Long Term COVID Risks in Kids

Emily Oster

10 min Read Emily Oster

Emily Oster

Long Term COVID Risks in Kids

Emily Oster

10 min Read

By now, you likely heard that kids are less affected than adults by COVID-19. They are somewhat less likely to get COVID-19 and much less likely to be seriously ill or to die from the disease. Compared to an adult in their early 70s, a child of 10 who has COVID-19 is 40 times less likely to be hospitalized and 1300 times less likely to die.

Even accepting these low immediate COVID risks, though, the fear of long term complications looms large for many parents. What if you think your child has a mild case, but then months later they are very ill? What if they have no symptoms but then later something bad happens? What if they do get sick and the symptoms last for months?

Today’s post is going to go through what we know, and what we do not, about long term COVID complications in kids focusing on both MIS-C and on “long COVID”. Three caveats before we start.

First, this post is narrow. It is very specifically about what we know about long term issues in kids. I’m not going to talk about broader issues of spread, or even about kids risk of getting infected in the first place. Making choices about what activities to do or not will require thinking about these considerations as well, and factoring in the community risks (see calculator, linked at bottom!!)

Second: I’m not going to talk specifically about variants, but I think the analysis here does apply. Check out this helpful article for some context on B.1.1.7 in particular and kids.

Third: Especially when it comes to our kids, we all have our own risk tolerance. Some people let their eight year old walk to school, some don’t. Some people let their kids play football, some don’t. And our approach to COVID-19 risks is similar. I can give you some limited numbers here to help make your choices, but there isn’t going to be just one right choice for everyone.

MIS-C

You might have first heard about MIS-C back in late spring or summer of last year, when it was sometimes called “Kawasaki-like illness” and there were a number of cases in New York City. MIS-C stands for “multisystem inflammatory syndrome in children” and you can see the CDC discussion of it here. The syndrome causes inflammation in various organs, fever, rash, and neurological symptoms. It can be very, very serious and often requires hospitalization.

MIS-C is related to, but presents slightly differently, from Kawasaki Disease, which is a rare complication of febrile illnesses like the flu. Kawasaki generally affects very young children and MIS-C has been seen in a broader range of ages. What they share is some features of the timing: both show up as complications often weeks after acute infection is over.

MIS-C appears to be a complication of COVID-19 infection. I say “appears to be” since there hasn’t been definitive linking of the two. But the circumstantial evidence is strong enough that people have generally accepted the relationship. And MIS-C is scary: it can show up even in kids with mild or asymptomatic infections and the complications are serious. There have been a small number of deaths.

This is a real risk. It’s not fake news. But it’s also extremely rare. The CDC counts about 3100 MIS-C cases in the US, with 36 deaths. A recent JAMA article attempted to summarize the characteristics of identified cases and calculate an overall incidence number (article here). They identified about 1700 cases of MIS-C in people under 21, with more serious illness in older teenagers than in small children.

The JAMA paper estimates and overall incidence of 2.1 in 100,000, meaning this illness affects 2.1 in 100,000 children over the last year. By comparison, the incidence of childhood cancer is several times higher (there are typically around 10,500 cases of childhood cancer diagnosed per year).

Bottom line: very rare, but serious, complication of COVID-19 in children.

Long COVID

MIS-C is an acute, serious illness which develops as a longer-term consequence of COVID. “Long COVID”, in contrast, refers to the phenomenon in which people have complications and symptoms from COVID which persist long after acute illness. Long COVID has been recognized in adults, and the NIH has started an initiative to study it. Not everyone is as sold on the idea, so this is an ongoing discussion.

There are also concerns about long COVID in kids. One piece of this is kid who are very sick from COVID-19 (rare, but happens) and take a long time to recover. There are certainly instances of this, as there are with other serious illness like the flu or RSV.

The more nebulous concern I hear is that even children who do not get very sick, or are totally asymptomatic, can have long term symptoms like fatigue, headache or brain fog weeks later. This concern has been bolstered by some recent data from the UK and Italy, which reported out something like 12 to 40% of children with documented COVID-19 cases still had symptoms weeks later.

