Table 1 Recommendations on identification and management of children and adolescents with long COVID

Recommendation 1. Long COVID is a clinical condition that includes all pathological manifestations following the acute phase of SARS-CoV-2 infection and which cannot be attributed to causes other than SARS-CoV-2. Although it is not currently possible to precisely define the type and time limits of these manifestations, long COVID can be considered after 3 months from the diagnosis of SARS-CoV-2 infection in the presence of symptoms that last for at least 2 months and which cannot be explained by another diagnosis.

Recommendation 2. Although the true prevalence of long COVID in pediatrics is not exactly determined, it seems appropriate to recommend evaluating the presence of symptoms suggestive of long COVID near the end of the acute phase of the disease, between 4 and 12 weeks from this.

Recommendation 3. Long COVID in children and adolescents should be suspected in presence of persistent headache and fatigue, sleep disturbance, difficulty in concentrating, abdominal pain, myalgia or arthralgia. Persistent chest pain, stomach pain, diarrhea, heart palpitations, and skin lesions should be considered as possible symptoms of long COVID.

Recommendation 4. Primary care pediatricians should visit all subjects with a suspected or a proven diagnosis of SARS-CoV-2 infection after 4 weeks to check for the presence of symptoms of previously unknown disease. In any case, a further check-up by the primary care pediatrician should be scheduled 3 months after the diagnosis of SARS-CoV-2 infection to confirm normality or to address emerging problems. The subjects who present symptoms of any organic problem must undergo a thorough evaluation of the same. Children and adolescents with clear symptoms of mental stress will need to be followed up by existing local services for problems of this type.