Managing COVID-19 residual symptoms

There have been over 4 million pediatric COVID-19 cases in the United States, often less severe than what has been seen in adults. However, the long-term effects of these infections can be significant. To aid pediatricians in providing care to these patients, the American Academy of Pediatrics has issued interim guidance to guide follow-up care.¹

Every child who tests positive for COVID-19 should have at least 1 follow-up visit at their primary care office/medical home. Due to the wide range of ways that post-COVID-19 symptoms can manifest, it helps to have a main care hub. For children who had either asymptomatic or mild disease severity (<4 days of fever >100.4°F, <1 week of myalgia, chills, and lethargy), a phone or video follow-up visit may be all that is required as long as any residual symptoms are resolved. However, children who had moderate or severe disease are at potential risk of subsequent cardiovascular disease and should have follow-up care in person. These visits should occur after the recommended quarantine period, but before returning to physical activity.

During the follow-up visit, there are some things that should be discussed, regardless of whether or not the patient had residual symptoms. Vaccination should be recommended to all patients who are aged over 12 years and do not have any contraindications. They can be administered after the recommended quarantine period, unless the patient was given monoclonal antibody therapy, which causes a 90-day delay. Pediatricians should work with families to help the patient return to daily activities, which may require a gradual return to school as well as academic accommodations. Patients who had moderate or severe symptoms should be given an extensive preparticipation examination, which includes intensive cardiac evaluation.

Pediatricians should educate families about the signs and symptoms of multisystem inflammatory syndrome in children that require further evaluation. Because the condition may progress rapidly, the patient should be cared for in a hospital that has tertiary pediatric/cardiac intensive care units, if possible.

Some ongoing or residual symptoms include:

• Respiratory – Chest pain, cough, and exercise-induced dyspnea
• Cardiac – Myocarditis, chest pain, shortness of breath, arrhythmias, and fatigue
• Anosmia and/or Ageusia – The loss in smell and taste can lead to reduced food consumption, changes in feeding behaviors, and avoidance of previously well-tolerated foods
• Neurodevelopmental – Neuroinflammatory disorders as well as motor, language, and cognitive deficits
• Cognitive Fogginess or Fatigue – “brain fog,” inattentiveness, forgetfulness

Reference

1. American Academy of Pediatrics. Post-COVID-19 conditions in children and adolescents. Published July 28, 2021. Accessed August 2, 2021. https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/post-covid-19-conditions-in-children-and-adolescents/