POST-COVID-19 COMPLICATIONS IN CHILDREN: CLINICAL MANIFESTATIONS, LONG-TERM OUTCOMES, AND MANAGEMENT

Abstract

Abstract: Background: Although most children recover from acute coronavirus disease 2019 (COVID-19), some experience persistent symptoms or develop post-infectious complications. These include post-COVID-19 condition (PCC), commonly referred to as long COVID, and multisystem inflammatory syndrome in children (MIS-C). The clinical presentation, duration, and underlying mechanisms of these conditions vary considerably.

Objective: To review the current scientific evidence on post-COVID-19 complications in children and adolescents, focusing on clinical manifestations, potential mechanisms, diagnostic approaches, management, and long-term outcomes.

Materials and Methods: A narrative review of peer-reviewed publications, systematic reviews, clinical guidance, and recommendations from the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) was conducted. Particular attention was given to pediatric-specific case definitions, clinical reviews, and evidence concerning long-term outcomes. No original patient data or new statistical analyses were included.

Results: Pediatric post-COVID-19 complications may involve several organ systems. Commonly reported manifestations of PCC include fatigue, exercise intolerance, respiratory symptoms, headache, sleep disturbances, cognitive difficulties, and anxiety. MIS-C is a rare but potentially life-threatening inflammatory condition that may develop several weeks after SARS-CoV-2 infection and can affect the cardiovascular, gastrointestinal, respiratory, neurological, and other systems. Diagnosis of PCC requires clinical assessment and consideration of alternative explanations, as no single validated biomarker currently establishes the diagnosis. Most affected children improve over time, although a subgroup experiences persistent functional limitations requiring multidisciplinary care.

Conclusion: Recognition of post-COVID-19 complications in children is important for timely diagnosis, appropriate follow-up, and prevention of avoidable disability. Clinical management should be individualized according to symptoms, disease severity, functional impairment, and the presence of organ-specific complications. Further prospective studies are needed to clarify prevalence, risk factors, pathophysiological mechanisms, and effective treatment strategies.