It is worth digging into this data a little more for context.

Best documented is the data from Italy; pre-print available here. This study covers 129 children in Italy who were diagnosed with COVID-19 between March and November of 2020. The children experienced a range of illness, and the sample includes some asymptomatic kids. They were surveyed between 2 and 4 months after diagnosis and asked about various symptoms. The survey (which you can see here) was explicit that the study was about long term impacts of COVID-19 in children, and asked about symptoms in the last 7 days. The headline scary number is that 42% of the 68 kids interviewed 4 months after diagnosis reported symptoms.

There are various complications in interpreting this. One is the frame of the question — people may be primed to report more symptoms by the topic of the survey. But more important, I think, is that it’s hard to know the base rate. For example: 12.4% of children report nasal congestion. This is counted as a long COVID symptom but, of course, some kids have a runny nose for other reasons. The same is likely true for diarrhea, headache, rash, insomnia and the other symptoms listed (there are a total of 20 ). These symptoms are mostly mild. Of note, roughly 80% of the cases report that the symptoms bothered the child “not at all” or “only a little.”

The authors report two things which might help differentiate long COVID-19 from base rate symptoms. The first is that they ask about fatigue relative to before diagnosis. There, they do not find a COVID-19 effect. Overall, 75.4% of children report the same level of fatigue, 13.2% report less than before and 10.9% report more than before. The second is they compare children who had symptomatic COVID to those who had asymptomatic COVID, on the theory that long term symptoms associated with COVID-19 would be worse in the symptomatic group. This is a good idea, although they have too little data for precision; none of these comparisons rise to statistical significance.

Overall, in my view it’s hard to draw strong conclusions here. The scary headline number is certainly misleading. What they can realistically claim is that 42% of children in this group report one of a constellation of very common childhood complaints on a given day. Could they be long term COVID complications? They could be. But a large share of them likely reflect other illnesses or general child malaise and without a comparison group it’s difficult to know what share.

I would levy a similar concern with data from the UK which reports 12% of children have symptoms 5 weeks after a positive COVID test. These data are, again, derived from surveys which ask about a set of common illness symptoms and the base rate is difficult to derive.

This base rate concern isn’t idle. To get a sense of magnitude, I pulled data from the 2017-2018 National Health and Nutrition Examination Survey, which has a module on current health. Among children under 18 surveyed, 20% report a head cold or chest cold during the last month. This isn’t directly comparable to the numbers in the Italian or UK study for a number of reasons (they didn’t ask the same questions, it’s not the same time frame, and so on) but it does give some sense that these kind of symptoms are common.

None of this is to say that long COVID isn’t possible and, in fact, it would be surprising if we didn’t see lingering symptoms in at least a small number of children, especially those who got really sick. But the suggestion that 10%, 15%, 45% of children have symptoms months later — this is alarmist. The true numbers are likely much, much smaller than this.

We do need better data. The study in Italy had 129 children! In the US alone we have at least 3.7 million children who have tested positive, probably many more who had undetected infections. A better study of this would include a wide range of children, some of whom had known COVID and others who did not, and would include antibody testing so we could detect asymptomatic infections. Questions would be asked on symptoms at several time points, and comparisons could be made between children who had detected COVID, undetected COVID and no COVID. Together, this would give us a much better sense of the size of these longer term risks.

Summary

Where does this leave us, other than in our typical frustrating situation of not knowing enough?

Clearly, it is possible for children to have long term or extended complications from COVID-19. MIS-C is serious, but the risks are small. The long COVID risk is unclear in magnitude and the symptoms are largely mild.

When it comes to kids it is easy to be drawn into what-ifs. Sometimes, falling asleep at night, I am gripped by a vision of one of my kids running into the street in front of a car. These moments are terrifying, but making the right decisions about risks we take with our kids (and which we will let them take on their own) requires thinking rationally.

In this particular case, the problem is compounded by uncertainty. It’s not impossible to deal with, but requires you to think through varying scenarios. You can calculate the risk of COVID-19 infection, based on your community rate and features of the interaction you’re considering. You can incorporate the risks of MIS-C — perhaps 1 in 1500 after COVID-19 infection.

