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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Milestones. We celebrate them in pregnancy, in parenting, and they’re a fun thing to celebrate at work too. Just a couple years ago I couldn’t have foreseen what this community would grow into. Today, there are over 400,000 of you here—asking questions, making others feel seen wherever they may be in their journey, and sharing information that supports data > panic. 

It has been a busy summer for the team at ParentData. I’d love to take a moment here to celebrate the 400k milestone. As I’ve said before, it’s more important than ever to put good data in the hands of parents. 

Share this post with a friend who could use a little more data, and a little less parenting overwhelm. 

📷 Me and my oldest, collaborating on “Expecting Better”

Milestones. We celebrate them in pregnancy, in parenting, and they’re a fun thing to celebrate at work too. Just a couple years ago I couldn’t have foreseen what this community would grow into. Today, there are over 400,000 of you here—asking questions, making others feel seen wherever they may be in their journey, and sharing information that supports data > panic.

It has been a busy summer for the team at ParentData. I’d love to take a moment here to celebrate the 400k milestone. As I’ve said before, it’s more important than ever to put good data in the hands of parents.

Share this post with a friend who could use a little more data, and a little less parenting overwhelm.

📷 Me and my oldest, collaborating on “Expecting Better”
...

I spend a lot of time talking people down after they read the latest panic headline. In most cases, these articles create an unnecessary amount of stress around pregnancy and parenting. This is my pro tip for understanding whether the risk presented is something you should really be worrying about.

Comment “link” for an article with other tools to help you navigate risk and uncertainty.

#emilyoster #parentdata #riskmanagement #parentstruggles #parentingstruggles

I spend a lot of time talking people down after they read the latest panic headline. In most cases, these articles create an unnecessary amount of stress around pregnancy and parenting. This is my pro tip for understanding whether the risk presented is something you should really be worrying about.

Comment “link” for an article with other tools to help you navigate risk and uncertainty.

#emilyoster #parentdata #riskmanagement #parentstruggles #parentingstruggles
...

Here’s why I think you don’t have to throw away your baby bottles.

Here’s why I think you don’t have to throw away your baby bottles. ...

Drop your toddlers favorite thing right now in the comments—then grab some popcorn.

Original thread source: Reddit @croc_docs

Drop your toddlers favorite thing right now in the comments—then grab some popcorn.

Original thread source: Reddit @croc_docs
...

Just keep wiping.

Just keep wiping. ...

Dr. Gillian Goddard sums up what she learned from the Hot Flash  S e x  Survey! Here are some key data takeaways:

🌶️ Among respondents, the most common s e x u a l frequency was 1 to 2 times per month, followed closely by 1 to 2 times per week
🌶️ 37% have found their sweet spot and are happy with the frequency of s e x they are having
🌶️ About 64% of respondents were very or somewhat satisfied with the quality of the s e x they are having

Do any of these findings surprise you? Let us know in the comments!

#hotflash #intimacy #midlifepleasure #parentdata #relationships

Dr. Gillian Goddard sums up what she learned from the Hot Flash S e x Survey! Here are some key data takeaways:

🌶️ Among respondents, the most common s e x u a l frequency was 1 to 2 times per month, followed closely by 1 to 2 times per week
🌶️ 37% have found their sweet spot and are happy with the frequency of s e x they are having
🌶️ About 64% of respondents were very or somewhat satisfied with the quality of the s e x they are having

Do any of these findings surprise you? Let us know in the comments!

#hotflash #intimacy #midlifepleasure #parentdata #relationships
...

Should your kid be in a car seat on the plane? The AAP recommends that you put kids under 40 pounds into a car seat on airplanes. However, airlines don’t require car seats.

Here’s what we know from a data standpoint:
✈️ The risk of injury to a child on a plane without a carseat is very small (about 1 in 250,000)
✈️ A JAMA Pediatrics paper estimates about 0.4 child air crash deaths per year might be prevented in the U.S. with car seats 
✈️ Cars are far more dangerous than airplanes! The same JAMA paper suggests that if 5% to 10% of families switched to driving, then we would expect more total deaths as a result of this policy. 

