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Lisa Black

Guidance includes recommendations for children with “long COVID” and other symptoms after COVID infection

In new interim guidance from the American Academy of Pediatrics, “Post-COVID-19 Conditions in Children and Adolescents,”  the AAP offers pediatricians guidance in the follow-up care of infants, children, and adolescents after infection with COVID-19.

Pediatric health care visits are important to monitor resolution of COVID-19 symptoms, administer the COVID-19 vaccine and other routine vaccines, screen for and address mental health concerns, and coordinate care with specialists as appropriate.

“Pediatricians play a vital role in caring for children and adolescents after they’ve been infected with COVID-19,” said Dr. Sarah Risen, a pediatric neurologist at Texas Children’s Hospital and an author of the guidance. “A follow-up visit allows doctors to assess if there are any lingering or new symptoms or complications from the COVID-19 infection and gives pediatricians the chance to discuss the COVID-19 vaccination. Importantly, pediatricians are able to check for mental health and cognitive/learning issues and recommend the appropriate supports for children returning to daily life as seamlessly as possible.”

The AAP recommends that all children and adolescents who test positive for a COVID-19 infection have at least one follow-up conversation or visit with their primary care medical home. Follow-up visits should take place after the recommended quarantine period and before a child returns to physical activity.

At these visits, pediatricians can discuss vaccinations, and these vaccinations can occur immediately after the recommended quarantine period unless the patient received monoclonal antibody therapy, which requires a delay of at least 90 days. The AAP recommends COVID-19 vaccine for all children who are eligible and who do not have contraindications. Children and teens ages 12 and older currently are authorized for the COVID-19 vaccination.

Pediatricians can counsel families about the return to day care, team sports, and school, and should be on the lookout for new or residual mental and physical issues. AAP guidance on well child health care during the COVID-19 pandemic can be found here.

The guidance notes that a post-COVID-19 condition called long-haul COVID” is an umbrella term that encompasses physical and mental health consequences four or more weeks after a COVID-19 illness. Although the reported frequency of post-COVID-19 conditions varies widely, several studies show that long-term symptoms can occur in children and adolescents. If concerns persist past 12 weeks, then additional diagnostic testing and/or referral to a multidisciplinary post-COVID-19 clinic may be appropriate.

At the follow-up visit after infection, pediatricians should take note of ongoing or residual issues that can include:

  • Respiratory: Because the lungs are the most commonly affected organ for patients with COVID-19 infection, persistent respiratory symptoms following acute COVID-19 are not uncommon. The symptoms include chest pain, cough, and exercise-induced labored breathing.
  • Cardiac: One of the most concerning aspects of COVID-19 infection is the risk for heart problems, including myocarditis. Symptoms of myocarditis can include chest pain and shortness of breath, as well as arrhythmias and fatigue.
  • Cognitive fogginess or fatigue: “Brain fog” (a generic term that refers to unclear or “fuzzy” thinking, inattention, difficulty with concentration or memory) is a frequent neurologic complaint in adults after COVID-19 infection. School aged-children and adolescents may have similar complaints.
  • Physical fatigue/poor endurance: Children and adolescents may complain of fatigue and poor endurance even without known cardiac and respiratory symptoms. Assuming both cardiac and respiratory function are clinically normal, post-viral fatigue typically improves over time.
  • Mental health/behavioral health: Pediatricians should be aware of the impact of stress and adjustment disorders when diagnosing and managing new symptoms in children who have experienced COVID-19.

“It’s important for pediatricians to carefully consider other conditions, including multisystem inflammatory syndrome in children and myocarditis,” Dr. Risen said. “Patients and families also should be instructed about signs and symptoms that require further evaluation.”

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To request an interview, contact AAP Public Affairs.


The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

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