And then you can layer on top of this some long COVID scenarios. What if there is, say, a 1% chance that if your child gets COVID-19 they’ll have a runny nose, headache or insomnia in 4 months? This is another risk to incorporate alongside the immediate illness risk. What if this chance is 5%, or 0.1%?

If your answer is the same for all these scenarios then, well, you’ve got your answer. If not, you’ve got to think a bit more about how to deal with this uncertainty, and perhaps give more thought to how you read the long COVID evidence.

Ultimately, as a parent, you have to make the choice that works for you. It’s never going to be an easy one.

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Updated CDC Guidelines for School and Child Care

NO QUARANTINES!!!

Emily Oster

Instagram

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The AAP’s guidelines recommend sleeping in the same room as your baby “ideally for the first six months.” However, the risk of SIDS is dramatically lower after four months, and the evidence in favor of the protective effect of room sharing is quite weak (both overall and even more so after four months). There is also growing evidence that infants who sleep in their own room by four months sleep better at four months, better at nine months, and even better at 30 months.

With this in mind, it’s worth asking why this recommendation continues at all — or at least why the AAP doesn’t push it back to four months. They say decreased arousals from sleep are linked to SIDS, which could mean that babies sleeping in their own room is risky. But this link is extremely indirect, and they do not show direct evidence to support it.

According to the data we have, parents should sleep in the same room as a baby for as long as it works for them! Sharing a room with a child may have negative impacts on both child and adult sleep. We should give families more help in navigating these trade-offs and making the decisions that work best for them.

#emilyoster #parentdata #roomsharing #sids #parentingguide

The AAP’s guidelines recommend sleeping in the same room as your baby “ideally for the first six months.” However, the risk of SIDS is dramatically lower after four months, and the evidence in favor of the protective effect of room sharing is quite weak (both overall and even more so after four months). There is also growing evidence that infants who sleep in their own room by four months sleep better at four months, better at nine months, and even better at 30 months.

With this in mind, it’s worth asking why this recommendation continues at all — or at least why the AAP doesn’t push it back to four months. They say decreased arousals from sleep are linked to SIDS, which could mean that babies sleeping in their own room is risky. But this link is extremely indirect, and they do not show direct evidence to support it.

According to the data we have, parents should sleep in the same room as a baby for as long as it works for them! Sharing a room with a child may have negative impacts on both child and adult sleep. We should give families more help in navigating these trade-offs and making the decisions that work best for them.

#emilyoster #parentdata #roomsharing #sids #parentingguide
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It was an absolute pleasure to be featured on the @tamronhallshow! We talked about all things data-driven parenting and, in this clip, what I call the plague of secret parenting. To balance having a career and having a family, we can’t hide the fact that we’re parents. If mothers and fathers at the top can speak more openly about child-care obligations, it will help us all set a new precedent.

Watch the full segment at the link in my bio 🔗

#tamronhall #tamronhallshow #emilyoster #parentingsupport #workingparents

It was an absolute pleasure to be featured on the @tamronhallshow! We talked about all things data-driven parenting and, in this clip, what I call the plague of secret parenting. To balance having a career and having a family, we can’t hide the fact that we’re parents. If mothers and fathers at the top can speak more openly about child-care obligations, it will help us all set a new precedent.

Watch the full segment at the link in my bio 🔗

#tamronhall #tamronhallshow #emilyoster #parentingsupport #workingparents
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Invisible labor. It’s the work — in our households especially — that has to happen but that no one sees. It’s making the doctor’s appointment, ensuring birthday cards are purchased, remembering the milk.

My guest on this episode, @everodsky, has come up with a solution here, or at least a way for us to recognize the problem and make our own solutions. I’ve wanted to speak with Eve for ages, since I read her book Fair Play. We had a great conversation about the division of household labor, one I think you’ll get a lot out of!

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#emilyoster #parentdata #parentdatapodcast #parentingpodcast #householdtips #fairplay #invisiblelabor

Invisible labor. It’s the work — in our households especially — that has to happen but that no one sees. It’s making the doctor’s appointment, ensuring birthday cards are purchased, remembering the milk.

