AAPM&R Long COVID Pediatrics and Autonomic Dysfunction Guidance Statements Released

Members & Publications


September 28, 2022

We’re excited to announce the release of new guidance for diagnosing and treating pediatric patients with Long COVID symptoms and patients with autonomic dysfunction symptoms of Long COVID. The statements were developed by our PASC Collaborative, a multidisciplinary group of physicians, clinicians and patient advocates convened to address the pressing need for guidance in caring for patients with Long COVID.

Post-Acute Sequelae of SARS-CoV-2 infection (PASC) or Long COVID is a condition that occurs in individuals who have had COVID-19 and report at least one persistent symptom after acute illness. Long COVID patients may present with a constellation of symptoms that cross multiple body systems and may overlap. An estimated nine to twenty-eight million Americans have or have had symptoms of Long COVID, based on extrapolated data from the Journal of the American Medical Association and our Long COVID Dashboard.

As the pandemic has continued and more people of all ages have contracted COVID-19, the number of children potentially impacted by Long COVID has increased. The most common Long COVID symptoms children experience are fatigue and attention problems, ongoing fever, headaches, sleep issues and new mental health issues like anxiety and depression. Symptoms, management and rehabilitation for Long COVID differ for children and adults. Parents, caregivers, teachers and coaches are the front line in observing changes in children that may be related to Long COVID.

Rehabilitation in children should be geared towards participation in school, extracurricular activities and social engagement, which are important to a child’s typical development. Guidance for Long COVID in adults cannot be automatically used in pediatric patients.

“We know pediatricians and family care doctors are most likely going to be seeing, diagnosing and treating children and adolescents with Long COVID symptoms,” said Amanda Morrow, MD, FAAPMR, lead co-author of the pediatric Long COVID guidance statement. “They are vital to diagnosing and treating Long COVID in children. This guidance is intended to provide diagnosis and treatment recommendations from the multidisciplinary PASC Collaborative Pediatric Workgroup.”

Symptoms of autonomic dysfunction may occur from Long COVID and affect a patient’s ability to function and participate in home, community and work activities. The autonomic nervous system regulates the body’s involuntary functions, including heart rate, blood pressure, respiration, sweating and digestion. Patients with autonomic dysfunction due to Long COVID may have difficulty remaining upright or standing without experiencing symptoms.

Rehabilitation for patients with Long COVID symptoms should be individually tailored and move at the patient’s own pace rather than a set timetable. Many patients with autonomic dysfunction symptoms of Long COVID appear to tolerate physical activity during the activity, but symptoms may be triggered in the hours or days following exertion.

“Our goal with rehabilitation therapies for patients with autonomic dysfunction symptoms of Long COVID is to create functional adaptations that allow them to resume their normal activities and roles while recovering,” said Alba Azola, MD, lead author of the autonomic dysfunction guidance statement. “Encouragingly, autonomic dysfunction symptoms can sometimes be eased with common medications and dietary changes.”

Our PASC Collaborative released its first consensus guidance on fatigue in August 2021, followed by guidance on breathing discomfort and cognitive symptoms in December and cardiovascular complications in June. Additional consensus guidance statements on Long COVID in mental health and neurology will be published on a rolling basis.

Please join us in sharing this guidance with your colleagues to support patients. Learn more about our Call to Action (and our successes!) and our Long COVID Dashboard.


Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.