How many patients in your practice were hospitalized for COVID-19, MIS-C, or a post-COVID-19 condition? According to a study released in the June 2022 edition of Pediatrics, over 1 in 4 children had symptoms that lasted 2 months or more after their hospitalization. The way that pediatricians for kids with post-COVID-19 symptoms is evolving as study continues; here’s what we know so far about how to care for kids with post-COVID conditions, including “long COVID,” MIS-C, obesity, PTSD, and more.
Post-COVID Conditions in Pediatrics
Pediatric patients recovering from COVID-19 or related post-COVID-19 conditions may require additional follow up care and specialist treatment for any lingering symptoms. The three primary conditions pediatricians are likely to find in practice are “long” or “long-haul COVID”, Multi-System Inflammatory Syndrome in Children (MIS-C), or post-COVID conditions that could include many factors and symptoms.
The American Academy of Pediatrics’ most recent state data lists 13.5 million cases of pediatric COVID-19 as of summer 2022, with 5 million cases being added in 2022. The proliferation of the Omicron variant of COVID-19 in the United States has seen the most dramatic rise in pediatric COVID-19 cases, making it necessary for pediatricians to prepare for caring for patients’ long-term post-COVID care.
According to the June 2022 Pediatrics study, patients with obesity are at higher risk of post-COVID conditions, including MIS-C. Other populations in your patient population may be at higher risk, such as patients with chronic conditions, or who are immunocompromised. The Centers for Disease Control & Prevention (CDC) are currently studying whether people at higher risk of COVID-19 infection are also at increased risk for post-COVID conditions.
Long-Haul COVID Care
Studies continue on “long-haul COVID”, also known as post-acute COVID-19 or post-acute sequelae of SARS CoV-2 infection (PASC). Symptoms usually occur after the initial resolution of COVID-19, even if the symptoms of that infection are mild or negligible. The CDC lists 4 weeks post-infection as the point where symptoms could begin to be classified as long-haul COVID.
Symptoms may include many common childhood illness symptoms like cough or fever, but may include identifying characteristics similar to COVID-19 symptoms, such as increased fatigue, heart palpitations, and changes in smell or taste. It’s important to note that symptoms may be hard for patients or caregivers to specifically qualify, as some patients report symptoms similar to other chronic conditions like chronic fatigue syndrome that are not yet well understood.
HealthyChildren.org, an AAP website for parents, recommends that if symptoms persist for more than 3 months children can be referred to a subspecialist for treatment.
Vaccination and prevention efforts against COVID-19 remain the best way to protect children 6 months are older from all long-haul and post-COVID-19 conditions. Check out our previous posts on vaccine hesitancy and drive-thru flu clinics for information on how to get vaccines into your community.
Practices can also help prevent COVID-19 infection and related conditions by educating at-risk populations on safe behaviors like hand washing, wearing face masks, and staying at home when COVID-19 appears in communities or school settings.
Recovery from MIS-C
Multi-system inflammatory syndrome in children (MIS-C) affects children who have had a COVID-19 infection. As the name suggests, the syndrome affects multiple body systems, and includes cardiac and breathing symptoms that usually resolve over time. Overall, MIS-C is rare in pediatric patients. It’s important to differentiate between long-haul COVID and MIS-C symptoms – in this 2021 study, the authors were able to find differentiating factors in age, race, and clinical presentations in a cohort of 1200 children.
Meanwhile, the 2022 Pediatrics study found that “Over one in four children hospitalized with acute COVID-19 or MIS-C experienced persistent symptoms or activity impairment for at least 2 months. Patients with MIS-C and respiratory conditions or obesity are at higher risk of prolonged recovery.”
Some MIS-C symptoms like shortness of breath, blue lips, or difficulty staying awake may require immediate treatment at the pediatrician’s or local urgent care/emergency department. Pediatric practices can educate parents of children who have tested positive for COVID-19 of the symptoms to watch out for, while reassuring them that cases of MIS-C are rare.
Other Post-COVID Conditions
Post-COVID conditions need further study to be categorized into further diagnoses than MIS-C or long COVID, but in the meantime, other conditions post-COVID infection are grouped together as “Post-COVID conditions”. Symptoms and treatments vary, but in particular pediatricians should be aware of new or worsening:
- Behavioral health disorders, including PTSD
- Cardiac or breathing symptoms
- Fatigue and learning difficulties, especially “brain fog”
- Loss of smell or taste
- Less physical endurance or tolerance for activities
Pediatricians can work with parents to determine safe and effective treatments for kids, as well as guidelines for when they can return to normal play, school, and extracurricular activities. Children recovering from COVID-19 or related conditions may recover fully from physical symptoms, but may show increased depression, anxiety, or symptoms of PTSD.
Resources for Pediatricians
Pediatric practices have plenty of proactive measures to take to protect community spread and prevent COVID-19 and related post-COVID infections in their patients. Vaccination is the most powerful tool against COVID-19 infection for children 6 months and older.
A good patient recall strategy is key for both ensuring children are vaccinated on time and to organize the long-term care of children with post-COVID-19 conditions. Ready to revitalize your recall process and keep your schedule sane? Be sure to check out PCC’s patient recall worksheets, customizable for every practice’s unique recall journey.