Chapter 5: How does Long Covid affect children?

CHAPTER 5

How does Long Covid affect children?

Can children under the age of 15 contract Covid-19?

Children under the age of 15 can contract Covid-19. Unlike adults,theyarelesslikelytobecomeseverelyill.76 Babies are at slightly higher risk for serious illness than older children, but overall Covid-19 infant and child mortality is rare.77

Do children experience the same Covid-19 symptoms as adults?

ChildrendisplaytheclassicsignsofCovid-19—cough,fever,sore throat,runnynose,diarrhea,nausea—thoughmoremildlythan inadults.Achildmayhaveveryfewormanysymptoms,butin eithercasewillrarelyneedtobehospitalized.Mostcanrecover athome.

Children can also display no symptoms. Studies estimate up to halfofinfectedchildrenhaveeitherverymildornosymptoms atall.78 ThisagegroupismostlikelytospreadCovid-19without knowing, as they remain infectious despite the lack of symptoms.79

76 COVID-19 in babies and children -Mayo Clinic 77 Children and COVID-19: State-Level Data Report 78 Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis | PNAS 79 Virologic features of SARS-CoV-2 infection in children | medRxiv

How do newborns contract Covid-19?

Inthehospital,newborntransmissionoccursprimarilythrough close contact with sick caregivers after birth, not through the womb.80 Parents can mitigate risks by wearing a mask and washingtheirhandsbeforeandaftercaringfortheirchild.Ifa caregiver does test positive once at home, CDC protocols recommend isolating and allowing a healthy caregiver to care forthebabyinthemeantime.81 Covid-19 is also unlikely to spread through breast milk.82 As a general rule, regardless of Covid-19 status, it is best to wash hands with soap and water before breastfeeding/expressing breastmilk.

Can children get Long Covid?

Thoughitisnotascommonasitisinadults,childrencandevelop LongCovidsymptoms. Around 13-35% of children who recover from Covid-19—mild cases included—experience Long Covid symptoms.83 Doctors and parents of children with Long Covid have reported that symptoms interfere with their ability to complete schoolwork andattendclass.84

Fatigue and brain fog are the most commonly reported symptoms. This age group is more prone to headaches and abdominalpainthanoldercohortsandlesspronetopost-Covid

80 FAQs: Management of Infants Born to Mothers with Suspected or Confirmed COVID-19 81 Breastfeeding and Caring for Newborns if You Have COVID-19 | CDC 82 COVID-19 in babies –here’s what to expect 83 Preliminary evidence on long COVID in children 84 Researchers are studying long COVID in kids --here's what they know so far

lung damage.85 Other pediatric symptoms include loss of taste and smell, frequent headaches, muscle soreness, joint pain, general weakness, trouble sleeping, feelings of anxiety/mood changes,andevenrashes.86 87

Is multisystem inflammatory syndrome in children (MIS-C) the same as Long Covid?

LongCovidandMultisystemInflammatorySyndrome(MIS)are twodistinctpost-Covidsyndromes. Multisystem inflammatory syndrome is a rare complication of SARS-CoV-2 infection. It is characterized by an excessive immune response and extensive inflammation of the body and organ systems—the heart, brain, kidneys, digestive system, lungs,skin,andeyes.88 Itismostfrequentlyseeninschool-aged children, labeled multisystem inflammatory syndrome in children (MIS-C), but has since also been confirmed in adults (MIS-A),definedasanyone21yearsofageorolder.89,90 Since the beginning of the pandemic, 8,210 pediatric Covid-19 patientsintheUnitedStateshavemettheMIS-Ccasedefinition. There have been 68 total deaths.91 Data from a Danish study suggests the incidence of MIS-C in both vaccinated and

85 What is long covid? Current understanding about risks, symptoms and recovery. -The Washington Post 86 Pediatric Post-COVID Program | Children's National Hospital 87 An 11-year-old with long Covid says it is 'very difficult and frustrating'. 88 Multisystem Inflammatory Syndrome (MIS) 89 MIS-C and COVID-19: Uncommon but Serious Inflammatory Syndrome in Kids and Teens | Johns Hopkins Medicine 90Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults: A Systematic Review | Global Health | JAMA Network Open 91 CDC COVID Data Tracker

unvaccinatedchildrenandadolescentsinfectedbytheOmicron variantislowerthanwithpreviousstrains.92 Long Covid and MIS-C share some overlap in symptoms, especiallyheartpalpitations,dizziness,andshortnessofbreath. ThehallmarksymptomofMIS-Cisahighfeverthatpersistsfor threeormoredaysincombinationwithgastrointestinalissues suchasdiarrhea,abdominalpain,andvomiting.Bloodshoteyes, theonsetofarash,andinseverecases,paleorblue-coloredskin andlips,arealsoassociatedwithMIS-C.93 If caught in time, MIS-C cases are treatable via intravenous antibodies, steroids, and anti-inflammatory drugs. These are cleartherapeuticinterventionsthatcanhelppatientsrecover.

How do I support the educational needs of my child with Long Covid?

StudentswithLongCovidareeligibleforaccommodationsunder the Individuals with Disabilities Education Act (IDEA)94 and Section504oftheRehabilitationActof1972(S.504).Theselaws indicatethatstudentswithdisabilitiesareentitledtofreeequal andappropriateaccesstoeducationalopportunitiesatfederally fundedschools.95

Theselawsstatethateligiblestudentsmaybeentitledtospecial education and related services based on their health

92 Risk and Phenotype of Multisystem Inflammatory Syndrome in Vaccinated and Unvaccinated Danish Children Before and During the Omicron Wave

93 Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2 | Adolescent Medicine | JAMA 94 LongCovid under Section 504 and the IDEA 95 Workbook focuses on supporting students with Long Covid

impairment. If Long Covid prevents a student from attending school in person, they may be entitled to virtual or assisted learningopportunities. Other possible accommodations could include “extended time on tests, reduced-distraction testing environments, audio recording for classes, note-taking support, alternative text materials,priorityscheduling,andreducedcourseload.” InadditiontodifficultiespeoplewithLongCovidmayfaceinthe classroom,thereareaddedstressestoreturningtoschools,such as in-person social dynamics, navigating between classes on large campuses, and close-quarters interactions with students thatmaybeinfected. In most cases prior to the pandemic, schools could allow sick students to complete work from home and resume classes whenever possible, but Long Covid introduces the unknown characteristicofthediseasecourse.Nobodyknowsexactlyhow longaten-year-oldchildwithLongCovidwillexperiencetrouble concentrating,fatigue,orvisionproblems.