At the beginning of the pandemic, we were told that children were spared from the worst of COVID-19. Thankfully, that’s still largely true, but some kids experience serious symptoms that require hospitalization. Others develop “long COVID” that lingers for weeks or months after a diagnosis—and it can even follow mild or asymptomatic cases.
A small subset of kids might present with a particularly troubling side effect: neurological symptoms. Usually mild and short-lived, these symptoms can range from brain fog and memory loss to confusion and headache. Severe neurological effects aren't particularly common in children, but when they happen, they greatly impact everyday life.
"Children who have persistent [cognitive] symptoms will have trouble with school attendance and school performance," says Sandra Bonat, M.D., pediatric physician advisor at VIP StarNetwork. She adds that they could also affect social life, mental health, and overall well-being.
We spoke with pediatric neurologists and other experts learn how many kids experience neurological issues during or after COVID-19 infection, what they typically look like, and how parents can help.
Reported Neurological Symptoms From COVID-19
It's important to understand that there's a wide spectrum of neurological symptoms that COVID can produce in children. Most are mild and short-lived, but others are more serious and can impact a child's life more severely.
The most common "brain-related" COVID symptoms in kids include:
- Headache
- Fatigue
- Brain fog
- Memory issues
- Loss of taste and smell
Most of the time, these symptoms will resolve in about a week after infection, says Dr. Bonat. “However, some children may have persistent neurologic symptoms—most commonly headache, fatigue, sleep disturbances, muscle aches, and trouble concentrating—which can last weeks to months after infection,” describes Dr. Bonat.
Kids will occasionally experience severe neurological symptoms, especially if they develop multisystem inflammatory syndrome in children (MIS-C), a rare but serious inflammatory condition that appears within a few weeks of COVID infection, explains S. Nick Russo, M.D., pediatric neurologist at UT Health and Children’s Memorial Hermann in Houston. “In more severe cases, including MIS-C, patients can develop confusion, altered mental status, trouble with walking and/or coordination, strokes, and brain damage,” he says. These symptoms may last longer than milder symptoms; some may even become permanent conditions.
How Common Are Neurological Symptoms With COVID-19?
"Neurologic symptoms due to COVID infection are less common in children than in adults," assures Stephen Thompson, M.D., a pediatric neurologist at the University of Maryland Children's Hospital. About half of all adults will experience a neurological symptom during a COVID-19 infection, says Dr. Thompson, but it's far lower in kids. Still, the number of children experiencing neurological issues is not zero.
A 2021 study published in the Italian Journal of Pediatrics found that of 3,700 children who were infected with COVID, about 17% dealt with neurological symptoms. Most symptoms were mild and short-lived, including headache and loss of smell. However, about 1% of children had severe brain impacts. The numbers were much higher in children who experienced multi-system inflammatory syndrome (MIS-C). Among children diagnosed with MIS-C, 55% faced neurological symptoms.
Take another study published March 2021 in JAMA Neurology that focused on 1,995 patients—ages 21 and under—who were hospitalized for severe COVID-19 or MIS-C. Of these, 365 experienced neurological symptoms, 43 developed life-threatening neurologic disorders (like stroke or brain damage), and 11 died. An additional 17 patients reported ongoing neurological problems. Children with preexisting neurological conditions were more than twice as likely to report these brain-related issues; this makes sense, considering research suggests that children with chronic neurological diseases might experience worsening symptoms after COVID-19 infection.
What's Causing Neurological COVID Symptoms?
COVID-19 is a relatively new virus, so researchers are still trying to understand why it affects the brain the way that it does. Experts agree that there's likely more than one cause at play here.
The current line of thinking is that COVID-19 causes an immune response that triggers an inflammatory state in the body, which damages parts of the nervous system, says Dr. Russo. It’s also possible that the virus itself is invading the nervous system and causing direct damage, he explains.
"There also doesn't seem to be a clear answer as to why some children develop more severe disease than others, even without underlying diseases," says Dr. Russo. Researchers are continuing to study these questions.
How Might Neurological Symptoms Impact A Child's Life?
Severe neurological symptoms can happen after COVID-19 infection, but they're rare. That said, even "mild" neurological symptoms in children can have strong impacts on their day-to-day lives, especially if they persist for weeks or months.
“The impact depends very much on the symptom,” says Dr. Thompson. For example, headaches can affect a child’s ability to learn or socialize. And although loss of taste and smell might seem like a simple nuisance, the persistence of symptoms can lessen a child’s desire to eat and consume nutritious meals.
Children with lingering neurological symptoms after COVID may have trouble with school attendance and performance. They may also lack desire to participate in extracurricular or social activities. “This could lead to negative effects on their mental health and wellbeing,” says Dr. Bonat.
Spotting Brain Issues In Your Child After COVID-19
If your child seems to be showing signs of neurological issues—such as memory loss, headaches, brain fog, trouble concentrating, or ongoing fatigue—or if your child just doesn’t seem like themselves following a COVID-19 infection—always trust your instincts and contact their pediatrician. They’ll help you understand what’s going on, perform any necessary diagnostic testing, and figure out a treatment plan moving forward.
If you want to help prevent the most severe outcomes of COVID-19, Dr. Thompson recommends vaccinating and boosting your child when they’re eligible. “As they say, an ounce of prevention is worth a pound of cure,” he says.
