#152: Long Story Short: Understanding Long COVID in Children and Adolescents 

September 10, 2025 | By Sam Masur

Audio

Summary:

What does Long COVID really look like in kids and teens? In this episode, we’re joined by Dr. Peter Rowe from Johns Hopkins to unpack the recognition, diagnosis and treatment of Long COVID in pediatric settings. From hallmark symptoms like post-exertional malaise and brain fog, to risk factors, disparities, and treatment strategies, Dr. Rowe shares practical insights to help clinicians better recognize and care for young people living with Long COVID.

Long COVID Pearls

1. Treatment is symptom-targeted and often multi-systemic: Managing pediatric Long COVID may require interventions used for ME/CFS or POTS, such as beta-blockers, stimulants (e.g., methylphenidate), and supportive measures like increased salt and fluid intake. 
2. There are currently no biomarkers for Long COVID so the history and physical exam are keys to making the diagnosis.
3. Post-exertional malaise along with timing of acute COVID infection can help distinguish Long COVID from other causes of fatigue or brain fog.

Long COVID Notes 

Defining Long COVID

The National Academies of Science, Engineering and Medicine defines Long COVID as an infection-associated chronic condition (IACC) that occurs after SARS-CoV-2 infection and is present for at least 3 months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems (NASEM 2024). This is also seen in the literature as a postacute sequelae of SARS-CoV-2 (PASC). Establishing prevalence in pediatrics remains difficult, but recent studies suggest 10-20% of children will develop PASC within 6 months after acute infection (Rao 2024). 

Establishing the Diagnosis of Long COVID 

There is a broad list of symptoms associated with Long COVID. Dr. Rowe focuses on post exertional fatigue, brain fog or new problems with concentration and lightheadedness. The following diagram is from Postacute Sequelae of SARS-CoV-2 in Children published in Pediatrics in February 2024. 

There are no current biomarkers for Long COVID. It is important to do a through history and physical exam to determine appropriate workup and screen for conditions that may lead to similar constitutional symptoms. Dr. Rowe shares that post exertional malaise can be a helpful differential in diagnosing Long COVID. 

Long COVID may mirror Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. In 2015, the Institute of Medicine published diagnostic criteria that included substantial impairment, post exertional malaise, and unrefreshing sleep with additional symptoms including cognitive impairment or orthostatic intolerance (CDC 2024). Relation to COVID infection can help differentiate the two. 

Preventing Long COVID and Risk Factors 

The COVID 19 vaccines can be  protective against Long COVID (Razzaghi 2024, Camporesi 2024). Risk factors for Long COVID include number of comorbidities, infection with pre-omicron variants and older age, female sex and hypermobility (Morello 2023, Ha 2023, Ganesh 2024). 

Disparities in Long COVID 

There are disparities in Long COVID outcomes that reflect existing social inequities and structural determinants of health (Rao 2025, Zhang 2025). 

Treatment in Long COVID

Treatment is directed at symptoms and might look similar for caring for patients with ME/CFS or POTS. Dr. Rowe outlines ways to use beta blockers, midodrine, stimulants like methylphenidate, fluids and salt supplementation. Dr. Chiu notes that there are retraining options for improving taste and smell. 

Goal

Listeners will recognize, diagnose and manage Long COVID in the pediatric population while understanding risk factors and disparities in care. 

Learning Objectives

After listening to this episode listeners will…  

1. Define Long COVID in children and distinguish it from related chronic conditions such as ME/CFS.
2. Recognize important clinical features and perform an appropriate diagnostic evaluation for pediatric Long COVID.
3. Identify risk factors and disparities associated with Long COVID in children.
4. Describe available treatment options and approaches for managing symptoms of Long COVID in pediatric patients.

Disclosures

Dr. Rowe reports no relevant financial disclosures. The Cribsiders report no relevant financial disclosures. 

Citation

Nwora C, Mehr G, Rowe P, Masur S, Chiu C, Berk J. “#152 Long Story Short: Understanding Long COVID in Children and Adolescents”. The Cribsiders Pediatric Podcast. https:/www.thecribsiders.com/ 10th September, 2025.