The American Academy of Pediatrics (AAP) has issued new interim guidance for care of children and adolescents after Covid-19. The Academy has recommended that all children and adolescents who test positive for a COVID-19 infection should have follow-up visits, at least one, with their doctor. These visits should take place after the recommended quarantine period and before return to physical activity.

These visits should be taken as an opportunity for pediatricians to continuously monitor their patients for any residual effects of Covid-19 and to also discuss Covid-19 vaccination, including other vaccines.

All eligible children should receive Covid-19 vaccine, which can be administered after the recommended quarantine period. But a 90 day-wait is required before the vaccine, if the child had been treated with monoclonal antibodies. The CDC has recommended Covid-19 vaccination for everyone aged 12 years and older. The Pfizer-BioNTech vaccine is approved for children ≥12 years in the US.

The common post-covid conditions relate to the respiratory system (chest pain, cough, and exercise-induced labored breathing), heart (symptoms of myocarditis - chest pain, shortness of breath, arrhythmias and fatigue), brain fog (unclear or “fuzzy” thinking, inattention, difficulty in concentration or memory), fatigue or poor endurance, loss of smell and/or taste (nutritional status, reduced oral intake, avoiding food that was earlier well-tolerated) and headache (due to changes in routine and sleep, medication overuse, social isolation and poor hydration). Stress is also a very important factor that should be taken into consideration when managing children with post-Covid symptoms.

The child or adolescent must also be evaluated for their ability to return to activities of daily living or physical activity/sports. The ongoing symptoms affect learning and completion of assignments. Hence, additional support may be planned for them such as gradual return to school, addition of cognitive “rest periods” throughout the school day and educational activities based on their strength and endurance. Schools should avoid penalizing these students. Cardiac assessment may be done before resuming sports.

Children who have had Covid-19 may be at risk of developing multisystem inflammatory syndrome in children (MIS-C) requiring intensive care. It is a rare complication that typically occurs 2 to 4 weeks following SARS-CoV-2 infection and is characterized by hyper inflammatory syndrome, leading to multi organ failure. “A persistent fever without a clear clinical source that is accompanied by new symptoms or coincident with recent exposure to a person with COVID-19 should raise suspicion of possible MIS-C.”

Studies show that long-term symptoms ≥4 weeks after Covid-19 termed “long-haul Covid-19” can also occur in children and adolescents, although their incidence varies widely. Hence, they too need regular monitoring. Assessment and timely management of these symptoms will help ease the transition back into their daily routines.

Currently, India does not have Covid-19 vaccine for children. Zydus Cadila has tested their vaccine candidate (ZyCov-D) in the 12-18 years age group in one arm of the phase III trials. The vaccine is not yet approved. Zydus also plans to test the vaccine in the 5-12 years age group.

Recently, the Health ministry has also advised states to establish post-Covid clinics in appropriate health facilities for patients who have recovered from Covid-19.

(Source: American Academy of Pediatrics (AAP) News Release August 2, 2021 & Post-COVID-19 conditions in children and adolescents, Covid-19 Clinical Interim Guidance)