How Much Weight Should be Used in Strength Training?

Patient Presentation
In the middle of a busy clinic, the triage nurse said she had a telephone call from a mother who wanted to know about her 15-year-old male and how much weight he should be lifting for his weight training. The pediatrician smiled and said, “That’s a small question with a big answer. It really depends on many things and there isn’t a specific amount I can tell you. It depends on his puberty status, why is he doing the training, who is supervising, and many other questions.” The nurse said she would convey this to the mother, and had already noticed that he had his health maintenance examination appointment scheduled for the following week. “I think that we can discuss this issue at that appointment, but he should use reasonable care if there are weight lifting questions before then or they can try to move the appointment earlier,” he counseled.

Discussion
The benefits of strength training includes improved performance, injury prevention and rehabilitation, improved cardiovascular fitness, improved bone mineral density, improved blood lipid profiles and mental health. The most common risk is injury and most of these “…occur on home equipment with unsafe behavior and unsupervised settings.” Children with a variety of health problems should be evaluated first including hypertension, congenital heart disease, previous use of cardiotoxic medication, seizures, obesity, and Marfan syndrome. Other counseling issues regarding strength training include discussing with the child, teen and family the possibility of eating disorders, distorted body image, and the use of anabolic steroids and other substances.

The American Academy of Pediatrics (AAP) recommends not to begin strength training until at least 7-8 years or when balance and postural controls skills have matured to adult levels which is around this age. There are other general pragmatic considerations too. The child should be able to listen, wait, understand and follow the instructions of an adult. They should have some body sense and control over their body so they can perform the exercise properly, and make the necessary adjustments when they are not doing it properly. Children should be enjoying the activity and not feel coerced to initiating or continuing the activity. These are sensible considerations for any sport. Children and adolescents should perform more repetitions of the exercise using a low amount of weight (i.e. increased weight with fewer repetitions is not recommended). Explosive, rapid lifting of weight is not recommended. Similarly there are no specific ages when an adolescent can begin power training, body-building, or maximal lifts, but many experts including the AAP recommend after the adolescent is skeletally mature to mitigate the risks to the bones, tendons, ligaments and muscles themselves.

Children and teens should have supervision so they can learn to perform the exercises properly initially, receive feedback and have ongoing monitoring so that they continue to perform the exercises properly. Supervision also about numbers of repetitions and weights for workouts can also be devised and monitored. Children and adolescents also do not always use the best judgement and adult supervision can help to ensure safety in the weight room.

Learning Point
As with many things in life, slow and steady strength training can pay dividends. Improvements in strength can be found in properly structured programs of at least 8 weeks duration occurring at least 1-3 times/week. Strength training more than 4x/week does not add to strength and may lead to overuse injuries. Gain in strength, power and muscle size are lost after ~6 weeks of discontinued resistance training.

A 2020 narrative review recommended the following specifics regarding strength training:

  • Prepubertal (pre-peak height velocity)
    • Training focus is on learning the proper movements and techniques
    • General strength training is recommended with emphasis on functional movements
    • 1-3 sets of 8-10 repetitions per training session
  • During puberty (at peak height velocity)
    • Training focus continues on the foundation movements and techniques but also with increases in load and intensity
    • Strength development with increases in training intensity
    • 2-3 sets of 6-8 repetitions, load is 70-80% of maximum strength for 1 repetition (other authors use 60-80% of maximum strength, another author says 8-15 repetitions)
  • Post puberty (post peak height velocity)
    • Training focus continues on function movements, high-intensity loading and increase in intensity
    • High intensity resistance training with traditional and weightlifting movements
    • 3-4 sets x 1-6 repetitions at 70-100% of maximum strength

Questions for Further Discussion
1. When a youth wants to “bulk up” for sports, how much weight gain is advised? A review can be found here
2. What qualifications are required for an adult to supervise youth strength training in your local schools?
3. How do you diagnose hypermobility? A review can be found here

Related Cases

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for these topics: Exercise for Children and Sport Fitness.

