Characterizing Long COVID Symptoms During Early Childhood
Authors: Rachel S. Gross, Tanayott Thaweethai, Amy L. Salisbury, Lawrence C. Kleinman, Sindhu Mohandas, Kyung E. Rhee, Jessica N. Snowden, Kelan G. Tantisira, David Warburton, John C. Wood, Patricia A. Kinser, Joshua D. Milner, Erika B. Rosenzweig, Katherine Irby, Valerie J. Flaherman, Elizabeth W. Karlson, Lori B. Chibnik, Deepti B. Pant, Aparna Krishnamoorthy, Richard Gallagher, Michelle F. Lamendola-Essel, Denise C. Hasson, Stuart D. Katz, Shonna Yin, Benard P. Dreyer, Frank Blancero, Megan Carmilani, K. Coombs, Megan L. Fitzgerald, Rebecca J. Letts, Aimee K. Peddie, Andrea S. Foulkes, Melissa S. Stockwell, Paul M. Darden, Lexie Dixon, Danielle N. Evans, Connor Garbe, Laura Hobart-Porter, Lee Howard, Kathy Hummel, Hannah Krehbiel, Haley Spradlin, Phaedra Yount, Grace Adam, Jyoti Angal, Maria Barber, Katelynne Clark, Clayton Dos Reis, Mandy Freesemann, Christa Friedrich, Christine Hockett, Rachel Johannsen, Emily Johnson-Vonk, Cassidy Kaiser, Alexa Kruse, Jennifer Lang, Peter Lim, Meggie McCoy, Lorie Miller, Shelby Petereit (Cerkovnik), Jaime RiChard (Werpy), Jessica Seiler, Bret Sundleaf, Joshua Svendsen, Billy Trosper, Olivia Vermeulen, Scott Young, Sean Dabney, Marie-Christine Fahrner, Torrey Gallagher, Karilyn Martini, Mary McNally, Sarah Vivensi Stiverson, Venkataraman Balaraman, JoAnn Cheung, Travis K.F. Hong, Shanelle Kalua, Evan Minami, Andrea Siu, Micah Tong, Marina Dantas, Tyler Kasmarcak, Kreighton Milks, Chijoke Ikomi, Marisa Meyer, Connie Nguyen, Gwen Pellicciotti, Thao-Ly Phan, Karen Ravin, Victoria Reynolds, Abigail Strang, Deepika Thacker, Dan Eckrich, Annabelle Goetter, Cheyenne Katz, Karen Kowal, Carol McDevitt, Genesis Agosto Roman, Akram Alshawabkeh, Ishwara Ayala Ortiz, Virginia Casey, Jose Cordero, Jocelyn De Jesus, Chrystal M. Galan Rivera, Gredia Huerta-Montanez, Nilda Otero, Mayra Rivera Robles, Priscilla Roman, Genesis Roman, Zaira Rosario-Pabon, Xiodenis Santiago, Carmen Velez-Vega, Carlos Vergara, Baylea Albarado, Tracey Allen, Allison Attuso, Taylor Ayers, Emily Bebler, Grace Bella, Alexa Bennett, John Brown, Alison Carville, Sydnie Darby, Kara Devall, Amber Dragg, Angela Elderedge, Elisabeth Fontenot, Greta Fry, Bethany Gildersleeve, Sara Goff, Lauren Harrington, Lisa Jones, Victoria Kaiser, Yejee Lee, Stephen Lee, Erin LeJeune, Robert Leonhard, Jennifer Levatino, Donald Lewis, Angrielle Lloyd, Ron Monce, Susannah Munro, Meghan Phillips, Blair Pucheu, Emily Rachal, Jennifer Rood, Stacey Roussel, Renee Rumsey, Connor Sanford, Monica Santos, Aryelle Stafford, Amy Thomassie, Celeste Waguespack, Katherine Walgamotte, Meredith Welch, Aubrey Windham, Tiffany Bell, Jackie Boyd, Soham Dasgupta, Sarah Deans, Katie Harris, Molly Hemmerle, Sarah King, Cameo McGuire, Brie Merten, Sarah Morris, Madison Ray, Brooklyn Reinhardt, Shellese Shemwell, Theresa Simeon, Katherine Walker, Sara Watson, Kathryn Weakley, Johnathon Figliomeni, Laura Fischer, Denise Hoover, Megan Morse, Aleisha Nabower, Evan Roberts, Alice Sato, Joann Von Bon, David Archuleta, Rebecca Brito, Richard Campbell, Jude Chavez, Walter Dehority, Noella Garcia-Soberanez, Eve Gronert, Matthew Kadish, Jerry Larrabee, Debbie Lovato, Karen Luo, Noah Martinez, Analyse Merlino, Emily Reese, Sarah Ward, Kevin Wilson, Ryan Brown, Ryan Butchee, Gina Fergeson, Ryan McKee, Brandon Mohler, Tiffany Moore, Valorie Owens, Sarah Stubbs, Timothy VanWagoner, Meghan Bethel, Laurie Chassereau, Thomas Lahiri, Lauren Lake, Kathy Moffett, Emily Polak, Sarah