A LARGE USA cohort study has identified prolonged symptoms in infants and preschoolers that are more likely to occur following SARS-CoV-2 infection, offering new insights into how long COVID presents in early childhood.
While long COVID has been characterised in adults and school-aged children, its manifestations in children aged under 5 years remain poorly defined. The RECOVER–Pediatrics study aimed to address this gap by comparing symptom patterns in 472 infants and toddlers (0–2 years) and 539 preschool-aged children (3–5 years), with and without prior SARS-CoV-2 infection. Conducted across more than 30 healthcare and community settings in the USA, the longitudinal cohort study evaluated a range of symptoms and developed empirically derived indices to identify probable long COVID in this age group.
Among infants and toddlers, those with an infection history were significantly more likely to experience trouble sleeping, fussiness, poor appetite, stuffy nose, and cough compared to uninfected peers. In preschool-aged children, dry cough and daytime tiredness, sleepiness, or low energy were more prevalent in those with prior infection. Symptom surveys were completed a median of 318 days (infants/toddlers) and 520 days (preschoolers) after infection.
The research team developed a scoring system to reflect the magnitude of association between symptoms and SARS-CoV-2 infection: for infants and toddlers, poor appetite (5 points), trouble sleeping and wet cough (3.5 each), dry cough (3), and stuffy nose (0.5); for preschoolers, daytime tiredness/sleepiness/low energy (6.5) and dry cough (3). An index threshold of ≥4 points in infants/toddlers and ≥3 points in preschoolers was used to classify probable long COVID. Using these criteria, 14% of infected infants/toddlers (40 of 278) and 15% of infected preschoolers (61 of 399) met the definition. Children with higher index scores were more likely to be reported as having poorer overall health, lower quality of life, and delays in reaching developmental milestones.
These findings highlight distinct, age-specific symptom clusters in young children that differ from those observed in older children and adults. The development of validated research indices may aid in future identification and management of long COVID in early childhood.
Reference
Gross RS et al. Characterizing long COVID symptoms during early childhood. JAMA Pediatr. 2025; DOI:10.1001/jamapediatrics.2025.1066.
