Infectious Disease

AAP issues guidelines for caring for children after COVID-19

August 02, 2021

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The AAP issued preliminary pediatric follow-up guidance for children who have had COVID-19, including recommendations for children with long-term COVID, a syndrome less common in children than adults.

The guideline recommends that all children and adolescents who have tested positive for COVID-19 have at least one follow-up appointment with their family doctor. Follow-up exams should be done after the recommended quarantine period and before returning to physical activity, the AAP said.

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Sarah Harz, MD, FAAP, a pediatric neurologist at Texas Children’s Hospital and co-author of the new guidelines, said pediatricians are critical to the care of children and adolescents infected with SARS-CoV-2.

“A follow-up visit allows doctors to assess whether there are persistent or new symptoms or complications of the infection and gives pediatricians an opportunity to discuss COVID-19 vaccination,” Resin said in a statement. “It is important that paediatricians are able to check for psychological and cognitive / learning problems and recommend the appropriate support for children who return to everyday life as smoothly as possible.”

If concerns about a long COVID-19 persist after 12 weeks, additional diagnostic tests and / or a referral to a multidisciplinary post-COVID-19 clinic may be appropriate, according to the AAP.

During the follow-up visit, providers should take note of any ongoing or remaining issues, including:

  • Respiratory: Since the lungs are the most commonly affected organ in COVID-19 cases, persistent respiratory symptoms are common. Symptoms include chest pain, cough, and exertion-induced shortness of breath.
  • Heart: The risk of heart problems, including myocarditis, is worrying. Symptoms of myocarditis can include chest pain, shortness of breath, irregular heartbeat, and tiredness.
  • Cognitive foggy or tiredness: “Brain fog” (a general term that refers to unclear or “fuzzy” thinking, inattention, difficulty concentrating, or having difficulty remembering) is a common neurological complaint in adults after a COVID-19 infection. School-age children and teenagers can have similar symptoms.
  • Physical fatigue: Children and adolescents can complain of exhaustion and poor endurance even without known heart or respiratory symptoms. Assuming both cardiac and respiratory functions are clinically normal, postviral fatigue typically improves over time.
  • Mental / Behavioral Health: Physicians should be aware of the effects of stress and adjustment disorders in diagnosing and treating new symptoms in children with COVID-19.

“It is important for pediatricians to carefully weigh other conditions, including childhood multisystem inflammatory syndrome and myocarditis,” said Risen. “Patients and families should also be educated about signs and symptoms that need further evaluation.”

References:

AAP. Post-COVID diseases in children and adolescents. Post-COVID-19 Conditions in Children and Adolescents (aap.org). Retrieved August 2, 2021.

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