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Council on Sports Medicine and Fitness. Strength Training by Children and Adolescents. PEDIATRICS. 2008;121(4):835-840. doi:10.1542/peds.2007-3790

Behringer M, Vom Heede A, Yue Z, Mester J. Effects of resistance training in children and adolescents: a meta-analysis. Pediatrics. 2010;126(5):e1199-1210. doi:10.1542/peds.2010-0445

Lesinski M, Prieske O, Granacher U. Effects and dose-response relationships of resistance training on physical performance in youth athletes: a systematic review and meta-analysis. Br J Sports Med. 2016;50(13):781-795. doi:10.1136/bjsports-2015-095497

Zwolski C, Quatman-Yates C, Paterno MV. Resistance Training in Youth: Laying the Foundation for Injury Prevention and Physical Literacy. Sports Health. 2017;9(5):436-443. doi:10.1177/1941738117704153

McQuilliam SJ, Clark DR, Erskine RM, Brownlee TE. Free-Weight Resistance Training in Youth Athletes: A Narrative Review. Sports Med. 2020;50(9):1567-1580. doi:10.1007/s40279-020-01307-7

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa

What are Some Risk Factors for Hypoxic-Ischemic Encephalopathy Outcomes?

Patient Presentation
An 18-month-old male came to clinic for his health maintenance visit. His parents were very pleased with his growth and his development. He was running, climbing, saying many words and occasionally would put 2 words together. He was scribbling, feeding himself and was very sociable with people.

The past medical history was remarkable for being a full-term male with moderate hypoxic-ischemic encephalopathy at birth (i.e. hypotonicity, decreased activity, intermittent bradycardia and periodic breathing), presumably due to a tight nucal cord, that was treated with hypothermia. He did not have any identified neonatal seizures. Since discharge from the neonatal intensive care unit the toddler had been meeting or exceeding his developmental milestones. He continued to not have any evidence of seizures, and he was still being followed by the neonatal followup program.

The pertinent physical exam showed an interactive male who appropriately vocalized some mild distress with examination.
His growth parameters were in the 25-75%. He had some mild eczema but the rest of the examination was normal.

The diagnosis of a healthy male was made. The pediatrician reviewed the developmental screening including autism screening which was normal for his age. “Given that he has not had any problems to date, his overall prognosis looks very good, but as you know there can still be other problems such as learning or attentional problems that we may not see yet. That is why the neonatal program and I keep asking you all the developmental questions and we are going to continue to follow him. You should watch him and if you or other people like his daycare professionals have questions let us know. But you should also treat him like the wonderful young boy he is and enjoy him for who he is,” the pediatrician counseled.

Discussion
“Neonatal encephalopathy, manifesting as altered responsiveness, seizures, apnea and abnormal muscle tone and reflexes, resulting from hypoxic-ischemic injury is termed hypoxic-ischemic encephalopathy (HIE).” Neonatal encephalopathy can be associated with other problems including stroke, hemorrhage, infection, pre-term brain injury and hypoglycemia as some examples. Sometimes more than one of these entities occurs simultaneously such as hypoglycemia and HIE. HIE can result in long-term neurological problems including motor, behavioral, and cognitive problems that can become apparent even years later. HIE occurs in 1-3/1000 live births. Causes of HIE can be broadly separated into two general types:

  • Acute catastrophic asphyxia is associated with about 25% of cases and is associated with placental abruption, uterine rupture, cord prolapse, fetal entrapment and cord problems
  • Chronic which appears to be associated with about 66% of cases where they are “repeated but relatively short periods of deep hypoxia” and is associated with the “direction function of the inherent intermittent “asphyxia” of labor.”
  • Another ~10% of moderate to severe HIE appears to have problems preceding labor onset with abnormal fetal heart rate and associated preceding fetal compromise.

Although labor contractions cause intermittently impaired uteroplacental perfusion, authors note the “In face, it appears that the fetus is spectacularly good at defending itself against hypoxia, and injury only occurs in a very narrow window between intact survival and death.”