My guest on this episode, @everodsky, has come up with a solution here, or at least a way for us to recognize the problem and make our own solutions. I’ve wanted to speak with Eve for ages, since I read her book Fair Play. We had a great conversation about the division of household labor, one I think you’ll get a lot out of!

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#emilyoster #parentdata #parentdatapodcast #parentingpodcast #householdtips #fairplay #invisiblelabor
...

Prenatal vitamins 💊 If there is any product that seems designed to prey on our fears, it’s this one. You’re newly pregnant and you want to do it right. Everyone agrees you need prenatal vitamins, so you get them. But do you want to be that person who just… buys the generic prenatal vitamins?

Good news: fancier vitamins are not better.  Folic acid is the most important prenatal ingredient. Iron (with vitamin C) and DHA are also nice to have. Other included ingredients have only weak or no evidence to support their use. (If you do not consume animal products, add B12, plus a few others depending on your diet.)

Vitamins are just vitamins. Any prenatal vitamin that contains these is enough. 

Comment “Link” for a DM to an article with everything you need to know about prenatal vitamins.

#emilyoster #parentdata #prenatalvitamins #pregnancydiet #pregnancytips

Prenatal vitamins 💊 If there is any product that seems designed to prey on our fears, it’s this one. You’re newly pregnant and you want to do it right. Everyone agrees you need prenatal vitamins, so you get them. But do you want to be that person who just… buys the generic prenatal vitamins?

Good news: fancier vitamins are not better. Folic acid is the most important prenatal ingredient. Iron (with vitamin C) and DHA are also nice to have. Other included ingredients have only weak or no evidence to support their use. (If you do not consume animal products, add B12, plus a few others depending on your diet.)

Vitamins are just vitamins. Any prenatal vitamin that contains these is enough.

Comment “Link” for a DM to an article with everything you need to know about prenatal vitamins.

#emilyoster #parentdata #prenatalvitamins #pregnancydiet #pregnancytips
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When it comes to introducing your newborn to the world, timing matters. It’s a good idea to minimize germ exposure in the first 6-8 weeks; after that, it’s inevitable and, very likely, a good idea! This doesn’t mean you need to be trapped inside. The most significant exposure risks are from seeing other people at home — family, etc. These interactions are not infinitely risky, but they do pose more risk than a walk or a trip to the grocery store, since they involve closer interaction. Think simple and make sure everyone is washing their hands before holding the baby. 💛

#parentdata #emilyoster #newborncare #parentingadvice #parentingtips

When it comes to introducing your newborn to the world, timing matters. It’s a good idea to minimize germ exposure in the first 6-8 weeks; after that, it’s inevitable and, very likely, a good idea! This doesn’t mean you need to be trapped inside. The most significant exposure risks are from seeing other people at home — family, etc. These interactions are not infinitely risky, but they do pose more risk than a walk or a trip to the grocery store, since they involve closer interaction. Think simple and make sure everyone is washing their hands before holding the baby. 💛

#parentdata #emilyoster #newborncare #parentingadvice #parentingtips
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The first edition of Hot Flash is out now! Comment “Link” for a DM to learn more about the late-reproductive stage.

There are times when we expect hormonal shifts. Our reproductive lives are bookended by puberty and menopause. We discuss those changes often because they are definitive and dramatic — a first period is something many of us remember clearly. But between ages 13 and 53, our hormones are changing in more subtle ways. During the late-reproductive stage (in your 40s), you can expect a lot of changes in your menstrual cycle, including the length and symptoms you experience throughout. It’s an important time in our lives that is often overlooked!

🔥 Hot Flash from ParentData is a weekly newsletter on navigating your health and hormones in the post-reproductive years. Written by Dr. Gillian Goddard, Hot Flash provides all of the information you need to have a productive, evidence-based conversation about hormonal health with your doctor.

#emilyoster #parentdata #hotflash #perimenopause #womenshealth

The first edition of Hot Flash is out now! Comment “Link” for a DM to learn more about the late-reproductive stage.

