Children infected with SARS-CoV-2 are mostly asymptomatic or develop a mild form of the disease. Nevertheless, and even if their frequency is lower than in adults, symptoms of Covid-19 several weeks after infection have been described in adolescents and more rarely in children (with a frequency of 2 to 5% in studies with a control group). Fatigue, headaches, sleep disturbances, difficulty concentrating, diffuse joint pain, abdominal pain, exercise intolerance, dizziness, chest pain, or even weight loss and prolonged cough, these signals are numerous and often associated. While their impact is not negligible on the daily life of the child, especially at school, the High Authority for Health publishes the first Rapid Responses targeted at children and adolescents with prolonged symptoms of Covid-19 to allow early diagnosis and comprehensive and appropriate care.
Identify by eliminating differential diagnoses
The HAS emphasizes that it is essential to identify and diagnose prolonged symptoms of Covid-19 by adopting a pragmatic approach including a detailed anamnesis making it possible to trace the history of the symptoms and a clinical examination of the child. While the vast majority of children see their symptoms evolve favorably, often in less than three months, others need a longer recovery time and may be subject to relapses.
The HAS recommends carrying out an additional assessment only in a second step, to eliminate a rare complication linked to Covid-19 (myocarditis, pericarditis, PIMS, etc.) or to detect another disease unrelated to the virus. This assessment can be proposed if the symptoms have not disappeared or have not improved in less than 4 weeks, if their impact on daily life is significant or in the event of an anomaly detected during the anamnesis and physical examination.
Reassure through early, global and multidisciplinary care
The HAS recommends a global, holistic approach, in which the commitment of the attending physician is essential. This revolves around 5 axes:
- Define goals specific to each patient by taking an interest in the different areas of their daily life: school, social, leisure, peers, sport, physical activity, family life.
- Regulate different activities by influencing the rhythm of activity and rest, by resorting if possible to exercise rehabilitation respecting the capacities of the child, the regulation of sleep and food
- Support the child and his familythanks to listening to the attending physician and, if necessary, psychological support.
- Lmimic social impact with a flexible and progressive adaptation of daily life and sometimes an arrangement of school time and physical activity.
- Prescribe, depending on the symptoms, drug treatments (analgesic treatment, psychotropic treatment in collaboration with a child psychiatrist).
The doctor must pay particular attention to the psychological well-being of the child, taking care not to minimize or dismiss his feelings or those of his family. If necessary, he can call on specialists or other professionals for rehabilitative care adapted to the needs of the child (respiratory, olfactory, speech therapy, effort, etc.) or for psychological support. The attending physician, whose commitment is key to leading the therapeutic relationship with the family and the child, must reassure the fact that multidisciplinary care, quality follow-up and the child’s adherence reinforce the chance of a quick recovery.
The HAS specifies that the objectives set with the child and his family must evolve gradually, with continuous support from the doctor. Achieving these objectives and stabilizing them sometimes takes time, but this long-term approach is proving effective.
For more severe, prolonged or complex forms, multidisciplinary or hospital follow-up is recommended and more in-depth investigations may be necessary. The HAS sheets on prolonged symptoms of Covid-19 in adults can provide additional information depending on the symptoms.
The High Authority for Health specifies that its Rapid Responses will be updated according to the progress of knowledge.