If you want to buy a seat for your lap infant, or bring a car seat for an older child, by all means do so! But the additional protection based on the numbers is extremely small.

#parentdata #emilyoster #flyingwithkids #flyingwithbaby #carseats #carseatsafety

Should your kid be in a car seat on the plane? The AAP recommends that you put kids under 40 pounds into a car seat on airplanes. However, airlines don’t require car seats.

Here’s what we know from a data standpoint:
✈️ The risk of injury to a child on a plane without a carseat is very small (about 1 in 250,000)
✈️ A JAMA Pediatrics paper estimates about 0.4 child air crash deaths per year might be prevented in the U.S. with car seats
✈️ Cars are far more dangerous than airplanes! The same JAMA paper suggests that if 5% to 10% of families switched to driving, then we would expect more total deaths as a result of this policy.

If you want to buy a seat for your lap infant, or bring a car seat for an older child, by all means do so! But the additional protection based on the numbers is extremely small.

#parentdata #emilyoster #flyingwithkids #flyingwithbaby #carseats #carseatsafety
...

SLEEP DATA 💤 PART 2: Let’s talk about naps. Comment “Link” for an article on what we learned about daytime sleep!

The first three months of life are a chaotic combination of irregular napping, many naps, and a few brave or lucky souls who appear to have already arrived at a two-to-three nap schedule. Over the next few months, the naps consolidate to three and then to two. By the 10-to-12-month period, a very large share of kids are napping a consistent two naps per day. Over the period between 12 and 18 months, this shifts toward one nap. And then sometime in the range of 3 to 5 years, naps are dropped. What I think is perhaps most useful about this graph is it gives a lot of color to the average napping ages that we often hear. 

Note: Survey data came from the ParentData audience and users of the Nanit sleep monitor system. Both audiences skew higher-education and higher-income than the average, and mostly have younger children. The final sample is 14,919 children. For more insights on our respondents, read the full article.

SLEEP DATA 💤 PART 2: Let’s talk about naps. Comment “Link” for an article on what we learned about daytime sleep!

The first three months of life are a chaotic combination of irregular napping, many naps, and a few brave or lucky souls who appear to have already arrived at a two-to-three nap schedule. Over the next few months, the naps consolidate to three and then to two. By the 10-to-12-month period, a very large share of kids are napping a consistent two naps per day. Over the period between 12 and 18 months, this shifts toward one nap. And then sometime in the range of 3 to 5 years, naps are dropped. What I think is perhaps most useful about this graph is it gives a lot of color to the average napping ages that we often hear.

Note: Survey data came from the ParentData audience and users of the Nanit sleep monitor system. Both audiences skew higher-education and higher-income than the average, and mostly have younger children. The final sample is 14,919 children. For more insights on our respondents, read the full article.
...

Happy Father’s Day to the Fathers and Father figures in our ParentData community! 

Tag a Dad who this holiday may be tricky for. We’re sending you love. 💛

Happy Father’s Day to the Fathers and Father figures in our ParentData community!

Tag a Dad who this holiday may be tricky for. We’re sending you love. 💛
...

“Whilst googling things like ‘new dad sad’ and ‘why am I crying new dad,’ I came across an article written by a doctor who had trouble connecting with his second child. I read the symptoms and felt an odd sense of relief.” Today we’re bringing back an essay by Kevin Maguire of @newfatherhood about his experience with paternal postpartum depression. We need to demystify these issues in order to change things for the better. Comment “Link” for a DM to read his full essay.