Optimal treatment for HIE continues to evolve especially based on animal models. Hypothermia initiated within 6 hours of birth can improve outcomes in various studies. Hypothermia of ~3°C for approximately 72 hours is often used. Treatment of other problems such as concommitent hemodynamic and respiratory instability, neonatal seizures and possible neonatal infection also make balancing the physiological needs of treatment more difficult.

Learning Point
Predictions of clinical outcome for an individual or groups of individuals can be difficult as treatment changes over time and there are many parameters which cannot be easily measured or accounted for. However, clinicians discussing treatment with families are aware of some of the increased risks. Clinical examination can assist with diagnosis and also prognosis. Unsurprisingly, infants with a clinical examination that progressively deviates from normal are more severely affected and generally have poorer prognoses. The Sarnat and Thompson scores are two such scoring systems. These systems evaluate various neurological system components including consciousness, types of movement or positioning, tone, and autonomic nervous system functions (i.e. heart rate, respiration, pupils). Evolution of the neurological examination over the time of the hypothermia treatment period appears to help predict long term outcome better than the initial stage of HIE. Other risk factors include: lower Apgar score for longer periods of time (often 10 minute Apgar is used in studies), more hemodynamic/respiratory instability for longer periods of time, abnormal metabolic parameters (e.g. anemia, hypocarbia, glycemic control, lactate, and pH), certain electroencephalography patterns, and neuroiimaging injury patterns (e.g. deep brain structures affected such as the basal ganglia and thalamus, or watershed injury patterns).

HIE is not a good diagnosis to have and infants with moderate to severe HIE even with hypothermic treatment have a 48% chance of major neurological problems or death. Long term sequelae can include blindness, cerebral palsy, deafness, developmental delay, epilepsy, and intellectual impairment. Cognition appears to be a important marker of long-term problems for children. But cognitive problems may be present even without motor problems and some cognitive problems are more difficult to identify until later in life such as attentional issues, learning disabilities, memory and behavioral/social interaction problems.

Questions for Further Discussion
1. What are some seizure patterns/classifications? A review can be found here

2. What are some etiologies for intellectual disability? A review can be found here

3. What causes respiratory failure? A review can be found here

Related Cases

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for these topics: Traumatic Brain Injury and Brain Diseases.

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Gunn AJ, Thoresen M. Neonatal encephalopathy and hypoxic-ischemic encephalopathy. Handb Clin Neurol. 2019;162:217-237. doi:10.1016/B978-0-444-64029-1.00010-2

Goswami I, Guillot M, Tam EWY. Predictors of Long-Term Neurodevelopmental Outcome of Hypoxic-Ischemic Encephalopathy Treated with Therapeutic Hypothermia. Semin Neurol. 2020;40(03):322-334. doi:10.1055/s-0040-1702939

Nguyen T, Wusthoff CJ. Clinical manifestations of neonatal seizures. Pediatrics International. 2021;63(6):631-635. doi:10.1111/ped.14654

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa

What is the Difference Between a Paronychia and a Felon?

Patient Presentation
A 7-year-old male came to clinic with a sore 4th finger on the left hand. He had a history of nail biting and had started to have pain the evening before. He denied any known trauma. His mother noticed some pus at the edge of the nail and after soaking his hand was able to move the cuticle back with expression of pus. In the morning the pus had reaccumulated and seemed to have spread with increased pain and swelling of the fingertip. His past medical history revealed him to be a healthy male who was fully vaccinated.

The pertinent physical exam showed a male holding his left hand to protect it. He could not tell if the pain was worse when he put his hand down. He had normal growth patterns and vital signs. His left 4th finger was very swollen. Laterally along the nailbed there was an obvious abscess from approximately the 7-11 o’clock position that was also extending to the volar area. There was erythema around the abscess. It was difficult to tell if this extended into the fingertip pulp because there was a great deal of edema. The patient complained of pain with any manipulation of the finger.

The diagnosis of a paronychia with abscess or extension to a felon was made. The resident was keen to treat the patient in clinic, but the patient was referred to the emergency room. “You are right about how this needs surgical treatment, but in our clinic we don’t have all the necessary ingredients. We treat minor problems such as a minor paronychia, but this is going to require proper pain control with at least a digital block. It may also need more extensive debridement because this may actually be a felon. Plus I’m not sure he can actually cooperate with us to do the procedure. We also do not have surgical colleagues to back us up if needed. This is an appropriate emergency room referral where they have the appropriate facilities, people and backup,” said the attending.

