NIH-funded study finds teens affected by COVID differently than younger children

Press release

Wednesday August 21, 2020

Children were more likely than adolescents to complain of headaches and lack of energy/fatigue.

Colorized scanning electron microscope image of SARS-CoV-2 virus particles of the Omicron strain (yellow) on a pink cell, isolated from a patient sample. The image was captured by the NIAID Integrated Research Facility at Fort Detrick.NIAID

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Researchers who studied long-term COVID symptoms in children found that there were similar, but distinct, patterns for school-aged children (ages 6 to 11) and adolescents (ages 12 to 17) and their most common symptoms. The study was funded by the NIH and published in JAMAThe research that was conducted by the NIH Researching COVID for Enhancing Recovery Initiative (RECOVER).Long COVID is a chronic illness that persists after infection with the SARS-CoV-2 virus, which causes COVID-19.

SARS-CoV-2 infections in children and adolescents can cause prolonged symptoms. These symptoms affect nearly every organ system, and many have symptoms that span multiple systems.

David Goff, MD, PhD, director of the division of cardiovascular sciences at the National Heart, Lung, and Blood Institute, said most of the research describing long COVID focuses on symptoms in adults, leading to a misperception that long COVID is rare in children or that their symptoms are similar to those in adults. Providing the best care for children and adolescents affected by COVID is difficult because symptoms vary among individuals or follow different patterns.

In the observational study, 3,860 adolescents and children infected with SARS-CoV-2 were recruited from more than 60 sites in the United States between March 2022 and December 2023. The study also included a comparison group of 1,516 adolescents and children with no history of SARS-CoV-2 infection to determine whether prolonged symptoms experienced by people with COVID-19 are related to SARS-CoV-2 or to the overall effects of the pandemic.

Caregivers completed a detailed symptom questionnaire that included 75 symptoms that lasted at least a month and occurred 90 days or more after the initial SARS infection. Caregivers also completed a questionnaire about their child’s health and physical well-being. The researchers then used a widely used statistical technique to determine which symptoms best differentiated participants with and without a history of SARS-CoV-2 infection. The researchers identified distinct combinations of symptoms for each age group that, when combined, generated the Long COVID Index. This indicates whether or not a person is likely to have Long COVID.

The researchers identified 18 symptoms that were more common in school-aged children, such as headaches (57 %), memory problems (44 %), difficulty sleeping (44 %), stomach pain (43 %). The research index did not include other symptoms common in school-aged children, such as body, joint and muscle aches, daytime sleepiness, lack of energy or anxiety.

The 17 most common symptoms among adolescents were tiredness, sleepiness, and lack of energy during the day (80 %), body, joint, or muscle pain (60 %), headache (55 %), and difficulty with memory or concentration (47 %). Other symptoms reported by adolescents that were not included in the index were anxiety and difficulty sleeping.

The symptoms included in the index weren't all symptoms, or the worst ones, but symptoms are the best predictors of long COVID, according to Rachel Gross, MD, associate professor at New York University Grossman School of Medicine and lead author of the study.

14 symptoms were shared by both age groups. The new study compared previous research on long COVID in adults. It found that teens and adults had more symptoms in common, including a loss or change in smell or taste. The researchers found that there was less overlap in symptoms between school-aged children and adults, highlighting the need for age-specific studies of long COVID.

This study found distinct research indices and distinct symptom patterns for school-aged children as well as adolescents. The study found that 20 % of 751 children aged 6 to 18 with COVID-19 met the research index threshold. The researchers noted that all 3,109 adolescents infected with SARS-CoV-2 met the research index threshold. However, they cautioned against using these numbers as a measure of disease incidence in general, as their study included more children with long COVID than the general population.

The researchers note that this research index is a tool to look at common symptoms, not a clinical guide. It will be improved as more research studies are conducted on children with long COVID.

Gross said the next step would be to look at children ages 5 and younger to better understand the long-term effects of COVID on very young children.

This fall, in accordance with the NIH Data Sharing and Management Policy, a dataset containing data from the RECOVER Pediatric Observational Cohort (POC) study collected through June 15, 2024—which contains the data for this publication—will be made available on NHLBI BioData Catalyst.

The NIH funded the research reported in this release under grants OT2HL161841, OT2HL161847, and OT2HL156812. Grant R01 HL162373 provided additional support. The content is solely the responsibility of the authors and may not reflect the views of the NIH. Visit RECOVER for more information. https://recovercovid.org.

HHS COVID Coordination: The work done here is part of the National Research Action Plan The government's response to the terrorist attacks is described in (PDF, 1.33 MB). Memorandum from the President Directing the Secretary of the Department of Health and Human Services to respond fully and effectively to long-term COVID. The plan, led by Deputy Secretary of Health Admiral Rachel Levine and her companion Service and Support for COVID-19 Long-Term Impacts Report Long COVID (PDF, 1.66 MB) lays the foundation for progress in preventing, diagnosing, treating and providing services to those who suffer from long COVID.

RECOVER: The National Institutes of Health Researching CoVID to Enhance Recover (NIH-RECOVER) initiative brings together clinicians, researchers, caregivers, and patients with community members and other stakeholders to diagnose and treat COVID. RECOVER has created the largest and most diverse group of long-COVID participants in the world. The RECOVER trials are also testing potential interventions across five symptom domains. Visit the website for more information. recoveryCOVID.org.

The National Institutes of Health: The NIH is the medical research agency of the United States Department of Health and Human Services. It consists of 27 institutes and centers. The NIH, the nation's medical research agency, consists of 27 institutes and centers and is part of the United States Department of Health and Human Services. Visit the NIH for more information about its programs. www.nih.gov.

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