There are times when we expect hormonal shifts. Our reproductive lives are bookended by puberty and menopause. We discuss those changes often because they are definitive and dramatic — a first period is something many of us remember clearly. But between ages 13 and 53, our hormones are changing in more subtle ways. During the late-reproductive stage (in your 40s), you can expect a lot of changes in your menstrual cycle, including the length and symptoms you experience throughout. It’s an important time in our lives that is often overlooked!

🔥 Hot Flash from ParentData is a weekly newsletter on navigating your health and hormones in the post-reproductive years. Written by Dr. Gillian Goddard, Hot Flash provides all of the information you need to have a productive, evidence-based conversation about hormonal health with your doctor.

#emilyoster #parentdata #hotflash #perimenopause #womenshealth
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There are plenty of reels telling you how to parent. Plenty of panic headlines saying that “studies show” what’s best for your kid. Even good data, from a trusted source, can send us into a spiral of comparison. But I want you to remember that no one knows your kid better than you. It’s important to absorb the research, but only you will know the approach that works best for you and your child. 💙

Now tell me in the comments: what’s a parenting move you’ve made recently that feels right to you?

#parentingcommunity #parentingsupport #parentingquotes #emilyoster #parentdata

There are plenty of reels telling you how to parent. Plenty of panic headlines saying that “studies show” what’s best for your kid. Even good data, from a trusted source, can send us into a spiral of comparison. But I want you to remember that no one knows your kid better than you. It’s important to absorb the research, but only you will know the approach that works best for you and your child. 💙

Now tell me in the comments: what’s a parenting move you’ve made recently that feels right to you?

#parentingcommunity #parentingsupport #parentingquotes #emilyoster #parentdata
...

Let’s talk about sex (after) baby! Today on the podcast, I was lucky enough to speak with @enagoski about her new book on sexual connection in long-term relationships. Especially after having kids, this is something many people struggle with. Emily tells us to stop worrying about what’s “normal” and focus on pleasure in its many forms.

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #parentdatapodcast #emilyoster #emilynagoski #comeasyouare #cometogether #longtermrelationship #intimacy #relationships

Let’s talk about sex (after) baby! Today on the podcast, I was lucky enough to speak with @enagoski about her new book on sexual connection in long-term relationships. Especially after having kids, this is something many people struggle with. Emily tells us to stop worrying about what’s “normal” and focus on pleasure in its many forms.

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #parentdatapodcast #emilyoster #emilynagoski #comeasyouare #cometogether #longtermrelationship #intimacy #relationships
...

Ever wondered if you can safely use leftover baby formula? 🍼 The CDC says to throw out unused formula immediately because of the risk of bacterial growth. However, research suggests that bacterial concentrations do not appreciably increase after 3, 12, or even 24 hours at refrigerator temperatures. Good news! This means there’s not a strong data-based reason to throw out formula right away if you store it in the fridge.

Comment “Link” for a DM to an article on another common formula question: should you throw away old formula powder?

#emilyoster #parentdata #babyformula #babyfeeding #parentingstruggles

Ever wondered if you can safely use leftover baby formula? 🍼 The CDC says to throw out unused formula immediately because of the risk of bacterial growth. However, research suggests that bacterial concentrations do not appreciably increase after 3, 12, or even 24 hours at refrigerator temperatures. Good news! This means there’s not a strong data-based reason to throw out formula right away if you store it in the fridge.

Comment “Link” for a DM to an article on another common formula question: should you throw away old formula powder?

#emilyoster #parentdata #babyformula #babyfeeding #parentingstruggles
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What’s the most important piece of advice for new parents? Here’s one answer, but I want to hear from you! Share your suggestions in the comments ⬇️

#emilyoster #parentdata #parentingtips #parentingadvice #newparents #parentingcommunity

What’s the most important piece of advice for new parents? Here’s one answer, but I want to hear from you! Share your suggestions in the comments ⬇️

#emilyoster #parentdata #parentingtips #parentingadvice #newparents #parentingcommunity
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What's in the bag of a Vagina Economist? 👀 Someone please tell me this looks familiar to you.

