Long COVID in the pediatric population – clinical evolution, prevalence and management from the early pandemic to the current era: a systematic review

Paquita R. Q. Donoso; Jaime V. M. Muñoz; Joba E. I. Imbaquingo; Luis A. R. Vasconez; Eliana M. C. Peñafiel; Verónica J. M. Cuenca

doi:10.18203/2349-3291.ijcp20263317

Authors

Paquita R. Q. Donoso Universidad Central del Ecuador, Quito, Ecuador
Jaime V. M. Muñoz Hospital de Especialidades Fuerzas Armadas N°1, Quito, Ecuador
Joba E. I. Imbaquingo Hospital Isidro Ayora, Loja, Ecuador
Luis A. R. Vasconez Hospital Isidro Ayora, Loja, Ecuador
Eliana M. C. Peñafiel Hospital Isidro Ayora, Loja, Ecuador
Verónica J. M. Cuenca Hospital Isidro Ayora, Loja, Ecuador

DOI:

https://doi.org/10.18203/2349-3291.ijcp20263317

Keywords:

Long COVID, Post-acute COVID-19, Pediatric population, Prevalence, Clinical management, Dysautonomia

Abstract

Post-acute sequelae of SARS-CoV-2 infection (PASC), or Long COVID, in the pediatric population present a complex clinical picture that has evolved from the initial pandemic waves to the current era characterized by omicron lineages and widespread vaccination. Understanding its prevalence, clinical trajectory, and evidence-based therapeutic strategies remains crucial for pediatric healthcare. Objective of the study was to systematically evaluate the clinical evolution, changing prevalence rates, predominant symptom clusters, and therapeutic management strategies of Long COVID in pediatric patients from the early pandemic to the current era. Systematic review of literature published between 2020 and 2026 across PubMed, Scopus, Cochrane Library, and Embase. Observational studies, prospective cohort analyses, and clinical trial data assessing post-acute symptoms (≥12 weeks post-infection) in children and adolescents aged 0–18 years were included following PRISMA guidelines. Reported prevalence of pediatric Long COVID varied significantly across pandemic phases, decreasing from 10–25% during pre-Omicron variants to 2–8% in the post-Omicron era, largely moderated by pediatric vaccination coverage and previous hybrid immunity. The most persistent clinical manifestations shifted from systemic fatigue, headache, and dyspnea to persistent fatigue, neurocognitive dysfunction ("brain fog"), mood disturbances, and dysautonomia (e.g., POTS-like symptoms). Management strategies remain primarily multidisciplinary and symptom-targeted, focusing on tailored physical rehabilitation, cognitive pacing, and non-pharmacological interventions, with emerging evidence supporting pharmacological targeting of post-viral inflammatory and autonomic dysregulation. Long COVID in pediatric populations continues to present a dynamic clinical burden, with reduced overall incidence in recent years but persistent morbidity in vulnerable subsets. Integrated, multidisciplinary follow-up models and standardized diagnostic criteria are essential to optimize long-term clinical management and functional recovery in pediatric patients.

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