Stutler, Charlotte Workman, Emma Carpenter, Isabelle Dhindsa, Samantha Mejia, Nelly Moghadam, Candice Mulder, Sharon O'Neil, Alisha Osornio, Adrian Rios, Sydney Rosen, Andrea Smith, Deeba Tabibi, Sharon Tang, Ariana Teame, Melissa Stockwell, Brett Anderson, Tawanda Aquino, Elizabeth Berg, Steve Caddle, Marina Catallozzi, Wendy Chung, Tom Connors, Aliva De, Anny Diaz Perez, Michael DiLorenzo, Dani Dumitriu, Kanwal Farooqi, Michael Fremed, Sylvie Goldman, Kayla Kaplan, Usha Krishnan, Aimee Layton, Angela Lignelli-Dipple, Son McClaren, Jonathan Overdevest, Michelle Rodriguez, Jay Selman, Wendy Silver, Raul Silverio, Ana Valdez de Romero, Celibell Vargas, Daniella Caputo, Camille Leggieri, Pamela Pretsch, Kristin Davis, Miranda Griffith, Donna Harris, Everly Macario, Jennifer Steffes, Alessandra Torres, Chris Day, Kelsye Howell, Megan Mains, Emily Bean, Carlie DeFelice, Hassan El Chebib, Katherine W. Herbst, Stephanie Lesmes, Melissa Santos, Noah Schulman, Alicia Brooks-Greien, Karinne Colin, Ariadna Juarez-Colunga, Brian Manning, Joel Shields, Daphne York, Justine Griswold, Donna Lee, Amanda Nowakowski, Maryellen Riordan, Rozina Aamir, Mohammed Abuzahrieh, Nandini Bangalore, Alexis Brown, Wendy Dalton, Suzanne Fortuna, Judi Minium, Bonnie Rosolowski, Amal Ahmed, Suzanne Braniecki, Montserrat Contreras, Supriya Jain, Suzanne Kaseta, Zachary Messer, Armando Ramirez, Aalok Singh, Randy WIlliams, Almary Akerlundh, Natacha Akshoomoff, Maria Arroyo, Wendy Barrientos, Rakesh Bhattacharjee, Bryant Y. Chao, Maricela Diaz, Sergio Garcia, Sonia Garcia, Guadalupe Gomez, Trinidad Herrera, Margarita Holguin, Manaswitha Khare, Elizabeth Kiernan, Jeremy Landeo Gutierrez, Ileana Matta, Sofia Reyes, Julie Ryu, Cinthia Sanchez, Andrea Schreck, Megan R. Warner, Lisa Cerracchio, Amber Folnagy, Sherri Gzemski, Yue Hao, Simon Li, Sandee Moroso, Manette Ness-Cochinwala, Akhil Patel, Benjamin Richlin, Harsh Sharma, Damaris Soto, Christian Suarez, Bibiana Vargas Forero, Elizabeth Ricciardi, Vanessa Trespalacios, Matthew Kluko, Kyung E. Rhee, Kelan G. Tantisira, Diana Acosta Valle, Bryant Chao, Ashvin Choudhary, Maria Glenn-Arroyo, Elizabeth A. Kiernan, Jeremy Landeo-Gutierrez, Anika Madan, Katelyn McConnaughey, Lisa Ramos Vallejo, Cinthia E. Sanchez, Maira Suarez, Stephanie V. Caldas, Thomas Dylan Castro Ovalle, Anthony Chung, Jonathan S Farkas, Maria Isidoro-Chino, Deniz Kesebir, Eugenia Kim, Ashley Quarless, Alan Schlechter, Ranjini Srinivasan, Fatoumata Barry, Phoebe Burton, Rosa Cano Lorente, Caroline Cummins, Stephanie Wehbe, Jocelyn Espinoza, Sara Moyer, Amy Rider, Sally Russell, Michael Schecter, Lindsey Stevenson, Jeffrey Burns, Serena Spudich, Charles Bailey, Mine Cicek, Melissa M. Cortez, Felicia Davis Blakley, David Goff, Jessica Lasky-Su, Lisa T. Newman, Igho Ofotokun, Sudha Seshadri, James Stone, Brittany D. Taylor, PJ Utz, Neely A. Williams, Julie Abella, Quinn Barnette, Christine Bevc, Jennifer Beverly, Patricia Ceger, Julie Croxford, Emily Cunningham, Mike Enger, Katie Fain, Tonya Farris, Sean Hanlon, David Hines, Vicki Johnson-Lawrence, Kevin Jordan, Craig Lefebvre, Beth Linas, Bryan Luukinen, Meisha Mandal, Nikki J. McKoy, Susan Nance, Ashleigh Oakland, Demian Pasquarelli, Claire Quiner, Rita Sembajwe, Gwendolyn Shaw, Vanessa Thornburg, Kendall Tosco, Hannah Wright, Judith S. Hochman, Leora I. Horwitz, Stuart D. Katz, Andrea B. Troxel, Lenard Adler, Precious Akinbo, Ramona Almenana, Ola Bello, Sultana Bhuiyan, Nina Blachman, Ryan Branski, Jasmine Briscoe, Shari Brosnahan, Elliott