Rao, Suchitra, Gross, Rachel S, Mohandas, Sindhu et al. · Pediatrics · 2024 · DOI
Quick Summary
Some children who have COVID-19 experience symptoms that last for weeks or months after the initial infection—a condition called long COVID. This review summarizes what we currently know about long COVID in children, including how common it is, what symptoms children experience, and what might cause it. The authors also describe major research efforts being funded to better understand long COVID in young people and find effective treatments.
Why It Matters
This review is significant for ME/CFS research because it documents that myalgic encephalomyelitis/chronic fatigue syndrome is now recognized as a condition that can develop de novo following SARS-CoV-2 infection in children. Understanding long COVID mechanisms may illuminate similar pathophysiological processes in ME/CFS, including viral triggers, immune dysregulation, and post-infectious sequelae. The described research infrastructure and multi-system approach may inform better study designs for investigating post-infectious ME/CFS.
Observed Findings
Long COVID symptoms in children include persistent cough, headaches, fatigue, loss of taste and smell, and dizziness
Children with post-COVID infection can develop de novo conditions including postural orthostatic tachycardia syndrome, myalgic encephalomyelitis/chronic fatigue syndrome, autoimmune conditions, and multisystem inflammatory syndrome
Some children experience exacerbation of pre-existing underlying conditions following COVID-19 infection
Ongoing NIH-funded research includes both electronic health record cohorts and longitudinal prospective observational studies to track long COVID in children and young adults
Inferred Conclusions
Long COVID in children represents a significant clinical and public health concern that requires systematic characterization across diverse populations
Multiple pathophysiological mechanisms likely underlie pediatric PASC, ranging from persistent viral effects to immune dysregulation and multisystem involvement
Longitudinal studies with standardized definitions and biomarker assessment are essential to understand disease natural history and identify effective treatments
Pediatric PASC research infrastructure should employ both rapid-scale electronic health record methods and detailed prospective cohorts to balance statistical power with mechanistic insight
Remaining Questions
What are the true prevalence rates of long COVID in children, and how do these vary by age, demographics, and initial infection severity?
What This Study Does Not Prove
This review does not establish causal mechanisms for long COVID or ME/CFS—it summarizes emerging evidence and identifies areas needing investigation. It does not provide definitive prevalence estimates across populations, as data collection methods and case definitions remain inconsistent across studies. The review cannot determine which children are at highest risk of developing long COVID or which specific interventions are most effective, as these remain open research questions.