The long-term clinical status of pediatric patients after testing positive for COVID-19

A recent study published in Frontiers in Neurology found that the most common long COVID symptoms in the pediatric population had a higher prevalence in patients aged 6 to 17 years and were identical to those reported in adults. Although the neurological manifestations of the post-COVID syndrome faded over time, the psychological impacts persisted, and more so, in patients aged 6 to 17 years.

Study: Neurological and psychological effects of long COVID in a young population: A cross-sectional study. Image Credit: L Julia/Shutterstock

Background

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has claimed more than 6.5 million lives worldwide. Italy was among the most affected countries and experienced a high death rate.

The virus causes systemic inflammation and neurological dysfunctions and neurophysiological alterations that cause various psychiatric disorders like anxiety, depression, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and decreased cognition. In addition, infection precipitates somatic symptoms such as body aches and respiratory distress, as well as neurophysiological alterations, eg disruption of circadian rhythm, attention deficit, irritability and fatigue.

Post-SARS-CoV-2 infection symptoms can last for long periods of time. Symptoms that persist for more than three months after infection are collectively referred to as post-COVID syndrome or long COVID.

Various manifestations of post-COVID syndrome have been studied in adults, adolescents and pediatric patients. However, systematic findings from long COVID in adolescents and pediatric populations are limited.

The study

This study aimed to detect the occurrence and type of long COVID symptoms 3-5 months post-COVID in the pediatric population for comparison with previously reported post-COVID syndrome symptoms in children and adults.

The study was based on the assumption that the neurophysiological symptoms of post-COVID syndrome lead to psychological effects that interfere with normal adaptability.

This study was conducted in Italy between February and November 2021. The cohort included 322 people, aged 1 to 17, with a history of COVID-19. Neurophysiological conditions were assessed at 1 month and 3–5 months post-COVID, based on a COVID-19 symptom checklist. Additionally, long COVID symptoms were assessed through psychological questionnaires – completed by the children and their parents. The results were then analyzed statistically.

Results

At the start, 60% of participants had symptoms of COVID-19. The rest of the participants were asymptomatic at the start of the infection. After one month, 20% of patients had symptoms, while after 3–5 months, 22% of patients had symptoms.

Symptoms varied at different times. The most prevalent symptom at the start of the infection was headache, which persisted even after 3 to 5 months, although at a lower frequency. Fatigue and anosmia were also observed 3-5 months after COVID-19 infection. Ageusia was present at the onset of the disease, it increased at 3-5 months after infection after regressing at 1 month.

Neurophysiological symptoms of long COVID, such as headache, ageusia and fatigue, were more prominent in patients aged 6 to 17 years. These symptoms were rarely present in children under five. Musculoskeletal pain and anosmia occurred exclusively in 6-17 year olds. Alterations in eating habits, changes in circadian rhythm, cognition and behavior, and increased use of electronic gadgets have also been documented.

In the 6-17 year age group, circadian rhythm disruptions, dietary changes, behavioral issues, cognitive changes, and increased use of technological gadgets have been reported. The same changes were recorded in children 1.5 to 5 years old, but with lower incidence rates.

Among the psychological manifestations of long COVID, based on the Child Behavior Checklist (CBCL) questionnaire answered by parents, some children between the ages of 1.5 and 5 years old had scores higher than the average for anxiety/depressive symptoms, emotional reactivity, sleep problems, closure, and attention problems. It should be noted that internal issues were more important than external issues.

Parents of more than half of children in the 6-17 age group reported a deterioration in their children’s overall activity – in terms of their academic performance, recreational activities and social skills. Among the 1.5 to 5 year age group, more internalizing problems were reported. In this group, anxiety was the most common problem, followed by depression and closure, somatic problems, cognition problems, and oppositional problems.

To assess depressive-anxiety symptoms, children aged 6 to 17 years were divided into a subgroup of 8 to 16 years. The Multidimensional Anxiety Scale for Children-2 Self Report (MASC 2-SR) questionnaire scored above average for social and performance anxiety, followed by feelings of humiliation and rejection. Besides generalized anxiety, separation anxiety, obsessive-compulsive symptoms and fear of danger have also been described. These children also scored high on tension and panic – the physical manifestations of anxiety.

The Children’s Depression Inventory Questionnaire (CDI-2 SR) revealed negative self-esteem, mood, and physical symptoms. Many had functional issues with interpretation issues and felt ineffective. When comparing long COVID with anxiety scores, post-COVID syndrome showed significant correlations with obsessive-compulsive symptoms, social anxiety, and generalized anxiety.

The Trauma Symptom Checklist for Children-A (TSCC-A) questionnaire was used to study posttraumatic symptoms. Before answering this self-assessment questionnaire, parents were asked if their children were confronted with a traumatic situation immediately before the infection and during or after the infection. Few patients had high scores on this scale. Dissociative symptoms were also noted, with few showing overt dissociations and some showing hidden dissociation. Depression, anxiety and anger associated with the trauma were also detected.

Analysis of the results revealed significant correlations between post-COVID symptoms and scores for dissociations, PTSD, anger and depression. No significant association was found between the questionnaire scales and parent-reported traumatic events.

Conclusion

The long common COVID symptoms of pediatric patients were similar to those of older patients. Although the occurrence of long common symptoms of COVID is higher in adults and the elderly, the psychological manifestations seemed to persist longer in children (6-17 years). At the same time, neurological symptoms decreased over time in the pediatric population. Further studies exploring the relationship between long COVID and neuropsychiatric symptoms are warranted to plan for the prevention of chronic post-COVID symptoms.

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