Who is Most at Risk for Pediatric Long COVID?

While any child can develop Long COVID, risk factors include:

• Severity of Initial Infection – More severe cases may lead to prolonged symptoms, though even mild cases can result in Long COVID.
• Age – Older children may report symptoms more clearly than younger ones, skewing data.
• Gender – While both boys and girls are affected, our experience shows more boys seeking treatment for severe cases.
• Pre-Existing Conditions – Chronic illnesses, metabolic disorders, genetic disorders, autoimmune diseases, hypermobility spectrum issues and sleep disturbances increase risk. 

Long COVID & Hypermobility Disorders

​I want to especially expand on the link between Long COVID and hypermobility disorders. Emerging research indicates that children with hypermobile Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorders (HSD) may be at increased risk for developing Long COVID. A study published in BMJ Public Health found that individuals with generalized joint hypermobility were 30% more likely to experience prolonged symptoms after COVID-19 infection, including persistent fatigue—a hallmark of Long COVID (1). 

We are seeing that almost every patient with Long COVID also has hypermobility, most often undiagnosed. What complicates this is that the criteria for diagnosing hEDS and HSD is outdated and sometimes outright incorrect. For example, many patients with hEDS or HSD ironically do NOT have hypermobile joints. Importantly, hEDS and HSD are not solely defined by visible joint hypermobility. Many patients, especially children, may not exhibit overt hyperflexibility but still suffer from underlying connective tissue abnormalities that affect multiple systems, including the autonomic nervous system. This can lead to symptoms such as dizziness, rapid heartbeat, and gastrointestinal issues, which are also common in Long COVID.​

In practice, we are noticing an explosion of hEDS and HSD post-COVID and post-COVID vaccine. I believe that while this disorder is not always expressed genetically, it can become expressed (or symptomatic) by illness, trauma, or vaccines. 

The overlap in symptoms suggests a shared pathophysiology between hEDS/HSD and Long COVID, potentially involving immune dysregulation and autonomic nervous system dysfunction. Recognizing this connection is crucial for healthcare providers to identify at-risk pediatric patients and tailor management strategies accordingly.

Emerging research is uncovering biomarkers associated with Long COVID. A 2023 study identified distinct immune and hormonal differences in Long COVID patients, including low cortisol levels, abnormal T-cell activity, and Epstein-Barr virus reactivation. These findings may pave the way for targeted treatment strategies (2).