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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).

Children aged up to 18 years can access this service (see referral route in Referral section below).

For adults aged 18 and over please use the adult pathways.

Advice for Parents/careers

If you are a parent and you think your child has Long COVID, please talk to your GP. You may find further information on long COVID here: https://www.longcovidkids.org/

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

Changes to the South West Paediatric Long COVID Service from April 2022

The service will continue to offer multi-disciplinary assessments with advice and support for children and young people with suspected long COVID. However, the multi-disciplinary team will no longer be able to accept direct referrals: from Monday 25 April 2022, children and young people with suspected long COVID and fatigue should be referred to the Paediatric Specialist Fatigue Service at the Royal United Hospitals Bath. The team there will assess the patients and refer on those who require MDT assessment to the paediatric long COVID hub.

The paediatric long COVID hub for 2022-23 includes specialists in paediatric neurology, cardiology, respiratory medicine, infectious diseases, fatigue, general paediatrics and psychology.

How to refer

If you are a GP, you can refer to your local paediatric service for assessment (not available for children aged 16 and 17 in BNSSG so please see advice below*) and the assessing paediatrician can then refer to the Bath Chronic Fatigue Service as per the new pathway if indicated. If you are concerned about a delay to assessment, you can refer directly to the fatigue service at the same time as referring for local paediatric assessment. Children and young people do need a local paediatrician as further investigations or treatment may be necessary. Therefore, if you refer directly to the Bath Chronic Fatigue Service please ALSO refer to your local paediatric service.

For further information on the RUH Paediatric Specialist Fatigue Service please visit the service's website which can be found at: Specialist Treatment for Children & Young People with Fatigue | Royal United Hospitals Bath (ruh.nhs.uk)

*Young people aged 16 and 17 years

General paediatric services are not available in BNSSG for patients aged 16 and 17. In these patients, the referring GP should carry out initial investigations in primary care to rule out other conditions (see adult Long COVID pages) and can then refer to the RUH Paediatric Specialist Fatigue Service

 

Other Referral Options

  • Advice and guidance - If advice is required then please consider using one of  the paediatric advice and guidance services.
  • Paedatric specialty clinics - If children present with more specific symptoms following Long COVID, then please consider using existing paediatric specialist referral pathways.
  • Mental Health support - For children requiring support with their mental health please see the Mental Health Resource page.