The patient’s clinical course in the emergency room showed that the patient was given light conscious sedation to help with his cooperation along with a digital block. The incision and drainage and debridement did not find extension into the pulp space, but the patient was to followup in the surgery clinic in 2 days time.

Discussion
The hands are one of the most important parts of the body for interacting with the world. They are remarkably adapted having sensitive sensory receptors as well as feedback receptors for grasping, holding, and manipulating objects. Hands, especially with an opposable thumb, multiple joints within the hand, along with the wrist and elbow, allow the hand to move in multiple positions to manipulate the world. Hands also symbolize an emotional caring and sharing between individuals as hands are used to provide a true “human touch” in personal and social situations.

Due to their important interactions in the world, the hands are at risk for damage and infection. Most infections are superficial, acute and self-limited such as a cut, scratch or easily removed splinter. Osteomyelitis, deep space infection, septic arthritis, and tenosynovitis are emergent situations that need specialized treatment.

Fingertip infections are the most common hand infection. Again most of these are superficial such as a hangnail, but serious infections can occur. Paronychia is the most common. Felons are a different and less common but also important infection of the fingertip. Conditions which can look like paronychia and/or felon include herpetic whitlow, candida infection, reactive arthritis, and psoriasis in children. In adults other diseases such as cancer and gout occur. Hands are also where animal bites commonly occur. Cats cause more bites than other animals such as dogs. Below are some common infections associated with various species of bites or activities:

  • Cat – Pasteurela multocida, Bartonella henselea
  • Dogs – Staphylococcus sp., Streptococcus sp., Fusobacterium sp.
  • Sheep or goats – Parapox virus
  • Crustaceans and various livestock – Erysipolotrix rhusiopathiae
  • Gardening activities – Sporotrthrix schenckii (fungus)

Single or multiple infectious agents can be seen depending on the traumatic event (e.g. closed in a door, penetrating), situation (dirty area or clean), and potential animal species. Remember that human oral organisms are common causes of paronychia due to nail biting or people just putting their hands near/into their mouths during activities of daily living.

Learning Point
Paronychias are quite common and are usually caused by a breakdown of the seal between the nail fold and nail plate along the edge of the nail. This occurs often because of nail biting, hangnail manipulation, manicures, ingrown nails and other trauma. This is usually a polymocrobial infection with Staphylococcus aureus, Streptococcus sp.,Bacteroides, Enterococcus or Eikenella. Usually it is an acute infection but chronic infections (>6 weeks) can occur due to irritants or allergens. Clinically there is erythema, edema and localized pain at the lateral nail bed. It may feel boggy and tender. An abscess may also be present with purulent appearing fluid being trapped in the tissue adjacent to the nailbed. The Turkman test for abscess involves pressing lightly on the volar aspect of the digit. There will be a localized area of skin blanching around the nail if an abscess is present. The paronychia can extend under the nail bed and even around to the other side. Early stages without abscess formation are usually treated with oral antibiotics. Although soaking does not have clear evidence to recommend it, it is a common treatment used to keep the area clean and the cuticles softened to allow any accumulating fluid to drain. A localized abscess requires drainage. Depending on the extent, blunt dissection, sterile needle drainage, or more extensive incision and drainage may be necessary. Pain control with a digital block is often used and local pain control may include lidocaine. Epinephrine and/or finger tourniquets may be needed for more extensive debridement to help with blood control. Frequent dressing changes, post-procedure antibiotics and followup are important to make sure the infection has been mechanically cleared and is healing properly.

