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Long COVID and Post-Viral Illness
Some young people do not fully recover from a viral infection. Long after the illness should have passed, they still experience fatigue, dizziness, brain fog, pain, or exhaustion after exertion. When this follows COVID-19, it is called long COVID, and when it follows other infections, it is often called post-viral illness. These conditions can upend a young person’s life, even when standard testing appears unremarkable. The symptoms are real, and recognizing them is the first step toward helping a child recover.
How post-viral illness can look
Post-viral illness rarely presents with a single symptom. Fatigue is the most common complaint among children. Other symptoms include sleep problems, dizziness or lightheadedness, brain fog, headaches, joint pain, loss of smell or taste, stomach problems, and anxiety. Symptoms can worsen after even minor physical or mental exertion. Many of these symptoms overlap with patterns long familiar in pediatric rheumatology, including dysautonomia and POTS. A teenager may appear perfectly well on the outside while struggling to get through a school day.
The link with dysautonomia and POTS
POTS that begins in the teenage years sometimes follows an illness. In POTS, the autonomic nervous system adjusts circulation too slowly when a person changes position or becomes active, so the heart races to compensate and the person feels dizzy, faint, or exhausted. Its symptoms, including dizziness, a racing heart, fatigue, and brain fog, can overlap with those of post-viral illness. Recognizing that overlap matters because POTS has an established treatment plan.
What helps
There is no single test or treatment for post-viral illness, so care focuses on each young person’s symptoms. A careful evaluation can identify related conditions, such as POTS, that respond to treatment. A return to activity paced to the child’s tolerance, attention to sleep, nutrition, and hydration, and support at school can help a young person rebuild function over time. Many young people improve gradually, while some need ongoing care. The course varies from child to child.
How Dr. Shulman approaches it
Dr. Shulman is a pediatric rheumatologist who cares for young people with dysautonomia and POTS and speaks about Long COVID and other post-viral illnesses. He explains how these conditions present, how they overlap with patterns long familiar in pediatric rheumatology, and why they deserve to be taken seriously. His approach begins with taking symptoms seriously, because these patients have often been told, incorrectly, that nothing is wrong. Questions about illness and being believed run through his forthcoming book, Cramp: A Doctor’s Notes on Pain.
Frequently Asked Questions
What is long COVID?
Long COVID refers to symptoms that continue or develop after a COVID-19 infection has passed, such as fatigue, dizziness, brain fog, pain, and exhaustion after exertion. Similar lingering symptoms can follow other viral infections, which is why the broader term post-viral illness is also used. The symptoms are real even when standard testing appears unremarkable.
Can children get long COVID?
Yes. Most children recover from COVID-19 without lasting effects, but some develop lingering symptoms that affect school, activities, and daily life. Research suggests that school-age children and teenagers are at higher risk than the youngest children.
How is post-viral illness related to POTS?
POTS sometimes begins after an illness, and its symptoms can overlap with those of post-viral illness. The two share symptoms such as dizziness, a racing heart, fatigue, and brain fog. Identifying POTS matters because the treatment plan for POTS can then be put in place.
Why are my child's tests normal?
Many post-viral symptoms involve how the nervous system regulates functions such as heart rate and circulation, which routine tests are not designed to assess. Normal results do not mean the symptoms are imagined. A careful look at the full pattern of symptoms is often more informative than any single test.
Will my child recover?
Many young people improve gradually, while some need ongoing care. The course varies from child to child. Identifying and treating related conditions such as POTS, along with a return to activity paced to the child’s tolerance, can support recovery.
What kind of doctor treats post-viral illness in children?
A pediatrician is usually the first step. Depending on the symptoms, care may involve a pediatric rheumatologist or other specialists familiar with autonomic conditions. What matters most is a clinician who takes the symptoms seriously and looks at the full pattern.
For appointments or clinical questions, please contact Rady Children’s Health Orange County (formerly CHOC).