data, the researchers have developed a score that ranks how closely a young person’s symptoms correspond to possibly having long covid. Currently, diagnoses hinge on doctors ruling out other conditions and being aware of the different forms long covid can take. “Doctors like to have scores or more objective criteria, and these kinds of tools are definitely useful to help clinicians to at least recognise a child can have long covid,” says Buonsenso.