What`s in the bag of a Vagina Economist? 👀 Someone please tell me this looks familiar to you. ...

Comment ”link” for a DM to learn more about tongue ties 🔗

Breastfeeding is often difficult, especially at the start. For babies with tongue ties, many infants (and their moms) struggle to get the hang of a good latch. This can lead to painful nipples and to inefficient feeding, and then low weight gain.

So what does the data say about the increasingly common practice of cutting tongue-ties in infants to improve breastfeeding success? Several weeks ago, @nytimes published a long and quite scary article on this topic.

After diving into the data, here is what I found. There is limited evidence that frenotomy procedures improve breastfeeding efficacy and the harms of the procedure are minimal. Many women do report that it alleviates pain and helps them with breastfeeding. However, it should not be a first-line treatment for breastfeeding problems.

#parentdata #emilyoster #tonguetie #tonguetiebabies #breastfeedingsupport

Comment ”link” for a DM to learn more about tongue ties 🔗

Breastfeeding is often difficult, especially at the start. For babies with tongue ties, many infants (and their moms) struggle to get the hang of a good latch. This can lead to painful nipples and to inefficient feeding, and then low weight gain.

So what does the data say about the increasingly common practice of cutting tongue-ties in infants to improve breastfeeding success? Several weeks ago, @nytimes published a long and quite scary article on this topic.

After diving into the data, here is what I found. There is limited evidence that frenotomy procedures improve breastfeeding efficacy and the harms of the procedure are minimal. Many women do report that it alleviates pain and helps them with breastfeeding. However, it should not be a first-line treatment for breastfeeding problems.

#parentdata #emilyoster #tonguetie #tonguetiebabies #breastfeedingsupport
...

Tag a friend who needs to hear this 💛 For many choices in parenting, there is no one right answer. We can use research and data to make informed decisions, but ultimately, it won’t tell you what to do. Only you can decide what will be best for your kids and your family.

I’m here to remind you to take a deep breath and trust yourself. I’ll be here to support you along the way. 

Thank you to everyone who submitted videos, including:
@sarah.consoli
@jess_lynn627
@nicolevandenwills
@thedrblair
@ncbenedict29
@haleycimini
@iamkellysnodgrass
@calesse_smith
@garnet__gordon
@jencoopgaiser87
@danigirl18c
@jamielundergreen
@carly_comber
@thecelebratingmama
@emilyannbynum
@eeliz413

#emilyoster #parentdata #parentingadvice #parentingsupport #parentingquotes

Tag a friend who needs to hear this 💛 For many choices in parenting, there is no one right answer. We can use research and data to make informed decisions, but ultimately, it won’t tell you what to do. Only you can decide what will be best for your kids and your family.

I’m here to remind you to take a deep breath and trust yourself. I’ll be here to support you along the way.

Thank you to everyone who submitted videos, including:
@sarah.consoli
@jess_lynn627
@nicolevandenwills
@thedrblair
@ncbenedict29
@haleycimini
@iamkellysnodgrass
@calesse_smith
@garnet__gordon
@jencoopgaiser87
@danigirl18c
@jamielundergreen
@carly_comber
@thecelebratingmama
@emilyannbynum
@eeliz413

#emilyoster #parentdata #parentingadvice #parentingsupport #parentingquotes
...

Congratulations on making it through another year of panic headlines! We’ve had some doozies this year, like aspartame causing cancer and the perils of white noise, but these headlines are very often based on poor data. Correlation does not equal causation. There will certainly be more panic headlines in 2024, but ParentData is here to debunk them for you.

#emilyoster #parentdata #happynewyear2024 #panicheadline #datadriven

Congratulations on making it through another year of panic headlines! We’ve had some doozies this year, like aspartame causing cancer and the perils of white noise, but these headlines are very often based on poor data. Correlation does not equal causation. There will certainly be more panic headlines in 2024, but ParentData is here to debunk them for you.

#emilyoster #parentdata #happynewyear2024 #panicheadline #datadriven
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