{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T16:46:28Z","timestamp":1784565988567,"version":"3.55.0"},"reference-count":61,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T00:00:00Z","timestamp":1694649600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"<jats:p>Contrary to what is true for adults, little is known about pediatric long COVID (LC). Studies enrolling children are relatively few and extremely heterogeneous. This does not allow to draw definitive conclusions on the frequency and pathogenesis of pediatric LC and limits the development of appropriate and effective measures to contain the clinical, social and economic impact of this condition on the pediatric population. Depending on the methods used to collect and analyze data, studies have found that the incidence rate of pediatric LC may vary from about 25% to less than 5%. However, despite true prevalence of pediatric LC cannot be exactly defined, studies comparing children with previous COVID-19 and uninfected controls have shown that most of the clinical manifestations detected in infected children, mainly mood symptoms, mental health disorders and heart abnormalities could be diagnosed with similar frequency and severity in uninfected subjects also. This seems to indicate that SARS-CoV-2 is the cause of pediatric LC only in a part of children and other factors play a relevant role in this regard. Pandemic itself with the persistent disruption of child lives may have caused persistent stress in all the pediatric population causing mood symptoms, mental health disorders or several organ and body system functional alterations, regardless SARS-CoV-2 infection. These suppositions suggest the need for long-term physical control of all the children after COVID-19 especially when they were already suffering from an underlying disease or have had a severe disease. Moreover, attention should be paid to the assessment of change in children\u2019s emotional and behavioral functioning in order to assure adequate interventions for the best emotional and behavioral well being. However, whatever its origin, it seems highly likely that the prevalence of the pediatric LC is set to decline in the future. Preliminary observations seem to suggest that recently developed SARS-CoV-2 variants are associated with less severe COVID-19. This suggests that, as already seen in adults, a lower number of pediatric virus-associated LC cases should occur. Furthermore, the use of COVID-19 vaccines, reducing incidence and severity of SARS-CoV-2 infection, may reduce risk of LC development. Finally, elimination of restrictive measures should significantly reduce mood symptoms and mental health disorders.<\/jats:p>","DOI":"10.3389\/fmicb.2023.1225952","type":"journal-article","created":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T14:57:57Z","timestamp":1694703477000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["True prevalence of long COVID in children: a narrative review"],"prefix":"10.3389","volume":"14","author":[{"given":"Susanna","family":"Esposito","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michela","family":"Deolmi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greta","family":"Ramundo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Puntoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Caminiti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Principi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,9,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1038\/s41380-021-01224-9","article-title":"The neuroendocrinology of stress: the stress-related continuum of chronic disease development","volume":"27","author":"Agorastos","year":"2022","journal-title":"Mol. Psychiatry"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1177\/01410768211032850","article-title":"Symptoms, complications and management of long COVID: a review","volume":"114","author":"Aiyegbusi","year":"2021","journal-title":"J. R. Soc. Med."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e29719","DOI":"10.7759\/cureus.29719","article-title":"The impact of COVID-19 on the behaviors and attitudes of children and adolescents: a cross-sectional study","volume":"14","author":"Annam","year":"2022","journal-title":"Cureus."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1007\/s12519-021-00457-6","article-title":"Risk factors for post-COVID-19 condition in previously hospitalised children using the ISARIC global follow-up protocol: a prospective cohort study. Eur Respir J. 2022;59:2101341. Asadi-Pooya AA, Nemati H, Shahisavandi M, Akbari a, Emami a, Lotfi M, et al. Long COVID in children and adolescents","volume":"17","author":"Asadi-Pooya","year":"2021","journal-title":"World J. Pediatr."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e509","DOI":"10.1097\/INF.0000000000003285","article-title":"Long COVID in children: observations from a designated pediatric clinic","volume":"40","author":"Ashkenazi-Hoffnung","year":"2021","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1113\/EP090802","article-title":"Long COVID: mechanisms, risk factors and recovery","volume":"108","author":"Astin","year":"2023","journal-title":"Exp. Physiol."