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REMEDY : BNSSG referral pathways & Joint Formulary

Long COVID in children

Checked: 08-12-2021 by vicky.ryan Next Review: 07-12-2022

Overview

Long COVID in children is an area of ongoing uncertainty and there is currently still no universally agreed definition of Long COVID (1) or Post Covid Syndrome in children. Persistent symptoms in children following COVID-19 infection do occur, but the pattern is different to the pattern of symptoms in adults. In the CLoCk study, 14 % of children aged 11-17 reported persistent symptoms 3 months following infection (2).

Most children who develop COVID-19 will have mild disease and make a full recovery. For those children with persistent symptoms, the commonest reported at three months following COVID infection were: tiredness, headache, shortness of breath, dizziness and anosmia. There is also evidence of mental health effects and that mental and physical health symptoms are closely related. (1)

The effects of different variants on Long COVID symptoms is currently not known but studies are ongoing.(1)

 

(1) Long COVID - the physical and mental health of children and non-hospitalised young people 3 months after SARS-CoV-2 infection; a national matched cohort study (The CLoCk) Study. - August 2021

(2) Long covid: One in seven children may still have symptoms 15 weeks after infection, data show - September 2021

Who to Refer

Most children will make a full recovery following COVID infection and if there are persistent symptoms, these will usually be mild. For those children who have significant ongoing symptoms more than 4 weeks following infection, then further investigations or referral may be required.

Prior to referral, a physical examination should be undertaken to exclude other potential causes of symptoms. A more urgent referral should be considered if there are Red Flags (see section below).

Red Flags

Please see the Children and Young People -2ww page for further advice on symptoms and signs that may warrant a 2WW referral.

Referral

South West Long COVID Hub

The South West Long COVID Hub for children and young people opened to referrals in September 2021. We offer multi-disciplinary assessments with advice and support for children and young people with suspected Long COVID. Children and young people can be referred for assessment by both paediatricians, GPs and other health professionals. A trained specialist clinician will conduct an online video assessment with the child or young person and their parents/carers and provide support and early symptomatic advice. The assessing clinician will then discuss the case with the specialist hub to decide if further investigations are required and make further recommendations on appropriate treatment. The Hub includes specialists in paediatric neurology, cardiology, respiratory medicine, fatigue, general paediatrics, psychology and psychiatry. This is a pilot project. 

How to refer:

If you are a GP, you can refer to your local paediatric service for assessment and the assessing paediatrician can refer to the Long COVID Hub. If you are concerned about a delay to assessment, you can refer to the Hub at the same time as referring for local paediatric assessment. If you refer directly to the Long COVID Hub, please use e-RS. Children and young people do need a local paediatrician as further investigations or treatment may be necessary. If you refer to the Long COVID Hub, please ALSO refer to your local paediatric service.

Please note that the Hub is not funded to provide treatment. However, children and families will be provided symptomatic advice and support and sign-posted to the appropriate treatment either locally or regionally.

Paedatric specialty clinics

If children present with more specific symptoms following Long COVID, then please consider using existing paediatric referral pathways.

Advice and guidance

If advice is required then please consider using the paediatric advice and guidance service.

Mental Health support

For children requiring support with their mental health please see the Mental Health Resource page.

ME/CFS service

The ME/CFS service for children is not specifically designed or resourced to manage children with Long COVID. However, for children aged under 18 with persistent fatigue for more than 3 months where other physical causes have been excluded, then please consider referral to the Paediatric Chronic Fatigue Syndrome service if criteria are met.