Bueler, Yvette Burgos, Nina Caplin, Domonique N. Chaplin, Yu Chen, Shen Cheng, Peter Choe, Jess Choi, Alicia Chung, Richard Church, Stanley Cobos, Nakia Croft, Angelique Cruz Irving, Phoebe Del Boccio, Iván Díaz, Vishal Doshi, Samantha Ebel, Arline Faustin, Elias Febres, Jeffrey Fine, Sandra Fink, Jennifer Frontera, Alejandra Gonzalez-Duarte, Sophia Hill, Shahidul Islam, Stephen Johnson, Neha Kansal, Rachel Kenney, Deepshikha Kewlani, Gregory Laynor, Terry Leon, Zoe A. Lewczak, Janelle Linton, Max Logan, Nadia Malik, Lia Mamistvalova, Hannah Mandel, Gabrielle Maranga, Patenne D. Mathews, Aprajita Mattoo, Tony Mei, Alan Mendelsohn, Emmanuelle Mercier, Patricio Millar Vernetti, Marc Miller, Maika Mitchell, Andre Moreira, Praveen C. Mudumbi, Erica Nahin, Nandini Nair, Joseph Nekulak, Kellie Owens, Brendan Parent, Nandan Patibandla, Peter Petrov, Radu Postelnicu, Isabelle Randall, Priyatha Rao, Amy Rapkiewicz, JohnRoss Rizzo, Johana Rosas, Chelsea Rose, Christina Saint-Jean, Michelle Santacatterina, Binita Shah, Aasma Shaukat, Naomi Simon, Aylin Simsir, Miranda Stinson, Wenfei Tang, Vasishta Tatapudi, Sujata Thawani, Mary Thomas, Lorna Thorpe, MeeLee Tom, Ethan Treiha, Jennifer Truong, Mmekom Udosen, Jessica Velazquez-Perez, Patricio M. Vernetti, Crystal Vidal, Anand Viswanathan, Crystal Wong, Marion J. Wood, Shannon W. Wuller, Chloe Young, Jonah Zaretsky, Susanna Zavlunova, Andrea Foulkes, Shawn Murphy, Shreya Ahirwar, Layne L. Ainsworth, Sonya Ajani, Ahmad Alsheikh, Rachel Atchley-Challenner, Paul Avilach, Trisha T. Balan, Nicholas Benik, Barbara Benoit, William J. Bonaventura, Natalie Boutin, Beverly Brion, Andrew Cagan, Tianrun Cai, Tingyi Cao, Victor M. Castro, Xander R. Cerretani, Mark Ciriello, Karen Costenbader, Dimitar S. Dimitrov, Hossein Estiri, Meng Fang, Maria Fayad, Candace H. Feldman, Vivian Gainer, Bhaswati Ghosh, Randy Gollub, Alan Harris, Karl Helmer, Andrew Hendrix, Ana Holzbach, Weixing Huang, Daniel Kaufman, Diane Keogh, James D. Kerr, Jeffrey G. Klann, Jessica A. Lasky-Su, Katherine P. Liao, Doug MacFadden, Anupama Maram, Megan W. Martel, Michael Mendis, Reeta Metta, Jonathan Monteiro, Eduardo Morales, Marc-Danie Nazaire, Gregory Neils, James Norman, Henry H. Paik, Heekyong Park, Zihan Qian, Kathleen Rossi-Roh, Leah M. Santacroce, Caitlin A. Selvaggi, William Simons, Lynn A. Simpson, Zachary Strasser, Ayesha Tariq, Madeleine Thorn, Philip Trewett, Dustin Van Fleet, Kavishwar B. Wagholikar, Haoyang Wang, Taowei D. Wang, Nich Wattanasin, Griffin Weber, Michael A. Williams, Thomas J. Flotte, Erik M. Boysen, Nancy Chang, Evan Ellingworth, Erika Frisch, Gary Welch, Abdullahi Yusuf, Nicole Zahnle, Marta Cerda, Victor H. Clash, Brittany Taylor, Mike Zissis, Teresa Akintonwa, Heather-Elizabeth Brown, Debra Copeland, Yvonka Hall, kevin kondo, Lydia Lerma, Jacqui Lindsay, Heather Marti, Christine Maughan, Tony Minor, Hyatt Vincent, Andra L. Blomkalns, Ingrid V. Bassett, Rebecca G. Clifton, Hannah Davis, Nathan Erdmann, Margot Gage Witvliet, Mark P. Goldberg, Zoe Guan, Mamta K. Jain, Jonathan D. Klein, Thomas Martinez, Rebecca McGrath, Sairam Parthasarathy, Priscilla Pemu, Jacqueline Rutter, Judy L. Aschner, Andrew M. Atz, Dithi Banerjee, Amanda Bogie, Hulya Bukulmez, Katharine Clouser, Lesley A. Cottrell, Kelly Cowan, Viren A. D’Sa, Allen Dozor, Amy J. Elliott, E. Vincent S. Faustino, Alexander G. Fiks, Sunanda Gaur, Maria L. Gennaro, Stewart Gordon, Uzma N. Hasan, Christina M. Hester, Alexander Hogan, Daniel S. Hsia, David C. Kaelber, Jessica S. Kosut, Sankaran Krishnan, Russell J. McCulloh, Ian C. Michelow, Sheila M. Nolan, Carlos R. Oliveira, Lynn M. Olson, Wilson D. Pace, Paul Palumbo, Hengameh Raissy, Andy Reyes, Judith L. Ross, Juan C. Salazar, Rangaraj Selvarangan, Cheryl R. Stein, Michelle D. Stevenson, Ronald J. Teufel, Alan Werzberger, John M. Westfall, Kathleen Zani, William T. Zempsky, Emily Zimmerman, Marie-Abele C. Bind, James Chan, Zoe Guan, Richard E. Morse, Harrison T. Reeder, Torri D. Metz, Jane W. Newburger, Dongngan T. Truong
