Peer-reviewed article
Management of long COVID-19 in children and adolescents: from diagnosis to therapeutically approaches.
Olga Adriana Caliman-Sturdza, Roxana Gheorghita, Andrei Lobiuc, Roxana Filip, Iuliana Soldanescu et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This review examines long COVID-19 in children and adolescents, a condition causing persistent symptoms even after mild infection. Diagnosis is difficult because symptoms vary widely and there are no specific biomarkers. Treatment focuses on individualized care combining self-management strategies, rehabilitation programs like graded exercise therapy and cognitive behavioral therapy, and targeted medications for specific problems. Most children gradually improve over months, but some remain symptomatic for over a year with significant disability. The review calls for standardized diagnostic tools and more high-quality evidence for treatments.
Key points
- Long COVID-19 in children can occur after mild or asymptomatic acute infections with symptoms that may persist, fluctuate, or relapse
- Most young patients experience gradual improvement over months, but a significant subset remains symptomatic for >1 year with substantial disability
- Multimodal rehabilitation programs including graded exercise therapy and cognitive behavioral therapy have shown promise in improving fatigue, mental health, and quality of life
- No definitive cure exists; care is individualized and multidisciplinary, tailored to each patient's predominant issues
- High-quality evidence for medications remains limited, and global efforts are underway to develop standardized diagnostic tools and evidence-based interventions
Limitations
This is a narrative review synthesizing existing literature rather than primary research, so it cannot provide definitive evidence of effectiveness for specific interventions. The document does not report specific outcome data, sample sizes, or detailed comparative results from individual studies.
Abstract
INTRODUCTION: Long Coronavirus disease 2019 (COVID-19), also termed post-acute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC), has emerged as a complex multisystem condition in children and adolescents worldwide. It can occur even after mild or asymptomatic acute infections, with symptoms that may persist, fluctuate, or relapse over time. This review aims to comprehensively explore the characteristic manifestations, management and current therapeutic possibilities of pediatric Long COVID-19 (L-C19). METHODS: A systematic search was conducted in multiple databases such as PubMed, Scopus, Web of Science, and Google Scholar, for literature published between January 2020 and October 2025. RESULTS: Diagnosing pediatric L-C19 is challenging due to the heterogeneity of symptoms and lack of specific diagnostic biomarkers. Most young patients experience gradual improvement over months, but a significant subset remains symptomatic for >1 year with substantial disability, underscoring the need for timely diagnosis and intervention. Current clinical consensus emphasizes an individualized, multidisciplinary management approach focused on symptom relief and functional rehabilitation. No definitive cure exists for L-C19; thus, care is tailored to each patient's predominant issues. Therapeutic strategies combine supportive self-management (e.g. energy conservation and pacing) with both non-pharmacological and pharmacological interventions. Multimodal rehabilitation programs - including graded exercise therapy and cognitive behavioral therapy - have shown promise in improving fatigue, mental health, and overall quality of life. Targeted treatments for specific sequelae (such as autonomic dysfunction or chronic pain) are applied on a case-by-case basis, although high-quality evidence for medications remains limited. Globally, interdisciplinary collaborations have been established to provide harmonized diagnostic and treatment protocols, and major research initiatives are underway to evaluate novel therapies and include children in L-C19 clinical trials. CONCLUSION: Ongoing international efforts to develop standardized diagnostic tools, outcome measures, and evidence-based interventions are crucial to optimize care and long-term outcomes for children and adolescents affected by L-C19.