RECOVER study identifies unique symptom patterns of Long COVID in young children
The most common Long COVID symptoms experienced by children 0 to 5 years old can be different than those experienced by older children and adults.
Long COVID can affect everyone differently based on many factors, including a person’s age. The RECOVER pediatric observational study focuses on advancing our understanding of and ability to diagnose, prevent, and treat Long COVID in infants, children, adolescents (young people 12 to 17 years old) and young adults (18 to 25 years old).
In a new publication featured in the Journal of the American Medical Association (JAMA) Pediatrics, RECOVER researchers report that children who are only a few years apart in age can nevertheless experience very different symptoms of Long COVID.
Researchers analyzed data collected from 1,011 parents and caregivers of the youngest children taking part in RECOVER’s pediatric observational study. Study participants included 472 infants and toddlers (children 2 years old or younger) and 539 preschoolers (children 3 to 5 years old). Of the 677 children in the study who had a SARS-CoV-2 infection, approximately 15% (101) were identified as likely having Long COVID.
“We found a distinguishable pattern for both age groups of young children, including symptoms that are different than what we see in older children and adults,” says co-senior author Andrea Foulkes, ScD (Massachusetts General Brigham and Harvard Medical School). Adds principal investigator and co-author Tanayott (Tony) Thaweethai, PhD (Massachusetts General Brigham and Harvard Medical School), “Children with these symptoms often had worse overall health, lower quality of life, and delays in development.”
Researchers looked at a variety of Long COVID symptoms in both age groups: 41 symptoms in the infant and toddler group and 75 symptoms among preschoolers. Infants and toddlers with Long COVID were more likely to experience trouble sleeping, fussiness, poor appetite, stuffy nose, and cough. Preschoolers were more likely to experience a dry cough and daytime tiredness/low energy.
These findings emphasize the need for age-specific approaches to diagnosing, preventing, and treating Long COVID. To help address that need, the study’s researchers created 2 tools called research indexes to help identify Long COVID in young children. One tool is specific to infants and toddlers, and the other is specific to preschoolers. As Dr. Foulkes explains, “The tools from this study can be used in future studies to better understand Long COVID in young children and develop ways to care for them.”
In three previously published RECOVER studies—Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection (JAMA, 2023), 2024 Update of the RECOVER-Adult Long COVID Research Index (JAMA, 2024), and Characterizing Long COVID in Children and Adolescents (JAMA, 2024)—researchers developed similar research indexes to examine different Long COVID symptoms and symptom patterns in adults, school-aged children (aged 6-11), and adolescents (aged 12-17). Collectively, these studies highlight age-specific differences in Long COVID symptom patterns and the importance of understanding Long COVID experiences across the lifespan. This study was supported by NIH as part of the RECOVER research program under the following agreements: OT2HL161841, OT2HL161847, OT2HL156812, and R01 HL162373.
Study: RS Gross, T Thaweethai, AL Salisbury, et al., Characterizing Long COVID Symptoms During Early Childhood, JAMA Pediatrics, May 27, 2025.DOI: 10.1001/jamapediatrics.2025.1066.
