Young kids with long COVID more likely to have headaches while teens struggle with fatigue: Study

Children with long COVID-19 may show different symptoms depending on their age, a new study suggests.

The study, published Wednesday in the journal JAMA, is the first looking at how long COVID affects children and teens from the National Institute of Health (NIH)-funded RECOVER initiative, which seeks to better understand, diagnose, prevent and treat the condition.

Among younger children, between ages 6 and 11, headache was the primary symptom followed by trouble with memory, focus and sleep, as well as stomach pain.

Teens and pre-teens between ages 12 and 17 tended to report more fatigue-related symptoms, such as daytime sleepiness or low energy, body aches and pains, and neurological symptoms, including headaches and difficulty with memory and focus. This age group was also more likely to experience changes in taste or smell.

"We really wanted to understand how does long COVID look different across the ages?" Dr. Rachel Gross, lead study author and a general pediatrician and clinical researcher at NYU Langone Health, told ABC News.

Study participants were recruited from more than 60 U.S. health care and community settings between March 2022 and December 2023, with children between ages 6 and 17 with and without previous COVID-19 infection.

"We know that children are changing over time, we know that they're growing over time, that they're developing, that their immune system may be changing, that their hormones may be changing. So, we weren't surprised that we were seeing differences across these different age groups," Gross said. "But next steps, we really need to understand why this is happening so we can understand the underlying mechanisms that may be related to these differences."

Gross said most of what researchers know about long COVID comes from studies of adults, and this is one of the first studies to characterize what prolonged symptoms children may be experiencing. She said much more long COVID research needs to focus on children.

"There have been many misperceptions about COVID and children, even since the beginning of the pandemic," she said. "There was a common misperception that children didn't get COVID infections, and we know that's not true. And now there's a common misperception that children don't develop long COVID, and we know from studies like this and others that that is not true, and that long COVID in children is not a rare condition."

'I can't figure out what's wrong'

Gabrielle "Gabby" Jospa, from Plainview, New York, is one of many children who knows all too well that children can, and do, develop long COVID.

The now 15-year-old contracted COVID-19 in December 2021. At first, she thought it was just a cold or a less severe virus. However, she developed severe symptoms including a high fever, fast heart rate, nausea, body aches, stomachache and falling oxygen levels that required a visit to the emergency room, Gabby told ABC News.

Once the initial symptoms were gone, there were many lingering after-effects. Gabby's pulse and oxygen levels improved but not to where they were pre-COVID, according to her mother, Amy Jospa, and they knew something was wrong.

Gabby started experiencing fatigue and brain fog, and developed swollen joints, unexplained rashes and even postural orthostatic tachycardia syndrome (POTS), a condition that causes the heart to beat faster than normal when transitioning from sitting or lying down to standing, Amy Jospa told ABC News.

Gabby also has a history of migraines, experiencing them about once a year, but they worsened after COVID-19 to once per week and then once per day. They visited several doctors, none of whom could figure out what was wrong.

"The doctors will just tell you like -- and it's not the doctor's fault -- 'Oh, it's just a cold' or 'Oh, I'll just give you headache medicine' but it doesn't go away, and you're starting to feel after a while, after seeing a million doctors, like 'I can't figure out what's wrong with me. It's hopeless,'" Gabby told ABC News.

In September 2023, with some help from Gabby's cardiologist getting her the right series of tests, Gabby was diagnosed with long COVID. Gabby said she was "excited" more than upset to finally have a proper diagnosis.

Gabby and her mother tried to enroll in several long COVID studies at hospitals but she was rejected before she was accepted into the RECOVER study at NYU Langone, and had her first in-person visit in November 2023.

They say the RECOVER study has been helpful in terms of helping Gabby improve and better manage her long COVID symptoms.

"The RECOVER study also doesn't include just medical testing," Amy Jospa said. "They do cognitive testing on her, and it's helped Gabby feel more normal and less stigmatized about the process, because she's not the only one with brain fog. Like, 'I have this; it stinks, but I'm not alone, and there are people who are working really hard to figure this out and get me to where I need to be.' It's like positive change, and I think that's been the nicest part, seeing the shift mentally for her."

Gabby and her mother say she's still not 100% back to where she was before COVID. Before contracting COVID, Gabby, who swims competitively, used to be able to swim for 45 minutes straight. Now, she physically exhausts more easily so she needs breaks.

Amy Jospa said they made modifications to Gabby's gym schedule at school and that Gabby has more time between classes because she can't rush in the hallways between classes.

"I still manage, even though there are struggles," Gabby said. "I managed to find a way to make it work so I can keep going mentally as well as physically."

ABC News' Dr. Kierstin Luber contributed to this report.