Journal: JAMA Pediatrics (2025)

Importance Recent studies have identified characteristic symptom patterns of long COVID (LC) in adults and children older than 5 years. However, LC remains poorly characterized in early childhood. This knowledge gap limits efforts to identify, care for, and prevent LC in this vulnerable population. Objectives To identify symptoms that had the greatest difference in frequency comparing children with a history of SARS-CoV-2 infection to those without, to identify differences in the types of symptoms by age group (infants/toddlers [0-2 years] vs preschool-aged children [3-5 years]), and to derive an index that can be used in research studies to identify young children with LC. Design, Setting, and Participants This was a multisite longitudinal cohort study with enrollment from over 30 US health care and community settings, including infants, toddlers, and preschool-aged children with and without SARS-CoV-2 infection history. Study data were analyzed from May to December 2024. Exposure SARS-CoV-2 infection. Main Outcomes and Measures LC and 41 symptoms among infants/toddlers and 75 symptoms among preschool-aged children. Results The study included 472 infants/toddlers (mean [SD] age, 12 [9] months; 278 infected with SARS-CoV-2; 194 uninfected; 234 male [50%]; 73 Black or African American [16%]; 198 Hispanic, Latino, or Spanish [43%]; 242 White [52%]) and 539 preschool-aged children (mean [SD] age, 48 [10] months; 399 infected with SARS-CoV-2; 140 uninfected; 277 female [51%]; 70 Black or African American [13%]; 210 Hispanic, Latino, or Spanish [39%]; 287 White [54%]). The median (IQR) time between first infections and completion of symptom surveys was 318 (198-494) days for infants/toddlers and 520 (330-844) days for preschool-aged children. A research index was derived for each age group based on symptoms most associated with infection history. The index is calculated by summing scores assigned to each prolonged symptom that was present, where higher scores indicate greater magnitude of association with history of SARS-CoV-2 infection: poor appetite (5 points), trouble sleeping (3.5 points), wet cough (3.5 points), dry cough (3 points), and stuffy nose (0.5 points) for infants/toddlers, and daytime tiredness/sleepiness/low energy (6.5 points) and dry cough (3 points) for preschool-aged children. Among infants/toddlers with infection, 40 of 278 (14%) were classified as having probable LC by having an index of at least 4 points. Among preschool-aged children, 61 of 399 (15%) were classified as having probable LC by having an index of at least 3 points. Participants with higher indices often had poorer overall health, lower quality of life, and perceived delays in developmental milestones. Conclusions and Relevance This cohort study identified symptom patterns and derived research indices that were distinct between the 2 age groups and differed from those previously identified in older ages, demonstrating the need to characterize LC separately across age ranges.