Felons are less common and are an infection in the fingertip pulp. Multiple septae that run from the bone to the skin providing support for the pulp but also create closed spaces where infections can try to hide. There is usually erythema and a great deal of edema which leads to very painful intense throbbing of the area which often increases with the hand in a dependent position. If the pressure increases there can be ischemia of the tissue due to the pus formation and edema. Felons occur more often on the first and second digits usually caused by penetrating trauma but patients may not identify the trauma commonly. They can occur due to paronychia extension. Felons require surgical treatment with appropriate incision, drainage and debridement. Because of the multiple septae, more extensive blunt dissection may be necessary. Because of patient age or the extent of the tissue involved, treatment in the operating room may be necessary but they are often treated in the surgical clinic or emergency room. As with paronychia, frequent dressing changes, post-procedure antibiotics and followup are important to make sure the infection has been mechanically cleared and is healing properly.

Questions for Further Discussion
1. How do you treat paronychias in your location?
2. What are indications for consultation with a hand surgeon?
3. How does compartment syndrome occur?
4. How common is tetanus in extremity injuries? A review can be found here

Related Cases

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for this topic: Hand Injuries and Disorders

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Koshy JC, Bell B. Hand Infections. J Hand Surg Am. 2019;44(1):46-54. doi:10.1016/j.jhsa.2018.05.027

Barger J, Garg R, Wang F, Chen N. Fingertip Infections. Hand Clin. 2020;36(3):313-321. doi:10.1016/j.hcl.2020.03.004

Macneal P, Milroy C. Paronychia Drainage. In: StatPearls. StatPearls Publishing; 2021. Accessed September 28, 2021. http://www.ncbi.nlm.nih.gov/books/NBK559146/

Nardi NM, McDonald EJ, Schaefer TJ. Felon. In: StatPearls. StatPearls Publishing; 2021. Accessed September 28, 2021. http://www.ncbi.nlm.nih.gov/books/NBK430933/

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa

Does Long COVID Exist in the Pediatric Age Group?

Patient Presentation
A 16-year-old male came to clinic for his sports physical examination. He had no overall concerns but it was noted that he had lost about 4 kilograms of weight. He complained that, “After I had COVID last fall, my sense of smell has never come back and everything just tastes like cardboard. I eat but I’m not really hungry or interested in food.” He noted that there were some foods with strong flavors that tasted somewhat different but not really any better. He was eating a balanced diet because “if I’m going to play well then I have to eat well.” The past medical history showed that he had a mild case of COVID 7 months previously.

The pertinent physical exam revealed normal vital signs and growth pattern except for the weight loss. His physical examination was normal.

The diagnosis of a healthy male was made with long standing anosmia and dysguesia. The pediatrician asked him to continue to monitor his weight and check back in 3 months to make sure he wasn’t losing an excessive amount of weight. She also mentally added him to her list of other patients with longer term symptoms of COVID including a younger girl with paresthesias and one of her partner’s patients with dysguesia of certain foods.

Discussion
With COVID-19, the scientific research process is playing out daily in the press where the general public can see for themselves and share in the new knowledge and frustrating events that occur usually behind the curtain of science. People try to understand the little snippets of new knowledge that come forth and how they fit into the COVID problem, and most importantly how it may affect themselves, the people they care about and their community. Patients and families daily ask questions of their health care providers who themselves have the same questions, and answer something like “We’re learning something new every day.”

Scientists grapple with a variety of the fundamental scientific questions for COVID or any other scientific research question including:

  • What is the disease and its variations? What are the agreed-upon definitions?
  • What is the incidence and prevalence and other epidemiological data of the disease?
  • What populations are affected or at higher or lower risk? Why does this appear to be the case? What population is even being studied in the research? Are the findings consistent across populations and locations?
  • What appears to mitigate or promulgate the disease process?
  • What alternative diagnoses need to be considered?
  • Are rare findings associated with the disease disease? Are they a cause of it? Are they just a random occurence?
  • What is the natural history of the disease? What are the long-term problems in 1, 5, 10 years or potentially over a lifetime?
  • What are the pros/cons of the medical decisions made today and what about the future?

It can be frustrating for both patients, families, health care providers and the scientific community to need to make important health care decisions based upon incomplete data, but COVID is not unique. Consider cancer treatment where despite having a great deal of research, often scientific data is not available which specifically matches the patient’s characteristics and medical situation. Therefore, the best-fit for the general characteristics and medical situation must be used for treatment decisions. Scientific research provides new treatments, but they are often used for small numbers of patients meeting specific criteria and therefore it is not known how the new treatment may affect a different or wider population, or what the long-term side effects are 1, 5, or 10 years later.

