As Child Covid Cases Rise, Doctors Watch for Potential Long-Term Effects

Most child cases of Covid are mild. But some kids have longer-term symptoms such as headaches, shortness of breath and gastrointestinal problems.

Illustration: Ryan Inzana

As more children become infected with Covid-19, doctors are paying closer attention to potential long-term effects.

In adults, one of Covid’s most troubling effects has been so-called long-haul cases, in which people whose illness initially seemed moderate end up having symptoms for months, sometimes getting worse over time. Now as doctors warn that children may be more vulnerable to the virus than initially believed, researchers are looking more closely at longer-term symptoms in kids, too.

香蕉视频苹果下载Children now represent about 9% of all Covid-19 cases in the U.S., up from 2% in March, according to the most recent issued from Children’s Hospital Association and the American Academy of Pediatrics. The number of child Covid-19 cases has doubled since July 9, totaling 406,109 as of Aug. 13, according to cases reported from 49 states.

The majority of children experience mild illness or even no symptoms from Covid-19, doctors say. But some are reporting symptoms that persist for weeks, or the development of post-viral syndromes. Symptoms reported include fever, cough, headaches, shortness of breath and gastrointestinal problems.

“It’s an important area for study because certainly we’re still learning a lot about the virus, particularly about its impact on children,” says Sean O’Leary, vice-chair of the American Academy of Pediatrics Committee on Infectious Diseases, who himself is experiencing long-term symptoms from Covid-19. “At least acutely it’s less severe in children, but we also need to understand whether there are potentially consequences of long-term effects.”

One challenge with tracking longer-term symptoms in children is that testing has been inconsistent. Covid-19 tests were difficult to get for children in the early weeks of the pandemic. The number of tests done in children has increased over the past five months, though declined in recent weeks. So far, discussion of children and Covid—around school reopening, for instance—has focused more on risks for community transmission than potential longer-term effects.

Matthew Kelly, an assistant professor of pediatric infectious diseases at Duke University Medical Center, oversees a registry of more than 400 children in North Carolina who tested positive for Covid or who had a close contact test positive.

香蕉视频苹果下载So far, children under age 14 appear to recover quickly and have fewer symptoms, according to from the registry published Saturday on the preprint server medRxiv which haven’t yet been reviewed by other researchers.

香蕉视频苹果下载Patients 14- to 20-years-old had a range of symptoms similar to what adults have experienced, with respiratory and flu-like symptoms, such as headache and muscle aches. And while most teens had symptoms that resolved in a week, 25% still reported symptoms after 12 days, and 10% still had symptoms after 17 days, such as cough, fever and shortness of breath.

So far the main complication in children with Covid is multisystem inflammatory syndrome (MIS-C), a serious inflammatory syndrome where different body parts—including the heart and brain—can become inflamed, causing a fever, stomach pain, rash and gastrointestinal symptoms. There have been at least , according to the CDC. Children usually present with the syndrome two to four weeks after having Covid-19 and are often hospitalized.

香蕉视频苹果下载Dr. Kelly speculates that MIS-C is likely the extreme end of a spectrum of post-infectious inflammatory syndromes children may experience after Covid-19. “That’s the severest form…but there seems to be a larger group of children who develop inflammatory illnesses less severe than what is seen in MIS-C,” says Dr. Kelly.

Gabriela Maron, an associate faculty member in the infectious diseases department at St. Jude Children’s Research Hospital in Memphis, Tenn., and Ronald Dallas, a clinical research scientist in the infectious diseases department at St. Jude’s, oversee and manage another pediatric Covid-19 registry. So far it includes about 4,000 cases of children and adolescents under age 21 with lab-confirmed Covid.

For most, symptoms resolved on average three days later. But between days eight and 28, about 199 kids out of roughly 2,500 whose long-term information has been entered were still reporting symptoms.

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Tania Dempsey is an internist and integrative medicine doctor in Purchase, N.Y., who specializes in autoimmune disorders. She has a couple of teenage patients who she has diagnosed with mast cell activation syndrome, a disorder of the immune system that she believes was triggered by a Covid-19 infection.

香蕉视频苹果下载“I think it’s becoming clearer as more kids are getting sick that there’s a cohort of children whose immune systems are going to react inappropriately and set off an escalating degree of inflammation,” says Dr. Dempsey.

Mary Pflum Peterson, and her son, Roman, 13, who live in Manhattan, both have some persistent symptoms from Covid-19.

Photo: Dean Peterson

香蕉视频苹果下载 Mary Pflum Peterson, a writer and television producer in New York City, has had persistent symptoms after being diagnosed with Covid in March. Her son Roman Peterson, 13, was diagnosed with Covid in April based on his symptoms and exposure to her, Ms. Peterson said. Two of her other children were also sick but recovered within days.

Roman had a fever for four weeks, chest pain, no appetite, a sore throat, and severe headaches. For months, he experienced a racing heartbeat. He’s feeling better now, but he still gets periodic headaches, has nausea, and gets dizzy. “They’re really irritating headaches,” he says. “I have them like once every two or three days.”

“I feel like people think [Covid] is just bad for the elderly and those with conditions,” he adds. “It actually really takes all the energy out of you.”

“Could this cause long-term or permanent damage? Nobody knows yet,” says Ms. Peterson. “It’s not as simplistic as some of us want to think.

Because cases in children are rarer and tests have often been conducted less frequently, they can be difficult to untangle. Casey Whiston-Hodnett says her 13-year-old daughter, Joeyanna, first became very sick in March and then started to feel a little better in May. She began regressing in June and was hospitalized at Boston Children’s Hospital in early July.

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Joeyanna wasn’t able to get tested for Covid until June—more than three months after first getting sick, which is generally too late to detect the virus’ genetic material. Esra Meidan, her pediatric rheumatologist at Boston Children’s, says antibody tests have come up negative, but experts say antibody tests can also have reliability problems.

香蕉视频苹果下载Dr. Meidan has diagnosed her with several conditions that she believes were triggered by two separate viral infections, the first of which may have been Covid-19. One of the conditions is a neurological one called dysautonomia, which occurs when the autonomic nervous system is out of balance. The condition can be triggered by viruses and is being seen in many adult Covid-19 patients with long-term symptoms.

“I’m always tired and then I have really bad joint pain and muscle aches and chest pain and stomach pain,” says Joeyanna.

香蕉视频苹果下载She’s lost more than 10 pounds and can barely eat because of intense stomach pain, says her mom. “This has just totally changed her, she can’t even get off the couch,” says Mrs. Whiston-Hodnett. “They’re telling me she’s going to recover but you look at her and you wonder how much longer?”

Write to Sumathi Reddy at sumathi.reddy@wsj.com

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