Management of long COVID-19 in children and adolescents: from diagnosis to therapeutically approaches

TL;DR

This review explores the diagnosis and treatment of long COVID-19 in children and adolescents, emphasizing the need for personalized, multidisciplinary care due to the condition's complex and persistent symptoms.

Contribution

The paper provides a comprehensive review of pediatric long COVID-19 management strategies, highlighting gaps in evidence-based treatments and the importance of standardized protocols.

Findings

Diagnosing pediatric long COVID-19 is challenging due to varied symptoms and lack of biomarkers.

Multimodal rehabilitation programs show promise in improving fatigue and mental health in affected children.

Current treatments are individualized and focus on symptom relief, with limited high-quality evidence for medications.

Abstract

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).

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.

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.

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.

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