While a prior article discussed which children get Long Hauler COVID and how often, today we add to that scientific understanding with more on which symptoms children get in this troublesome post-viral syndrome. Those of us practicing medicine have long recognized the concept of post-viral syndromes, but we do appreciate the newly found interest in post-COVID illness providing opportunity for a lot of research. Whether caring for children with PANS or PANDAS (pediatric autoimmune neuropsychiatric syndrome or pediatric autoimmune disorder associated with Strep) after a viral illness or for an adult with irritable bowel syndrome after an intestinal virus, we deal with this practically daily in the office. Now we have millions of dollars looking at how a virus can cause persisting symptoms in both children and adults. In this article, we see that the rates of multiple symptoms are increased after SARS-CoV2 infection in children 1 to 6 months later.
While COVID and its trigger, SARS-CoV2 need no formal introduction, a quick review of Long Hauler or Post-COVID will help set the stage for our discussion. In 2020, the acute stage of this viral infection triggered hysteria across the globe, yet the long-term effects beyond the acute threat and hysteria did not emerge for a few months. As 2020 progressed, besides the prolonged health effects in severely affected patients that we would all expect after a hospitalization, especially for those in the ICU, reports of milder acute cases experiencing ongoing symptoms began popping up. Groups of recovering patients began growing until doctors also recognized that something else was happening besides recovery form severe illness. The medical worlds admitted that a post viral syndrome, soon to be called Long Hauler, was causing lasting suffering on thousands upon thousands of people for months.
Once the medical world acknowledges this reality, research began looking at why this was happening with hopes of prevention and therapy. Of course, we all know that vaccines were developed and touted to solve the problem of COVID at its root, but given this failed attempt, we are looking more to the other side of research, how to help patients recover faster. This paper does not consider mechanisms; it looks at which kids get post-COVID or Long Haulers and which symptoms they experience in order to contrast it with adult’s experience.
Using the electronic health records (HER) data from almost 660,000 children in the National Institute of Health Researching COVID to Enhance Recovery initiative who were tested for COVID in a specific time period. They compared the over 59,000 children who tested positive for COVID with the rest who tested negative. Many interesting findings are reported.
Many want to know which children are most at risk. We know that children are far less likely to contract acute COVID in a severe form which we are all thankful for. This study indicates that children are also less likely to develop post-COVID syndrome, but a significant proportion still do. Those children under 5 years old, those with complex pre-existing medical conditions, and who were hospitalized in the ICU are more likely than other children to develop post-COVID. That is helpful is knowing who to monitor for ongoing health issues.
The study also indicates that children experience some of the same symptoms as adults with Post-COVID, but not exactly the same. Like adults, children who had tested positive for COVID experienced a higher frequency loss of taste/smell, hair loss, abnormal liver enzymes, chest pain, fatigue and malaise, fever and chills, skin rashes, and diarrhea in the 1 to 6 months after the positive test. In terms of specific diagnoses, they also had more myocarditis (heart inflammation), myositis, acute respiratory distress, heart disease, fluid or electrolytes disturbances, mental health diagnoses, gum or teeth issues, and anxiety. All of these were statistically higher in the children who had positive tests but were still present in lower numbers in many other children without COVID. The largest difference between adults and children’s symptom was in terms of “abnormal liver enzymes, hair loss, skin rashes, and diarrhea” with children have more of these symptoms than adults.
With prior studies indicating anywhere from a 10% to 66% Post-COVID rate in children and this study indicating a wide array of symptoms and actual diagnoses, we can see that children should be monitored by their parents and health care providers for symptoms post COVID. I would go a step further and argue that given the inaccuracy of our current COVID tests, parents and providers should keep their eyes open for this issue even if their children tested negative or never demonstrated any acute symptoms. We know that acute symptoms are not required for later Post-COVID issues.
Once these symptoms are recognized, neither group should just throw their hands up and hope for the best or start throwing medications at the symptoms. Post-COVID syndromes in adults and kids have functional medicine therapies which alleviate and resolve symptoms faster at a root cause level rather than just a superficial band-aid. Helping patients, both adults and children, post COVID is just another success story for functional medicine restoring healthier more abundant lives.
Original Article:
Suchitra Rao, Grace M. Lee, Hanieh Razzaghi, Vitaly Lorman, Asuncion Mejias, Nathan M. Pajor, Deepika Thacker, Ryan Webb, Kimberley Dickinson, L. Charles Bailey, Ravi Jhaveri, Dimitri A. Christakis, Tellen D. Bennett, Yong Chen, Christopher B. Forrest. Clinical Features and Burden of Postacute Sequelae of SARS-CoV-2 Infection in Children and Adolescents. JAMA Pediatrics, 2022; DOI: 10.1001/jamapediatrics.2022.2800
Thanks to Science Daily:
Children’s Hospital Colorado. “Post-acute COVID-19 in children less common than in adults but more frequent than hospitalization rates for acute COVID-19, study finds: Higher risk of long COVID-19 in younger children, those with complex chronic conditions and those with more severe acute COVID-19 illness.” ScienceDaily. ScienceDaily, 29 August 2022. <www.sciencedaily.com/releases/2022/08/220829112851.htm>.
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.
