Infants and preschoolers show unique signs of long COVID

Infants, toddlers and preschoolers exhibit symptoms of long COVID, but the symptoms can be different and more difficult to identify in these children, according to Rutgers Health research.

The new study is part of the National Institutes of Health–funded Researching COVID to Enhance Recovery (RECOVER) initiative and published in the Journal of the American Medical Association Pediatrics.

Lawrence Kleinman, a professor and vice chair of the Department of Pediatrics at Rutgers Robert Wood Johnson Medical School and a professor of global public health at Rutgers School of Public Health, is the lead investigator for the Collaborative Long-term study of Outcomes of COVID-19 in Kids (CLOCK), a national consortium led by Rutgers.

The COVID pandemic began with a myth – that children are spared its ill effects. In contrast, many children were sick with COVID, and we now have a new chronic illness emerging. We are working hard to characterize long COVID in children and it will be critical for policymakers to assure that we have adequate resources to support and manage these children now and in the future."

Lawrence Kleinman, professor and vice chair of the Department of Pediatrics, Rutgers Robert Wood Johnson Medical School

Of the total 1,011 children included in the study, 472 were infants and toddlers (children 2 years old or younger) and 539 were preschoolers (children 3 to 5 years old). Overall, 101 (15%) of the 677 children with previous SARS-CoV-2 infection were identified as likely having long COVID. The symptoms of long COVID in these age groups differ from those reported among school age children and teens. Infants and toddlers with long COVID were more likely to experience difficulty sleeping, fussiness, poor appetite, stuffy nose and coughing while preschoolers were more likely to experience coughing and daytime tiredness and low energy.

Researchers said they can confirm that younger children can have long COVID. Clinicians and caregivers may not recognize long COVID in these children because they are unfamiliar with it. The authors explain too that the inability of younger children to describe how they feel may make identification of long COVID more difficult in this age group. For similar reasons it is important for pediatricians and family physicians to consider long COVID when children present with the symptoms described. The failure to diagnose long COVID quickly delays treatment and inhibits availability of supportive services to children with long COVID.

"This study is the largest systematic look at long COVID in younger children in the United States," said Sunanda Gaur, a professor of pediatrics and director of the Adult and Pediatric Clinical Research Centers at Robert Wood Johnson University Hospital. "It suggests that this is an illness that children, families, pediatricians and the health care and educational system will be dealing with for a generation."