September 28 News Release: Pediatrics and Autonomic Dysfunction Guidance Statements

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Pediatric and Autonomic Dysfunction Long COVID Symptoms Guidance Statements Released by the American Academy of Physical Medicine and Rehabilitation

ROSEMONT, IL – September 28, 2022 – Today, the American Academy of Physical Medicine and Rehabilitation (AAPM&R) announced new guidance for diagnosing and treating pediatric patients with Long COVID symptoms and patients with autonomic dysfunction symptoms of Long COVID. These statements are part of a multidisciplinary collaborative consensus guidance series for the most predominant Long COVID symptoms. 

Long COVID patients may present with a constellation of symptoms that cross multiple body systems and may overlap. Because a multidisciplinary and interdisciplinary approach may be beneficial for rehabilitation, AAPM&R convened the Multi-Disciplinary PASC Collaborative to provide best practices from established Long COVID clinics in caring for patients with Long COVID.  

An estimated nine to twenty-eight million Americans have or have had symptoms of Long COVID based on data from the Journal of the American Medical Association and AAPM&R’s 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.” 

AAPM&R’s PASC Collaborative published the consensus guidance statement as a peer-reviewed manuscript in the PM&R Journal. Its first consensus guidance on fatigue was released 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.

The American Academy of Physical Medicine and Rehabilitation is the national medical specialty organization representing more than 10,000 physicians specializing in physical medicine and rehabilitation. PM&R physicians, also known as physiatrists, treat a wide variety of medical conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles and tendons. PM&R physicians evaluate and treat injuries, illnesses and disability and are experts in designing comprehensive, patient-centered treatment plans. Physiatrists utilize cutting-edge as well as time-tested treatments to maximize function and quality of life. Since the beginning of 2021, AAPM&R has undertaken comprehensive efforts to support its call for a national plan to address PASC and the millions of Americans it affects.