Long COVID in Children and Adolescents

Terence Stephenson; Roz Shafran; Shamez N. Ladhani


Curr Opin Infect Dis. 2022;35(5):461-467. 

In This Article

Abstract and Introduction


Purpose of Review: Although acute COVID-19 has been milder in children and young people compared with adults, there is a concern that they may suffer persistent symptoms. There is a need to define the clinical phenotype, determine those most at risk, the natural course of the condition and evaluate preventive and therapeutic strategies for both mental health and physical symptoms.

Recent Findings: More recent studies with control groups reported a lower prevalence of persistent symptoms in children and young people exposed to SARS-CoV-2. A systematic review and meta-analysis found that the frequency of the majority of reported persistent symptoms is similar in SARS-CoV-2 positive cases and controls. Children and young people infected with SARS-COV-2 had small but significant increases in persisting cognitive difficulties, headache and loss of smell. Factors associated with persisting, impairing symptoms include increased number of symptoms at the time of testing, female sex, older age, worse self-rated physical and mental health, and feelings of loneliness preinfection.

Summary: This review highlights the importance of a control group in studies following SARS-CoV-2 infection, the need for case definitions and research to understand the outcomes of long COVID in children and young people.


SARS-COV-2 is the RNA virus, which causes Coronavirus Disease 2019 (COVID-19). Ongoing symptomatic COVID-19 and post COVID-19 syndrome are referred to as long COVID, but the term post COVID-19 condition is also used as is PASC (postacute sequelae of COVID-19) and 'long haulers' in the USA. This review was commissioned using the term long COVID and this is the term used by the public, healthcare professionals and in literature searches and systematic reviews.

There is no diagnostic test or agreed international definition of long COVID in children. The WHO has defined post-COVID-19 condition for adults: 'with a history of probable or confirmed SARS CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, cognitive dysfunction and others, which generally have an impact on everyday functioning. Symptoms may be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time'.[1]

England's National Institute for Health and Clinical Excellence has defined post-COVID-19 syndrome for adults as: 'signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks and are not explained by an alternative diagnosis. It usually presents with clusters of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body. Post-COVID-19 syndrome may be considered before 12 weeks while the possibility of an alternative underlying disease is also being assessed'.[2]