Post-acute sequelae of SARS-CoV-2 infection in children appears to be lower than in adults

Reviewed by Emily Henderson, B.Sc.Aug 29 2022

A new study conducted by the National Institutes of Health (NIH) RECOVER Pediatric Electronic Health Records (EHR) Cohort and authored by Suchitra Rao, MD, infectious disease specialist at Children's Hospital Colorado, found that the risk of post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID, in children appears to be lower than what has been reported in adults. However, more children have long COVID than those kids who are hospitalized with acute COVID-19. The study is featured in JAMA Pediatrics.

We concluded that many of the symptoms children experience post-COVID-19 are similar to what is seen in adults, but there are some features more unique to children, such as myocarditis, abnormal liver enzymes, hair loss, skin rashes and diarrhea. There has been a critical need to understand the impact of COVID-19 in children both in the short as well as long-term. This is one of biggest studies we know of to explore what the post-acute sequelae look like in kids. Studies using electronic health record data are a great way to explore research questions that require further confirmation in longer term prospective studies."

Suchitra Rao, MD, infectious disease specialist at Children's Hospital Colorado

While the presentation has some overlap compared with adults, distinct features exist in children. The risk for PASC appears to be higher in children younger than five years of age, those with medical complexity and those admitted to the intensive care unit with their initial COVID-19 infection.

The exploratory study, "Syndromic, Systemic and Medication Features of Post-acute Sequelae of SARS-CoV-2 Infection in Children and Adolescents: EHR-based Cohort Study from the RECOVER Program," used electronic health record data from PEDSnet member institutions of 659,286 children tested for SARS-CoV-2 and compared 59,893 children who tested positive with those who tested negative.

The NIH RECOVER Pediatric EHR Cohort investigators conducted a multistate analysis using EHR data of children and people younger than 21 years of age who underwent testing for SARS-CoV-2 at one of eight pediatric health systems in the country between March 1, 2020, and Oct. 31, 2021. Clinicians identified conditions, symptoms and medications associated with PASC in the one to six months following testing. Out of 660,000 children who underwent testing, 9% were positive and most were tested as outpatients.

Symptoms most strongly associated with infection included changes in loss of smell and taste, hair loss, chest pain, abnormal liver enzymes, skin rashes, fever and chills, fatigue and malaise. Conditions most strongly associated with infection included myocarditis, acute respiratory distress and myositis. There was also a higher association with mental health treatment among children who tested positive for PASC compared with those who tested negative.