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.1186\/s12889-021-11111-1","article-title":"Effective public health measures to mitigate the spread of COVID-19: a systematic review","volume":"21","author":"Ayouni","year":"2021","journal-title":"BMC Public Health"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"100405","DOI":"10.1016\/j.lana.2022.100405","article-title":"Severe COVID-19 outcomes in pediatrics: an observational cohort analysis comparing alpha, Delta, and omicron variants","volume":"18","author":"Bahl","year":"2023","journal-title":"Lancet Reg Health Am."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1016\/j.jad.2022.09.053","article-title":"Post-pandemic stress of COVID-19 among high-risk groups: a systematic review and meta-analysis","volume":"319","author":"Bajoulvand","year":"2022","journal-title":"J. Affect. Disord."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1597","DOI":"10.1007\/s00431-021-04345-z","article-title":"Long COVID symptoms and duration in SARS-CoV-2 positive children\u2014a nationwide cohort study","volume":"181","author":"Borch","year":"2022","journal-title":"Eur. J. Pediatr."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"577","DOI":"10.2217\/fmb-2021-0285","article-title":"Clinical characteristics, activity levels and mental health problems in children with long coronavirus disease: a survey of 510 children","volume":"17","author":"Buonsenso","year":"2022","journal-title":"Future Microbiol."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e361","DOI":"10.1093\/cid\/ciac275","article-title":"Coronavirus disease 2019 disease severity in children infected with the omicron variant","volume":"75","author":"Butt","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e000385","DOI":"10.1136\/bmjmed-2022-000385","article-title":"Effect of covid-19 vaccination on long covid: systematic review","volume":"2","author":"Byambasuren","year":"2023","journal-title":"BMJMED"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e1008559","DOI":"10.1371\/journal.pcbi.1008559","article-title":"The role of children in the spread of COVID-19: using household data from Bnei Brak, Israel, to estimate the relative susceptibility and infectivity of children","volume":"17","author":"Dattner","year":"2021","journal-title":"PLoS Comput. Biol."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1038\/s41579-022-00846-2","article-title":"Long COVID: major findings, mechanisms and recommendations","volume":"21","author":"Davis","year":"2023","journal-title":"Nat. Rev. Microbiol."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"2068883","DOI":"10.1080\/21645515.2022.2068883","article-title":"Delta variant (B.1.617.2) of SARS-CoV-2: mutations, impact, challenges and possible solutions","volume":"18","author":"Dhawan","year":"2022","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e000470","DOI":"10.1136\/bmjmed-2022-000470","article-title":"Impact of covid-19 vaccination on long covid","volume":"2","author":"Edwards","year":"2023","journal-title":"BMJ Med."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/s13052-022-01233-6","article-title":"Italian intersociety consensus on management of long covid in children","volume":"48","author":"Esposito","year":"2022","journal-title":"Ital. J. Pediatr."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"285","DOI":"10.3390\/life12020285","article-title":"Long COVID in children and adolescents","volume":"12","author":"Fainardi","year":"2022","journal-title":"Life (Basel)."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"2629","DOI":"10.3390\/v14122629","article-title":"Long-COVID symptoms in individuals infected with different SARS-CoV-2 variants of concern: a systematic review of the literature","volume":"14","author":"Fern\u00e1ndez-de-las-Pe\u00f1as","year":"2022","journal-title":"Viruses"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e2128568","DOI":"10.1001\/jamanetworkopen.2021.28568","article-title":"Short-term and long-term rates of postacute sequelae of SARS-CoV-2 infection: a systematic review","volume":"4","author":"Groff","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"102944","DOI":"10.1016\/j.autneu.2022.102944","article-title":"Stress-related dysautonomias and neurocardiology-based treatment approaches","volume":"239","author":"Gurel","year":"2022","journal-title":"Auton. Neurosci."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s15010-023-01996-y","article-title":"Comparing SARS-CoV-2 variants among children and adolescents in Germany: relative risk of COVID-19-related hospitalization, ICU admission and mortality","author":"Jank","year":"2023","journal-title":"Infection"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"9221","DOI":"10.1038\/s41598-021-88498-9","article-title":"Temporal dynamics of viral load and false negative rate influence the levels of testing necessary to combat COVID-19 spread","volume":"11","author":"Jarvis","year":"2021","journal-title":"Sci. Rep."