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According to an informal poll, about one-third of the AAP town hall attendees said they had cared for patients with long COVID symptoms.
Experts at Thursday’s virtual town hall discussed knowledge gaps associated with the long-term impact of COVID-19 infection in children. They urged pediatricians to listen to their patients and said adults and children with post-acute sequelae of COVID-19 (PASC) or “long COVID” may have been brushed off by some physicians because the condition is poorly understood.
Fortunately, the patient community has played a crucial role in shaping the direction of research, particularly related to PASC, said Robert F. Tamburro Jr., M.D., FAAP, senior adviser for clinical research in the Division of Extramural Research at the Eunice Kennedy Shriver National Institute of Child Health and Human Development. He shared information on National Institutes of Health-supported research programs on COVID-19, as well as multisystem inflammatory syndrome in children (MIS-C). They include:
Joining Dr. Tamburro were Sarah R. Risen, M.D., FAAP, a pediatric neurologist, and Stuart Berger, M.D., FAAP, a pediatric cardiologist, and chair of the AAP Section on Cardiology and Cardiac Surgery. They described what they have seen at their multidisciplinary clinics in Texas and Illinois, respectively.
Common symptoms of long COVID include dizziness, headaches, fatigue and shortness of breath, tachycardia, palpitations and headaches.
Dr. Berger said data suggest some patients with “long COVID” have autonomic dysfunction symptoms similar to postural orthostatic tachycardia syndrome (POTS). He said POTS is not a primary cardiac problem, but it is important to rule out to ensure the patient does not have underlying cardiac abnormalities.
Dr. Risen suggested pediatricians take a proactive approach with patients who are concerned about ongoing symptoms, noting that “we're beginning to recognize long COVID pretty consistently in a portion of children.”
Town hall moderator Anne R. Edwards, M.D., FAAP, AAP chief population health officer, posed several questions from attendees:
When should pediatricians refer a patient with symptoms related to PASC?
Dr. Risen said pediatricians should first think through the entire differential and determine if testing is needed. Then, they can address long COVID symptoms such as sleep problems and try lifestyle interventions such adjusting the daily schedule and addressing hydration. If the patient doesn’t respond to first-line management, if symptoms worsen or if there are other red flags, pediatricians might need to refer to specialists.
When should patients see a cardiologist?
“If there's ever any question, early is better,” Dr. Berger said.
How do pediatricians support children with symptoms of brain fog and fatigue during the school year?
Dr. Risen suggested an approach similar to when a child returns to learning after a concussion (https://bit.ly/3e3ZU7j). “I think working with the schools and proactively addressing the fact that the child might need more support or will need more support, and then tapering it over time depending on how the child is doing, is the most effective strategy for returning to school.”
Finally, Dr. Tamburro said pediatricians can let families know that researchers are working hard to find answers for children.
“The advice I want to share is that resources are being made available and that people are hearing their concerns,” he said. “Hopefully, we're going to be able to provide the answers … so that (pediatricians) will have the information to best care for these children and their families.”
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