Millions of U.S. children and teens have tested positive for SARS-CoV-2, the virus that causes COVID-19. Fortunately, they have been less likely than adults so far to become very ill. However, even if they had few or no symptoms, kids can develop a number of other conditions after the COVID infection. Some are minor and may go away on their own. Others are more serious and may need treatment.
If your child tests positive for COVID-19, talk with your child’s doctor about watching for lingering or new symptoms and what to do if you notice any. Your pediatrician also can help guide your child’s safe return to activities such as school, sports, camp, jobs and volunteer activities.
Symptoms and conditions that can affect children after COVID-19
Breathing problems. Because COVID-19 most often affects the lungs, lingering respiratory symptoms are not uncommon. These may include chest pain, cough, and more trouble breathing during exercise. Some of these symptoms can last for 3 months or longer. Children 6 years or older with lasting symptoms may need lung function tests. Children with exercise-induced breathing problems that don’t go away may need heart tests to rule out complications such as blood clots.
Cardiac issues. Myocarditis, an inflammation of the heart muscle, can develop after COVID-19 (and in extremely rare cases, receiving mRNA
vaccines). One study of adult patients who recently recovered from COVID-19 suggested that 60% of them had myocarditis, regardless of how severe their COVID symptoms were during the infection. Symptoms of myocarditis may include chest pain, shortness of breath, irregular heartbeat and fatigue. Children and teens who had moderate or severe symptoms within the last 6 months need a thorough exam, including heart tests, before returning to school or
sports activities.
Smell and taste. As many as 1 out of 4 children and teens age 10 to 19 years of age who had COVID experience changes to their sense of smell and taste. This can have a negative effect on their eating habits and mood. It can also prevent them from noticing dangerous odors. These symptoms typically go away in several weeks. When it doesn’t, your child’s doctor may recommend steps to test or help retrain these senses.
Developmental issues. Acute COVID-19 illness can affect the
nervous system and, in rare cases, lead to stroke or encephalitis (brain swelling). Children who’ve had COVID-19 may experience subtle changes in attention, speech, school work, movement and mood. Your pediatrician may refer you for follow up with a neurodevelopmental specialist, a speech language pathologist or physical or occupational therapists.
Mental fatigue. "Brain fog"—unclear or "fuzzy" thinking, concentration, or memory—is a frequent complaint among adults who’ve had COVID-19. Children and teens may have similar symptoms. Your child may seem more forgetful or have trouble paying attention. They may be slower at reading and need more repetition and breaks while
learning. Make sure your child get enough sleep and help them manage stress, which can worsen these symptoms. If post-COVID mental fatigue doesn’t improve or interferes with daily activities, your child may benefit from a team-based treatment and recovery plan.
Physical fatigue. After SARS-CoV-2 infection, children and teens may tire more easily and have less physical endurance, even if they had no heart or lung symptoms from the virus. This usually improves over time. Your pediatrician can advise a gradual increase in physical activity. If this doesn't improve symptoms, they may recommend a visit to a physical therapist or other specialist.
Headaches. Headache is a common symptom during and following SARS-CoV-2 infection. Getting enough sleep, drinking plenty of water, eating regular meals and managing stress can help. If the headaches are lasting and severe enough, your child's doctor may recommend preventive medicines.
Mental and behavioral health. Having had COVID-19 can affect a child’s mental health. For children with existing mental/behavioral illness, events surrounding COVID-19 (hospitalization, isolation, absence from school activities) may also make symptoms worse. Your pediatrician can check your child for signs of depression, anxiety and other mental health concerns, and advise
when your child may need more support.
Multisystem inflammatory syndrome in children (MIS-C) is a rare complication that typically happens 2 to 6 weeks after SARS-CoV-2 infection. Vaccination with two doses of the Pfizer-BioNTech is reported to prevent MIS-C in kids 12 to 18 years old. In addition, all of the critically ill MIS-C patients who required life support
in a recent study were unvaccinated.
If your child has symptoms such as fever without an obvious cause after having COVID-19, talk with your pediatrician. MIS-C can get worse quickly, and children who develop this condition should be examined by a pediatrician or pediatric subspecialist as soon as possible. Children with this condition will require hospitalization, often in the intensive care unit.
Symptoms of diabetes, including frequent urination, increased thirst, increased hunger, weight loss, tiredness or fatigue, stomach pain and nausea or vomiting, have been
reported in some children and teens who had COVID-19.
Long-haul COVID-19 is a general term that covers physical and mental health symptoms some patients experience 4 or more weeks after SARS-CoV-2 infection. No specific lab test can tell "long-haul COVID-19" apart from other conditions. For the first 4 to 12 weeks after illness, focusing mostly on healthy lifestyle approaches to help improve symptoms is usually best. If symptoms last beyond 3 months, your child’s doctor may recommend additional tests and possible referral to a specialized, multidisciplinary post-COVID-19 clinic.
Remember
All children and teens should receive the COVID-19 vaccine as soon as they are
eligible to prevent SARS-CoV-2 infection. Talk to your pediatrician to make certain they stay up to date. If your child tests positive for COVID-19, your pediatrician can discuss your questions and concerns including ways to help your child return safely to their normal activities.
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