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1016\/S2352-4642(22)00154-7","article-title":"Long COVID symptoms in SARS-CoV-2-positive children aged 0-14 years and matched controls in Denmark (LongCOVIDKidsDK): a national, cross-sectional study","volume":"6","author":"Kikkenborg Berg","year":"2022","journal-title":"Lancet Child Adolesc Health."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"851008","DOI":"10.3389\/fped.2022.851008","article-title":"Pulmonary function and Long-term respiratory symptoms in children and adolescents after COVID-19","volume":"10","author":"Knoke","year":"2022","journal-title":"Front. Pediatr."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"9950","DOI":"10.1038\/s41598-022-13495-5","article-title":"Long-COVID in children and adolescents: a systematic review and meta-analyses","volume":"12","author":"Lopez-Leon","year":"2022","journal-title":"Sci. Rep."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"247054701769232","DOI":"10.1177\/2470547017692328","article-title":"Neurobiological and systemic effects of chronic stress","volume":"1","author":"McEwen","year":"2017","journal-title":"Chronic Stress (Thousand Oaks)."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1618","DOI":"10.1016\/S0140-6736(22)00327-0","article-title":"Symptom prevalence, duration, and risk of hospital admission in individuals infected with SARS-CoV-2 during periods of omicron and delta variant dominance: a prospective observational study from the ZOE COVID study","volume":"399","author":"Menni","year":"2022","journal-title":"Lancet"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"13382","DOI":"10.3390\/ijerph192013382","article-title":"Comparison of Long-term complications of COVID-19 illness among a diverse sample of children by MIS-C status","volume":"19","author":"Messiah","year":"2022","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"e005427","DOI":"10.1136\/bmjgh-2021-005427","article-title":"Characterizing long COVID: a living systematic review","volume":"6","author":"Michelen","year":"2021","journal-title":"BMJ Glob. Health"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1097\/INF.0000000000003715","article-title":"Prevalence of persistent symptoms in children during the COVID-19 pandemic: evidence from a household cohort study in England and Wales","volume":"41","author":"Miller","year":"2022","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1016\/S2352-4642(22)00035-9","article-title":"Assessing the impact of the pandemic in children and adolescents: SARS-CoV-2 infection and beyond","volume":"6","author":"Molteni","year":"2022","journal-title":"Lancet Child Adolesc Health"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"101961","DOI":"10.1016\/j.eclinm.2023.101961","article-title":"Risk factors for post-COVID-19 condition (Long Covid) in children: a prospective cohort study","volume":"59","author":"Morello","year":"2023","journal-title":"EClinicalMedicine."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"e2111417","DOI":"10.1001\/jamanetworkopen.2021.11417","article-title":"Assessment of the frequency and variety of persistent symptoms among patients with COVID-19: a systematic review","volume":"4","author":"Nasserie","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref36","year":"2023"},{"key":"ref37","year":"2023"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1604501","DOI":"10.3389\/phrs.2022.1604501","article-title":"Long COVID through a public health Lens: an umbrella review","volume":"43","author":"Nittas","year":"2022","journal-title":"Public Health Rev."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"101762","DOI":"10.1016\/j.eclinm.2022.101762","article-title":"The prevalence and long-term health effects of Long Covid among hospitalised and non-hospitalised populations: a systematic review and meta-analysis","volume":"55","author":"O'Mahoney","year":"2022","journal-title":"EClinicalMedicine."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"2101341","DOI":"10.1183\/13993003.01341-2021","article-title":"Risk factors for post-COVID-19 condition in previously hospitalised children using the ISARIC global follow-up protocol: a prospective cohort study","volume":"59","author":"Osmanov","year":"2022","journal-title":"Eur. Respir. J."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1016\/j.arcmed.2021.03.010","article-title":"Post-COVID syndrome: incidence, clinical Spectrum, and challenges for primary healthcare professionals","volume":"52","author":"Pavli","year":"2021","journal-title":"Arch. Med. Res."},{"key":"ref42","doi-asserted-by":"publisher","first-page":"2924","DOI":"10.3390\/jcm12082924","article-title":"Impact of age and sex interaction on post-acute sequelae of COVID-19: an Italian cohort study on adults and children","volume":"12","author":"Puntoni","year":"2023","journal-title":"J. Clin. Med."