Learning Point
In the first few weeks to months after its description, it was noticed that some patients continued to have more than 1 symptom for weeks to months after the acute disease. This has been termed post-acute sequelae of SARS-CoV-2 (PASC) Long-haul COVID, or Long COVID among others. Initially it was first described in adult patients but then noticed in some pediatric patients as well. Different studies use different definitions but in general, the term Long COVID describes patients experiencing symptoms for more than 30 days (at least) or more after laboratory confirmatory testing of acute COVID. Patients do not have to be symptomatic.

In a population-based cohort of non-hospitalized patients, aged 12-82 years, researchers found that the prevalence of Long COVID was 68.7% at 30 days post-infection (N=303) and was 77.1% for those followed longer than 60 days (N=157). “The most common symptoms were fatigue (37.5%), shortness-of-breath (37.5%), brain fog (30.8%), and stress/anxiety (30.8%). Median number of symptoms was 3 (range 1-20).”

In one of the first studies of children performed in Italy (N=129, mean age 11 +/- 4.4 years) including 25.6% who were asymptomatic) who were assessed by telephone call 49-275 days after diagnosis (mean 162 days), it was found that 41.8% had recovered, but 35.7% had 1-2 symptoms and 22.5% had 3 or more. The most common symptoms were insomnia (18.5%), respiratory symptoms (14.7%), nasal congestion (12.4%), fatigue (10.8%), muscle problems (10.1%), concentration problems (10.1%) and joint pain (6.9%). The authors note that “An important and unexpected finding is that also children with asymptomatic or paucisymptomatic COVD-19 developed chronic, persisting symptoms, although followed-up for a relatively short time after diagnosis.” Given that COVID has only been identified for a relatively short time itself, these are important findings to be aware of for medical decision making.

In a prospective cohort in the United Kingdom (N=1734, ages 5-17 years using a mobile application device to assess symptoms, researchers found 4.4% had illness symptoms > 28 days and they usually had 2 symptoms. After 56 days, only 1.8% had symptoms and all had resolution by 8 weeks. Symptoms included headache, fatigue and loss of smell.

In a prospective study of children (N=90, ages 12 +/- 5 years) who presented to a designated Long COVID clinic at a tertiary pediatric care center, who were assessed 33-410 days after infection (mean 112 days), the median number of symptoms was 4 (range=1-14) with fatigue (71.1%), dyspnea (50%) and myalgia (45.6%) being the most common.

These studies show a small range of different types of studies, performed in different populations, with different definitions and assessments which then provide different answers. With more time, many of the fundamental scientific questions above should be further elucidated to better understand Long COVID in children.

Questions for Further Discussion
1. What is MIS-C? A review can be found here
2. Name some other recent emergent diseases?

Related Cases

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for these topics: COVID-19.
To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Buonsenso D, Munblit D, De Rose C, et al. Preliminary evidence on long COVID in children. Acta Paediatr. 2021;110(7):2208-2211. doi:10.1111/apa.15870

Bell ML, Catalfamo CJ, Farland LV, et al. Post-acute sequelae of COVID-19 in a non-hospitalized cohort: Results from the Arizona CoVHORT. PLoS One. 2021;16(8):e0254347. doi:10.1371/journal.pone.0254347

Lewis D. Long COVID and kids: scientists race to find answers. Nature. 2021;595(7868):482-483. doi:10.1038/d41586-021-01935-7

Ashkenazi-Hoffnung L, Shmueli E, Ehrlich S, et al. Long COVID in Children: Observations From A Designated Pediatric Clinic. Pediatr Infect Dis J. Published online August 5, 2021. doi:10.1097/INF.0000000000003285

Children rarely get ‘long COVID.’ J Paediatr Child Health. Published online August 19, 2021:10.1111/jpc.15708. doi:10.1111/jpc.15708

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa