DIAGNOSIS AND MANAGEMENT OF COVID-19 INFECTION
IN CHILDREN

Sri Lanka College of Paediatricians, Family Health Bureau and

World Health Organisation (WHO)- Sri Lanka

9 Clinical Definitions And Management Of Long Covid

‘Long COVID’ is an emerging clinical entity of the current COVID -19 pandemic. Recovery time for symptoms of acute infection varies, but most patients recovered by 12 weeks. According to the current literature, the likelihood of developing ‘long COVID’ does not directly relate to the severity of the acute infection.  Limited information on the paediatric population with ‘long COVID’ reveals the involvement of older children (median age of 12 years), with is a highly variable and wide range of symptoms. Fatigue, muscle and joint pain, headache, insomnia, respiratory problems, and palpitations were frequently reported like in adults.

NICE clinical definitions for acute to post covid syndrome 
Acute COVID-19 Signs and symptoms of COVID-19 for up to 4 weeks
Ongoing symptomatic COVID-19 Signs and symptoms of COVID-19 from 4 to 12 weeks
Post-COVID-19 syndrome signs and symptoms that develop during or after an infection consistent with COVID-19 continue for more than 12 weeks and are not explained by an alternative diagnosis
The common term of ‘long COVID’ describes both ongoing symptomatic and post covid -19 syndrome.

Common symptoms and signs of ‘long COVID.’
Respiratory symptoms Breathlessness, Cough
Cardiovascular symptoms Chest tightness, Chest pain, Palpitations
Generalized symptoms Fatigue, Fever, Pain
Neurological symptoms Cognitive impairment (‘brain fog,’ loss of concentration or memory issues), Headache, Sleep disturbance, Peripheral neuropathy symptoms (pins and needles/numbness), Dizziness
Gastrointestinal symptoms Abdominal pain, Nausea, Diarrhoea
Musculoskeletal symptoms Joint pain, Muscle pain
Psychological/psychiatric Symptoms Symptoms of anxiety
Ear, nose, and throat symptoms Tinnitus, Earache, Sore throat, Dizziness, Loss of taste and/or smell
Dermatological Skin rashes

Health care staff needs to suspect and refer to specialist care when children present with ongoing symptomatic COVID-19 or suspected post-COVID-19 syndrome, excluding alternative diagnoses, especially when they present with symptoms and signs of acute or life-threatening complications like breathlessness/hypoxemia or oxygen desaturation on exercise, signs of severe lung disease, chest pain and multisystem inflammatory syndrome in children.