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1001\/jama.2021.11880","article-title":"Long-term symptoms after SARS-CoV-2 infection in children and adolescents","volume":"326","author":"Radtke","year":"2021","journal-title":"JAMA"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1000","DOI":"10.1001\/jamapediatrics.2022.2800","article-title":"Clinical features and burden of Postacute sequelae of SARS-CoV-2 infection in children and adolescents","volume":"176","author":"Rao","year":"2022","journal-title":"JAMA Pediatr."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"752385","DOI":"10.3389\/fped.2021.752385","article-title":"Comparison of persistent symptoms after COVID-19 and other non-SARS-CoV-2 infections in children","volume":"9","author":"Roge","year":"2021","journal-title":"Front. Pediatr."},{"key":"ref46","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1111\/camh.12501","article-title":"Review: mental health impacts of the COVID-19 pandemic on children and youth \u2013 a systematic review","volume":"27","author":"Samji","year":"2022","journal-title":"Child Adolesc Ment Health."},{"key":"ref47","doi-asserted-by":"publisher","first-page":"e22","DOI":"10.1016\/S2352-4642(21)00124-3","article-title":"Post-acute COVID-19 outcomes in children with mild and asymptomatic disease","volume":"5","author":"Say","year":"2021","journal-title":"Lancet Child Adolesc Health."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1016\/j.jad.2021.09.090","article-title":"Physical and mental health impact of COVID-19 on children, adolescents, and their families: the collaborative outcomes study on health and functioning during infection times \u2013 children and adolescents (COH-FIT-C&a)","volume":"299","author":"Solmi","year":"2022","journal-title":"J. Affect. Disord."},{"key":"ref49","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1136\/archdischild-2021-323624","article-title":"Long COVID (post-COVID-19 condition) in children: a modified Delphi process","volume":"107","author":"Stephenson","year":"2022","journal-title":"Arch. Dis. Child."},{"key":"ref50","doi-asserted-by":"publisher","first-page":"e232328","DOI":"10.1001\/jamanetworkopen.2023.2328","article-title":"Comparison of symptoms associated with SARS-CoV-2 variants among children in Canada","volume":"6","author":"Sumner","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1002\/jmv.27376","article-title":"The global epidemic of SARS-CoV-2 variants and their mutational immune escape","volume":"94","author":"Tian","year":"2022","journal-title":"J. Med. Virol."},{"key":"ref52","doi-asserted-by":"publisher","first-page":"e000229","DOI":"10.1136\/bmjmed-2022-000229","article-title":"Efficacy of first dose of covid-19 vaccine versus no vaccination on symptoms of patients with long covid: target trial emulation based on ComPaRe e-cohort","volume":"2","author":"Tran","year":"2023","journal-title":"BMJ Med."},{"key":"ref53","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/S1473-3099(21)00475-8","article-title":"Hospital admission and emergency care attendance risk for SARS-CoV-2 delta (B.1.617.2) compared with alpha (B.1.1.7) variants of concern: a cohort study","volume":"22","author":"Twohig","year":"2022","journal-title":"Lancet Infect. Dis."},{"key":"ref55","doi-asserted-by":"publisher","first-page":"1293","DOI":"10.1016\/S1473-3099(22)00320-6","article-title":"Global impact of the first year of COVID-19 vaccination: a mathematical modelling study","volume":"22","author":"Watson","year":"2022","journal-title":"Lancet Infect. Dis."},{"key":"ref56","doi-asserted-by":"publisher","first-page":"6856","DOI":"10.1038\/s41467-022-34244-2","article-title":"Variant-specific symptoms of COVID-19 in a study of 1,542,510 adults in England","volume":"13","author":"Whitaker","year":"2022","journal-title":"Nat. Commun."},{"key":"ref57","year":""},{"key":"ref58","year":""},{"key":"ref59","year":""},{"key":"ref60","doi-asserted-by":"publisher","first-page":"832","DOI":"10.1111\/irv.12982","article-title":"COVID-19 severity from omicron and Delta SARS-CoV-2 variants","volume":"16","author":"Wrenn","year":"2022","journal-title":"Influenza Other Respir. Viruses"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"1057","DOI":"10.17179\/excli2017-480","article-title":"The impact of stress on body function: a review","volume":"16","author":"Yaribeygi","year":"2017","journal-title":"EXCLI J."},{"key":"ref62","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1016\/j.jiph.2023.03.005","article-title":"Prevalence and risk factor for long COVID in children and adolescents: a meta-analysis and systematic review","volume":"16","author":"Zheng","year":"2023","journal-title":"J. Infect. Public Health"}],"container-title":["Frontiers in Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2023.1225952\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T14:58:15Z","timestamp":1694703495000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2023.1225952\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,14]]},"references-count":61,"alternative-id":["10.3389\/fmicb.2023.1225952"],"URL":"https:\/\/doi.org\/10.3389\/fmicb.2023.1225952","relation":{},"ISSN":["1664-302X"],"issn-type":[{"value":"1664-302X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,14]]},"article-number":"1225952"}}