#parentdata #postpartum #postpartumdepression #paternalmentalhealth #newparents #emilyoster

“Whilst googling things like ‘new dad sad’ and ‘why am I crying new dad,’ I came across an article written by a doctor who had trouble connecting with his second child. I read the symptoms and felt an odd sense of relief.” Today we’re bringing back an essay by Kevin Maguire of @newfatherhood about his experience with paternal postpartum depression. We need to demystify these issues in order to change things for the better. Comment “Link” for a DM to read his full essay.

#parentdata #postpartum #postpartumdepression #paternalmentalhealth #newparents #emilyoster
...

What does the data say about children who look more like one parent? Do they also inherit more character traits and mannerisms from that parent? Let’s talk about it 🔎

#emilyoster #parentdata #parentingcommunity #lookslikedaddy #lookslikemommy

What does the data say about children who look more like one parent? Do they also inherit more character traits and mannerisms from that parent? Let’s talk about it 🔎

#emilyoster #parentdata #parentingcommunity #lookslikedaddy #lookslikemommy
...

SLEEP DATA 💤 We asked you all about your kids’ sleep—and got nearly 15,000 survey responses to better understand kids’ sleep patterns. Comment “Link” for an article that breaks down our findings!

This graph shows sleeping location by age. You’ll notice that for the first three months, most kids are in their own sleeping location in a parent’s room. Then, over the first year, this switches toward their own room. As kids age, sharing a room with a sibling becomes more common. 

Head to the newsletter for more and stay tuned for part two next week on naps! 🌙

#parentdata #emilyoster #childsleep #babysleep #parentingcommunity

SLEEP DATA 💤 We asked you all about your kids’ sleep—and got nearly 15,000 survey responses to better understand kids’ sleep patterns. Comment “Link” for an article that breaks down our findings!

This graph shows sleeping location by age. You’ll notice that for the first three months, most kids are in their own sleeping location in a parent’s room. Then, over the first year, this switches toward their own room. As kids age, sharing a room with a sibling becomes more common.

Head to the newsletter for more and stay tuned for part two next week on naps! 🌙

#parentdata #emilyoster #childsleep #babysleep #parentingcommunity
...

Weekends are good for extra cups of ☕️ and listening to podcasts. I asked our team how they pod—most people said on walks or during chores. What about you?

Comment “Link” to subscribe to ParentData with Emily Oster, joined by some excellent guests.

#parentdata #parentdatapodcast #parentingpodcast #parentingtips #emilyoster

Weekends are good for extra cups of ☕️ and listening to podcasts. I asked our team how they pod—most people said on walks or during chores. What about you?

Comment “Link” to subscribe to ParentData with Emily Oster, joined by some excellent guests.

#parentdata #parentdatapodcast #parentingpodcast #parentingtips #emilyoster
...

Humility. That’s why. That’s the whole reason.

#emilyoster #secondbaby #parentingjokes #parentinghumor

Humility. That’s why. That’s the whole reason.

#emilyoster #secondbaby #parentingjokes #parentinghumor
...

Bug season is upon us. Besides annoyance, this can bring up safety concerns, particularly with ticks. They are carriers of diseases, most notably Lyme disease. So what’s the best course of action?

Prevention is key! I suggest:
⭐ Regular tick checks
⭐ Using bug sprays with DEET 
⭐ Wearing long sleeves and pants in the woods

Some parents worry about DEET, but repellants with up to 30% DEET are recommended by both the CDC and AAP. The data says you’re in the clear, so go for it. Enjoy your summer!

#parentdata #emilyoster #tickseason #bugbites #bugspray

Bug season is upon us. Besides annoyance, this can bring up safety concerns, particularly with ticks. They are carriers of diseases, most notably Lyme disease. So what’s the best course of action?

Prevention is key! I suggest:
⭐ Regular tick checks
⭐ Using bug sprays with DEET
⭐ Wearing long sleeves and pants in the woods

Some parents worry about DEET, but repellants with up to 30% DEET are recommended by both the CDC and AAP. The data says you’re in the clear, so go for it. Enjoy your summer!

#parentdata #emilyoster #tickseason #bugbites #bugspray
...