Two Kennedy Krieger Institute clinicians, Dr. Laura Malone and Dr. Amanda Morrow, led an effort to create guidelines that will help pediatricians and primary care physicians across the country identify and treat pediatric post-COVID-19 or long COVID.
The guidelines were published this week in PM&R: The Journal of Injury, Function and Rehabilitation, a journal from the American Academy of Physical Medicine and Rehabilitation (AAPM&R). The guidelines include best practices from Kennedy Krieger's Pediatric Post-COVID-19 Rehabilitation Clinic, which opened in fall 2020 and has treated more than 100 pediatric patients with ongoing health issues related to prior COVID-19 infection.
"Much of our work has been identifying what long COVID looks like in children and teens and how best to treat it," said Dr. Malone, the guidelines' lead author. "Symptoms can vary from child to child, and we've determined that an interdisciplinary approach to treatment is beneficial for many children. Now we want to share this information with other physicians treating children with long COVID and with physicians who may want to start their own clinics."
Dr. Malone and Dr. Amanda Morrow collaborated with a pediatric workgroup of more than 30 clinicians from eight medical institutions nationwide that was convened by the AAPM&R to study pediatric long COVID.
The guidelines include nine tables of symptoms, classified by body system, as well as instructions for how physicians can evaluate those symptoms and how they can be treated with medications, lifestyle modifications, and additional considerations.
"Throughout the pandemic, this group of clinicians and researchers have collaborated and shared their findings as they treated some of the first patients with pediatric long COVID," said Dr. Stacy Suskauer, Kennedy Krieger's vice president of pediatric rehabilitation. "This sharing of knowledge has resulted in guidelines that will be extremely beneficial to clinicians across the country."
Long COVID in children often presents with lingering fatigue, dizziness, decreased endurance, poor conditioning, or orthostatic intolerance. Some kids also have anxiety or attention issues. One of the most common complaints from pediatric long COVID patients is that they do not feel like themselves.
Estimates suggest that 5 to 25% of children might develop long COVID symptoms after their acute or initial COVID infections. Clinicians at Kennedy Krieger have treated children as young as toddlers as well as school-aged children up through adolescence. A majority of the clinic's patients are in the pre-teen to adolescent age range.
The clinic's staff includes a physical rehabilitation physician, a neurologist, a behavioral psychologist, a physical therapist, a social worker, and others. Clinic staff works closely with neuropsychologists to complete cognitive and school based testing, and with a team of nurses who develop school accommodation recommendations.
Dr. Malone and Dr. Morrow co-direct the clinic.
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